Oxycodone/APAP is a narcotic analgesic containing oxycodone, an opioid, and acetaminophen, or Tylenol, used for the treatment of moderate to severe pain. It is sold in the United States under names such as Percocet and Endocet. Opioids, such as oxycodone, work to relieve pain by binding to opioid receptors in the brain, decreasing the perception of pain, and making it more tolerable. Acetaminophen, often abbreviated "APAP," works by elevating the pain threshold, and is often combined with opioid analgesics for additional pain relief.
Common Side Effects
Goodman and Gilman's "The Pharmacological Basis of Therapeutics" lists common side effects of oxycodone/APAP including mood changes, sedation, drowsiness, dizziness, euphoria, dysphoria, nausea and vomiting, sweating, headache, itchiness or rash, miosis, or pinpoint pupils, and constipation. Tolerance may develop to these side effects, although constipation generally persists throughout treatment with oxycodone/APAP. Nausea and vomiting tend to subside after a few days of treatment. Patients experiencing severe pain who require high doses of oxycodone/APAP may have minimal side effects from the medication initially, but as their pain subsides, it is common to experience undesirable side effects even at lower doses. Oxycodone/APAP may impair the ability to drive or to think clearly. Oxycodone/APAP can be habit forming and can lead to physical dependence, and should only be taken by the person for whom it was prescribed and only when needed as directed by a physician.
Serious Side Effects
Serious side effects of taking oxycodone/APAP listed in "The Pharmacological Basis of Therapeutics" include respiratory depression, anaphylaxis, a life threatening allergic reaction, seizures, severe hypotension or low blood pressure, coma, and death. Taking high doses of oxycodone/APAP or taking it with alcohol or other sedatives increases the chance of respiratory depression and death. People with underlying pulmonary dysfunction should be especially careful when taking oxycodone/APAP, as they are at a higher risk for breathing problems. People with asthma should be aware that due to oxycodone's ability to cause histamine release, it is possible to experience an exacerbation of asthma symptoms while taking oxycodone/APAP.
Signs of Overdose
If an overdose is suspected, contact an emergency health care professional or call 911 immediately. Signs of overdose include extreme sedation, disorientation, cold and clammy skin, slow shallow breathing, decreased heart rate, fainting, and coma.
Increased Side Effects with Certain Medications
Many commonly prescribed medications, including the antibiotics clarythromycin and erythromycin, and the antifungal medication fluconazole, are metabolized by the same pathway as oxycodone/APAP and may delay the breakdown of oxycodone in the body, according to "Pharmacotherapy: A Pathophysiologic Approach" by Joseph DiPiro. This can result in higher oxycodone concentrations and an increased chance of dangerous side effects. It is important to discuss all medications you are taking with your health care provider.
Important Warning about Acetaminophen
Acetaminophen is present in varying amounts based on the specific formulation of oxycodone/APAP. Acetaminophen is extremely harmful to the liver at high doses. Patients should limit their total daily dose to no more than 4 grams in 24 hours according to drugs.com. People who consume alcohol on a regular basis are more susceptible to liver damage and should restrict their acetaminophen intake even further.
Avoid Abrupt Cessation
If oxycodone/APAP has been taken for an extended period of time and it is no longer required for pain relief, it is important gradually taper the dose to avoid withdrawal symptoms. Signs of withdrawal include irritability, anxiety, restlessness, yawning, insomnia, chills, sweating, mydriasis, or dilated pupils, muscle cramps and twitching, vomiting, diarrhea, and increased blood pressure and heart rate.
References
- "Goodman & Gilman's The Pharmacological Basis of Therapeutics"; Hardman JG, Limbird LE, et al; 2001
- "Pharmacotherapy: A Pathophysiologic Approach"; DiPiro JT, Talbert RL, et al; 2005
- Acetominophen
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