• For Healthcare Professionals
Opioid pain relievers come with risks. Opioid pain relievers come with risks.

Opioid pain relievers come with risks. It’s important that we all learn how to take and store our pain medications more responsibly to help protect ourselves and our communities.

Managing pain responsibly

Opioid pain relievers can be helpful for managing pain. However, these medications often carry risks, not just to individuals but also to their friends, families, and surrounding communities. They can be misused, stolen, or abused, and they may put people who take too much at a risk of overdose. It’s important to understand the steps you can take to promote more responsible pain management, protect yourself and your prescription, and reduce the risks to those around you.

What are some potential risks I should be aware of when taking a pain medication?

Risk of misuse

One potential risk is misusing your medication. Misuse happens when someone takes a medicine incorrectly. Some people may misuse their medication in ways that seem harmless, like skipping a dose to avoid certain side effects or chewing a tablet so it’s easier to swallow. However, those small changes can have big effects on the way a medication works. Misuse of opioid medications, whether intentional or accidental, can cause potentially fatal adverse events.

Examples of misuse include:

Breaking a tablet into multiple pieces so it's easier to swallow

Breaking a tablet into multiple pieces so it’s easier to swallow

Taking a double dose to make up for a missed dose

Taking a double dose
to make up for a
missed dose

Cutting up a tablet or pill to strengthen or weaken a dose

Cutting up a tablet or pill to strengthen or weaken a dose

Risk of diversion

There is also the risk of your pain medication being taken by someone else. When a medication is stolen or otherwise ends up in the hands of someone who was not prescribed the medication, it’s known as diversion. It is important to be aware of this risk because there is no way to know how a drug will affect the body and health of someone who uses another person’s prescription medication.

Some examples of diversion include:

risk of someone else use medication
  • When someone finds a prescription medication belonging to someone else in a medicine cabinet or sitting on the kitchen counter and uses it
risks of selling or give to a family member
  • When someone steals a prescription with the intention of giving it or selling it to others
  • When someone gives a prescription medication to a family member or friend to help relieve that person’s pain

Risk of overdose

It is important to be aware of the risk of an overdose. Pain medications, such as long-acting opioid medications, can put you at risk for overdose if they are not taken correctly. An overdose can occur if a person takes more of a medication than was prescribed by a doctor, which can result in serious, negative consequences.

Signs and symptoms of a drug overdose include:

  • Small, constricted “pinpoint” pupils
  • Falling asleep or loss of consciousness
  • Slow, shallow breathing
  • Pale, blue, or cold skin
  • Slowed breathing rate or difficulty breathing
  • Constipation (severe)
  • Poor coordination
  • Seizures
  • Choking or gurgling sounds
  • Limp body

Setting yourself up for responsible pain management

  • Always follow your doctor’s instructions and take your medicine only as prescribed. Take each dose exactly as prescribed—no more and no less
  • If you have difficulty swallowing your pain medication, do not crush, grind, cut, or dissolve it without first discussing these methods with your doctor, as they may not be safe. Talk to your doctor about safe alternative ways to take your medicine
  • Do not stop taking your medication or change how or how often you take it without speaking to your doctor first
  • Don’t take your opioid medication while taking other medications or dietary supplements without speaking to your doctor to make sure it is safe to use them together. Some medications and supplements can interact with each other in harmful ways
  • Tell your doctor if your pain improves or changes because this information can help your doctor manage your pain more effectively and safely
  • If you’re struggling to manage side effects or feel that you aren’t getting enough pain relief, don’t alter your medication. Instead, consult your doctor. They can help you find the best way to take it and may adjust your dose to better manage both your pain and any side effects
  • Store your prescription opioid medication in a safe, secure location away from others, especially children, so that it cannot be taken or used without your knowledge
  • Never share or give away your medicine
  • If you need to dispose of your medication, make sure you dispose of it properly
ISI arrow
ISI arrow

