Opioids are frequently prescribed to treat severe pain and can be short- or long-acting agents. One commonly prescribed long-acting opioid is Xtampza ER. This long-acting form of oxycodone is a treatment option for around-the-clock pain control. However, as an opioid, the drug carries the risk of abuse, addiction and dependence. If you or a loved one takes Xtampza ER, it’s important to be aware of the drug’s side effects.

What Is Xtampza ER?

Xtampza ER is an extended-release form of oxycodone prescribed to people to help manage severe pain. This prescription medication is only intended for regular, around-the-clock treatment and not for short-term mild or breakthrough pain.

How Is Xtampza ER Used?

Xtampza ER should only be recommended to people as an alternative treatment to other opioid pain-relievers or immediate-release drugs that have proven ineffective, intolerable or inadequate at managing severe pain. This is an important consideration because taking opioid pain relievers like Xtampza ER puts people at risk for developing the psychological disease of addiction, a physical dependence or customary misuse.

In addition, this medication should only be taken as directed by your doctor. Do not adjust a medication’s dosage levels or treatment schedule without first consulting your doctor.

Xtampza ER Dosages

Xtampza ER should only be taken as directed by your doctor. The medication is typically prescribed to be used every 12 hours. As a long-acting form of oxycodone, it is not prescribed for as-needed use. It is instead meant to be taken on a regular basis. Available doses include:

  • Xtampza ER 9 mg equivalent to 10 mg oxycodone hydrochloride
  • Xtampza ER 13.5 mg equivalent to 15 mg oxycodone hydrochloride
  • Xtampza ER 18 mg equivalent to 20 mg oxycodone hydrochloride
  • Xtampza ER 27 mg equivalent to 30 mg oxycodone hydrochloride
  • Xtampza ER 36 mg equivalent to 40 mg oxycodone hydrochloride

Side Effects of Xtampza ER

Like all medications, Xtampza ER has side effects. While some may be mild and go away with time, others are more serious and may require medical attention. Any side effects you have on Xtampza ER should be reported to your doctor to determine whether or not intervention is needed.

Common Side Effects

Just like with any new medication, Xtampza ER may cause side effects in some people. Common side effects of Xtampza ER include:

  • Sweating
  • Itching
  • Cough
  • Anxiety
  • Irritability
  • Fatigue
  • Dizziness
  • Drowsiness
  • Blurred vision
  • Loss of appetite
  • Hot flashes
  • Chills
  • Nausea
  • Constipation
  • Diarrhea
  • Abdominal pain
  • Migraine
  • Swelling of hands and feet
  • Joint, back or muscle pain
  • Fever
  • Gastroesophageal reflux disease (GERD)

More serious side effects of Xtampza ER include:

  • Swelling (edema)
  • Fever
  • Skin picking
  • High blood sugar (hyperglycemia)
  • Joint pain
  • Muscle pain
  • Pain in the back of the throat
  • Excessive sweating
  • High blood pressure (hypertension)
  • Difficulty breathing
  • Low cortisol production (adrenal insufficiency)
  • Low production of male hormones (androgen deficiency)
  • Serotonin syndrome

These are not all of the potential side effects associated with Xtampza ER. Call your doctor or pharmacist to discuss the issue if you are experiencing a side effect from Xtampza ER not listed above.

Long-Term Side Effects

Xtampza should not be given to people who already have stomach or intestine blockages, like paralytic ileus. The drug can make these problems worse, especially if used for a long time. If you have issues with your bile ducts, your doctor should keep a close eye on your symptoms.

Long-term use of Xtampza ER might lead to adrenal insufficiency, which can show up as symptoms like:

  • Chronic fatigue
  • Dizziness
  • Nausea and vomiting
  • Weakness
  • Weight loss 
  • Low blood pressure

Xtampza ER Interactions

Xtampza ER can interact with other drugs. Some interactions are more concerning than others. To find out if Xtampza ER interacts with any of your medications and how significant it is for you, talk to your doctor or pharmacist. Always consult your doctor or pharmacist before starting or stopping any medications. This includes over-the-counter vitamins or supplements. Also, ensure your healthcare team knows you’re taking Xtampza ER when they prescribe any new medication.

