Background Oxycodone is a semisynthetic opioid, generally prescribed in patients who do not tolerate morphine. There has recently been concern that oxycodone is being used more frequently which would have cost implications. Regional guidelines suggest that oxycodone should be considered when patients have a GFR of less than 50.
Aims The aims of the audit were to see when oxycodone is prescribed by the specialist palliative care team and is oxycodone prescribed more frequently in patients with impaired renal function
Method Retrospective audit of specialist palliative care notes of all deaths between November–December 2010 (inclusive).
Results Sixty patient's notes were analysed The average eGFR for all patients (n=60) on referral was 70 17 (28%) patients had an eGFR of less than 60 (CKD stage 3–5) on referral. Thirty-three patients were on opioids on referral and 20 patients were commenced on them. Ten patients were either commenced or switched to oxycodone 2 patients were commenced oxycodone due to a previous rash with morphine (eGFR 30.7) and due to concern regarding renal function (eGFR 49.6), 8 patients were switched to oxycodone: the commonest reasons being renal impairment and drowsiness. The average eGFR for all patients on oxycodone (n=10) was 51. For the patients who remained on morphine (n=40) the average eGFR was 72
Conclusion The majority of patients tolerate morphine reinforcing that it should be the first choice in the majority of patients. There is limited evidence for the use of oxycodone in renal impairment. For patients who do have renal impairment, particularly with eGFR less than 50 it may be appropriate to consider oxycodone when fentanyl or methadone are not suitable. Further evidence on its use in renal impairment would be useful.
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