INDICATIONS AND USAGE

Xtampza® ER (oxycodone) is:

  • A strong prescription pain medicine that contains an opioid (narcotic) that is used to manage pain severe enough to require daily, around‑the‑clock, long‑term treatment with an opioid when other pain treatments, such as non‑opioid pain medicines or immediate‑release opioid medicines, do not treat your pain well enough or you cannot tolerate them
  • A long‑acting (extended‑release) opioid pain medicine that can put you at risk for overdose and death. Even if you take your dose correctly as prescribed by your healthcare provider, you are at risk for opioid addiction, abuse, and misuse that can lead to death
  • Not for use to treat pain that is not around‑the‑clock

IMPORTANT SAFETY INFORMATION ABOUT XTAMPZA ER

WARNING: ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); LIFE‑THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS

Addiction, Abuse, and Misuse

Xtampza ER exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient's risk prior to prescribing Xtampza ER and monitor all patients regularly for the development of these behaviors or conditions.

Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)

To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS‑compliant education programs available to healthcare providers. Healthcare providers are strongly encouraged to

  • complete a REMS‑compliant education program,
  • counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products,
  • emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist, and
  • consider other tools to improve patient, household, and community safety.

Life‑Threatening Respiratory Depression

Serious, life‑threatening, or fatal respiratory depression may occur with use of Xtampza ER. Monitor for respiratory depression, especially during initiation of Xtampza ER or following a dose increase.

Accidental Ingestion

Accidental ingestion of even one dose of Xtampza ER, especially by children, can result in a fatal overdose of oxycodone.

Neonatal Opioid Withdrawal Syndrome

Prolonged use of Xtampza ER during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life‑threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Cytochrome P450 3A4 Interaction

The concomitant use of Xtampza ER with all cytochrome P450 3A4 inhibitors may result in an increase in oxycodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in oxycodone plasma concentration. Monitor patients receiving Xtampza ER and any CYP3A4 inhibitor or inducer.

Risks From Concomitant Use With Benzodiazepines or Other CNS Depressants

Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

  • Reserve concomitant prescribing of Xtampza ER and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.
  • Limit dosages and durations to the minimum required.
  • Follow patients for signs and symptoms of respiratory depression and sedation.

Important information about Xtampza ER:

  • Get emergency help right away if you take too much Xtampza ER (overdose). When you first start taking Xtampza ER, when your dose is changed, or if you take too much (overdose), serious life‑threatening breathing problems that can lead to death may occur
  • Taking Xtampza ER with other opioid medicines, benzodiazepines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, decreased awareness, breathing problems, coma, and death
  • Never give anyone else your Xtampza ER. They could die from taking it. Selling or giving away Xtampza ER is against the law
  • Store Xtampza ER securely, out of sight and reach of children, and in a location not accessible by others, including visitors to the home

Do not take Xtampza ER if you have:

  • severe asthma, trouble breathing, or other lung problems
  • a bowel blockage, or have narrowing of the stomach or intestines

Before taking Xtampza ER, tell your healthcare provider if you have a history of:

  • head injury, seizures
  • liver, kidney, thyroid problems
  • problems urinating
  • pancreas or gallbladder problems
  • abuse of street or prescription drugs, alcohol addiction, or mental health problems

Tell your healthcare provider if you are:

  • pregnant or planning to become pregnant. Prolonged use of Xtampza ER during pregnancy can cause withdrawal symptoms in your newborn baby that could be life‑threatening if not recognized and treated
  • breastfeeding. Not recommended during treatment with Xtampza ER. It may harm your baby
  • taking prescription or over‑the‑counter medicines, vitamins, or herbal supplements. Taking Xtampza ER with certain other medicines can cause serious side effects that could lead to death

When taking Xtampza ER:

