The use of intermittent subcutaneous injections of oxycodone for opioid rotation in patients with cancer pain

Oxycodone is a strong opioid that has been available for at least 70 years. At present, commercially prepared parenteral oxycodone is only available, in Finland. We report in this paper our experience of administering oxycodo ne s.c. From 21 October 1996 to 31 July 1998, 63 advanced cancer patients r eceived intermittent s.c. injections of oxycodone via the Edmonton Injector , a simple, low-cost mechanical device. Local tolerance and systemic toxici ty were followed prospectively, Only 2 patients developed s.c. injection si te intolerance, and in both cases doses of 50 mg/ml or more were being admi nistered. Most of the patients in this study were rotated to oxycodone beca use of opioid toxicity, and in 34% of those patients their delirium subside d. A subgroup of 19 patients who underwent rotation to oxycodone SC from mo rphine and hydromorphone were studied for equivalent analgesia with oxycodo ne. We found a ratio (mean +/- SD) of 1.2 +/- 0.4 for morphine s.c. to oxyc odone s.c. and a mean ratio of 0.5 +/- 0.4 for hydromorphone s.c. to oxycod one s.c. When hydromorphone s.c. was converted to a morphine s.c. equivalen t dose and the results for these patients were added to those for the morph ine s.c. group, the mean and median overall ratios of morphine s.c. equival ent dose to oxycodone were 1.9 +/- 1.5 and 1.4, respectively. The cost of t he oxycodone s.c. was also evaluated and was found to be comparable to that of morphine s.c. and lower than that of hydromorphone s.c. We conclude tha t s.c. oxycodone can be an effective, safe and inexpensive alternative opio id agonist.