Is Oxycodone 20mg Too High Of A Starting Dose?

It is high if you have not been on opioids before or recently.

Nov 21, 2018

Nicole asked

My doctor gave me a prescription for oxycodone 20 mg, and I have never been on it before. Is it too high of a dose?

At a glance

  • 20mg of oxycodone would be considered a 'high' starting dose in someone that does not have tolerance to opioids. The usual starting dose is between 5-15mg every four to six hours.
  • Dosing for oxycodone is determined by multiple factors, including your history with opioids, pain relief needed and your medical status. Doses that are too high put you at risk for serious side effects such as respiratory depression.


20mg of oxycodone per dose is above most dosage guideline recommendations for a starting dose if you are opioid-naive (meaning you haven't developed any sort of tolerance from being on opioids recently).

Most pain management guidelines, and the prescribing information for oxycodone, recommend the following dosing for immediate-release formulations:

  • 5 to 15 mg by mouth every 4 to 6 hours as needed for pain for opioid-naive patients.

Once the initial dose is initiated, if stronger pain relief is necessary, slow and careful upward titration is required until tolerance develops to some of the side effects (e.g. respiratory depression, nausea).

If you are not opioid-naive, meaning you have some tolerance from being on opioids recently, dosing will depend on what drug you were taking, how much you were taking and other patient-specific factors.

Oxycodone IR Dosing

Dosing of opioid medications, like oxycodone, are individualized for each patient.

Among the factors to consider are:

  • Opioid tolerance
  • Physical/medical status
  • Degree of pain relief desired

If an individual is opioid-tolerant, higher than usual initial doses are generally required, and your doctor is the best resource to determine an appropriate starting dose.

Starting at too high of a dose greatly increases the risk of serious adverse effects, most notably respiratory depression, which can lead to death.

If you are opioid-tolerant, there are a number of factors your doctor will consider. When picking a dose, or converting from another opioid agonist, conversion tables are used, known as MME charts (Morphine Milligram Equivalents).

However, even with all the comparative efficacy data we have on opioids, it is important to understand that there is substantial variability among individuals.

It is impossible for the conversion charts to account for individual differences in metabolism, organ function etc... They are only be used to provide an estimate of a comparison dose.

In general, it is preferable to underestimate the patient's daily dose requirements than to overestimate and risk serious side effects.

About Oxycodone

Oxycodone is an oral semisynthetic opioid agonist, similar to hydrocodone.

It is used to treat moderate to severe pain and is available in a variety of dosage forms (e.g. immediate release, extended-release, liquid etc...).

Oxycodone works like all opioid medications, by agonizing µ-opiate (mu) receptors, which changes the perception of pain at the spinal cord as well as other locations in the central nervous system.

Oxycodone doses should always be titrated from the initial recommended dosage to the dose required to avoid serious adverse reactions.

Whether or not you should take oxycodone with food depends on the specific product.

For example, immediate-release oxycodone can be taken with or without food while one form of extended-release oxycodone (Xtampza ER) should always be taken with food. Be sure to discuss how you should take your prescription with your doctor or pharmacist.

  1. ClinicalKey: Oxycodone Monograph. ClinicalKey
  2. Oxycodone Prescribing Information. DailyMED
  3. Morphine Equivalent Chart. CDC

Ready for a more personal experience with your meds?