  • Do not change your dose. Take Xtampza ER exactly as prescribed by your healthcare provider. Use the lowest dose possible for the shortest time needed
  • Take your prescribed dose every 12 hours, at the same time every day. Do not take more than your prescribed dose. If you miss a dose, take your next dose at your usual time
  • If you cannot swallow Xtampza ER capsules, see the detailed Instructions for Use in the Medication Guide
  • Always take Xtampza ER capsules with approximately the same amount of food to ensure enough medicine is absorbed
  • Swallow Xtampza ER whole. Do not snort, or inject Xtampza ER because this may cause you to overdose and die
  • The contents of the Xtampza ER capsules may be sprinkled on soft food, sprinkled into a cup and then put directly into the mouth, or given through a nasogastric or gastrostomy tube
  • Call your healthcare provider if the dose you are taking does not control your pain
  • Do not stop taking Xtampza ER without talking to your healthcare provider
  • Dispose of expired, unwanted or unused Xtampza ER by promptly flushing down the toilet, if a drug take‑back option is not readily available. Visit www.fda.gov/drugdisposal for additional information on disposal of unused medicines

IMPORTANT SAFETY INFORMATION ABOUT XTAMPZA ER

WARNING: ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); LIFE‑THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS

Addiction, Abuse, and Misuse

Xtampza ER exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient's risk prior to prescribing Xtampza ER and monitor all patients regularly for the development of these behaviors or conditions.

Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)

To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS‑compliant education programs available to healthcare providers. Healthcare providers are strongly encouraged to

  • complete a REMS‑compliant education program,
  • counsel patients and/or their caregivers, with every prescription, on safe use, serious risks, storage, and disposal of these products,
  • emphasize to patients and their caregivers the importance of reading the Medication Guide every time it is provided by their pharmacist, and
  • consider other tools to improve patient, household, and community safety.

Life‑Threatening Respiratory Depression

Serious, life‑threatening, or fatal respiratory depression may occur with use of Xtampza ER. Monitor for respiratory depression, especially during initiation of Xtampza ER or following a dose increase.

Accidental Ingestion

Accidental ingestion of even one dose of Xtampza ER, especially by children, can result in a fatal overdose of oxycodone.

Neonatal Opioid Withdrawal Syndrome

Prolonged use of Xtampza ER during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life‑threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Cytochrome P450 3A4 Interaction

The concomitant use of Xtampza ER with all cytochrome P450 3A4 inhibitors may result in an increase in oxycodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in oxycodone plasma concentration. Monitor patients receiving Xtampza ER and any CYP3A4 inhibitor or inducer.

Risks From Concomitant Use With Benzodiazepines or Other CNS Depressants

Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

  • Reserve concomitant prescribing of Xtampza ER and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.
  • Limit dosages and durations to the minimum required.
  • Follow patients for signs and symptoms of respiratory depression and sedation.

While taking Xtampza ER, DO NOT:

  • Drive or operate heavy machinery, until you know how Xtampza ER affects you. Xtampza ER can make you sleepy, dizzy, or light‑headed
  • Drink alcohol or use prescription or over‑the‑counter medicines that contain alcohol. Using products containing alcohol during treatment with Xtampza ER may cause you to overdose and die

The possible side effects of Xtampza ER are:

  • constipation, nausea, sleepiness, vomiting, tiredness, headache, dizziness, and abdominal pain. Call your healthcare provider if you have any of these symptoms and they are severe

Get emergency medical help if you have:

  • trouble breathing, shortness of breath, fast heartbeat, chest pain, swelling of your face, tongue, or throat, extreme drowsiness, light‑headedness when changing positions, feeling faint, agitation, high body temperature, trouble walking, stiff muscles, or mental changes such as confusion

These are not all the possible side effects of Xtampza ER. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1‑800‑FDA‑1088. For more information, go to dailymed.nlm.nih.gov.

Please see full Prescribing Information, including Boxed Warning and Medication Guide, or speak to your healthcare provider if you have questions about Xtampza ER.

Are you a Healthcare Professional or Patient/Caregiver?

Healthcare Professional Patient/Caregiver