Common Drugs To Avoid on Xtampza ER

Examples of common drugs to avoid while taking Xtampza ER include but are not limited to:

  • Benzodiazepines like alprazolam (Xanax) and lorazepam (Ativan), due to the risk of overdose
  • Other opioids because they can increase the risk of opioid overdose if taken alongside Xtampza ER
  • Some antibiotics like ciprofloxacin (Cipro) because they can increase blood levels of Xtampza ER
  • Muscle relaxants like cyclobenzaprine due to the risk of excessive central nervous system depression
  • Certain oral steroids like dexamethasone, as they can reduce blood levels of Xtampza ER, making it less effective
  • Antipsychotics like haloperidol (Haldol) and quetiapine (Seroquel), due to the risk of excessive central nervous system depression
  • Some blood pressure medications like diltiazem and verapamil, as they can increase the risk of side effects like sleepiness
  • Some over-the-counter herbs like St. John’s Wort, as they can make Xtampza ER less effective
  • Sleep medications like suvorexant (Belsomra) and zolpidem (Ambien) because of the risk of central nervous system depression

Common Drugs You Can Take on Xtampza ER

Many medications are safe to take with Xtampza ER. If your doctor agrees, other pain medication may be fine to take along with Xtampza ER, such as:

  • Acetaminophen (Tylenol), which is available over the counter to treat pain
  • Non-steroidal anti-inflammatory drugs (NSAIDs), including over-the-counter medications ibuprofen and naproxen, as well as prescription-strength alternatives
  • Topical pain medications like topical lidocaine and diclofenac

Always ask your doctor or pharmacist before starting a new medication to ensure it is safe for you given your medical history.

Xtampza ER Warnings

Xtampza ER comes with multiple warnings, including Boxed Warnings. It is important to review the medication’s warnings with your doctor to make sure that Xtampza ER is safe for you to take. Your doctor can review the drug’s warnings with you to ensure that Xtampza ER is your best choice.

Alcohol and Xtampza

You should never mix Xtampza ER with alcohol because both can slow down your central nervous system. Using them together can harm your liver and even lead to life-threatening breathing problems.

The liver processes both alcohol and Xtampza ER. Mixing these substances can cause high levels of both alcohol and Xtampza ER in the bloodstream. This is because the liver becomes less efficient at breaking them down. People with liver problems are more likely to face these issues.

Several factors can impact the risk of opioid or alcohol toxicity. These include a person’s age, weight, overall health, kidney function, tolerance to opioids and genetics. Some people can handle larger amounts of Xtampza without as many issues. This is even when it’s mixed with alcohol. However, when you use Xtampza ER and alcohol together, it can worsen the side effects of both substances.

Mixing Xtampza ER and alcohol can also cause:

  • Pinpoint pupils
  • Blackouts
  • Nausea
  • Vomiting
  • Poor coordination
  • Muscle flaccidity
  • Fainting
  • Confusion
  • Loss of consciousness
  • Coma
  • Death 

If you or someone you know is experiencing severe side effects after consuming Xtampza and alcohol, call 911 immediately.

Pregnancy and Xtampza ER

Xtampza ER should only be used with extreme caution in pregnant women. The drug carries a Boxed Warning about its use in pregnancy. This is because of the risk of neonatal opioid withdrawal syndrome with long-term use in pregnancy. 

Xtampza ER itself has not been studied in pregnant women. However, its active ingredient, oxycodone, has been linked to lower fetal weight and behavioral changes in animal studies. For these reasons, it is important to carefully weigh the possible risks of Xtampza ER with your doctor before taking the drug during pregnancy.

Operating Machinery on Xtampza ER

Xtampza ER carries a warning to avoid driving or operating heavy machinery until you know how the drug impacts you. This is because Xtampza ER can cause side effects such as cognitive changes and excessive sedation. These effects can make it dangerous to operate machinery.

Switching from Other Opioids to Xtampza ER

Xtampza ER can be prescribed to a person who has never taken opioids before. But some people may be switched to the drug from other opioids. This can occur in a variety of situations. 

In some cases, the person has been taking short-acting oxycodone but requires longer-acting pain medication for around-the-clock pain coverage. In other cases, the person may be taking a different long-acting opioid but be switched to Xtampza ER. This change could be because of insurance coverage or side effects.

When switching from another opioid to Xtampza ER, your doctor and pharmacist will calculate an appropriate dose conversion for you. This conversion is based on the medications themselves. However, they are also based on other factors like your age, liver function and kidney function. 

Xtampza ER Withdrawal

Unpleasant withdrawal symptoms may occur if you suddenly stop taking a medication. Common Xtampza ER withdrawal symptoms may include:

  • Restlessness
  • Dilated pupils
  • Tearing 
  • Runny nose
  • Yawning
  • Irritability
  • Anxiety
  • Sweating
  • Chills
  • Muscle pain
  • Backache
  • Joint pain
  • Weakness
  • Abdominal cramps
  • Insomnia
  • Nausea
  • Vomiting
  • Diarrhea
  • Increased blood pressure
  • Increased breathing rate
  • Increase heart rate

Xtampza ER Withdrawal Timeline

Xtampza ER withdrawal timelines vary for each individual. Several factors influence someone’s bodily function. These factors also affect how the body processes Xtampza ER. Typically, withdrawal symptoms will last about a week for Xtampza ER. However, this time frame may be longer or shorter. It depends on how the individual’s body functions.

Managing Xtampza ER Withdrawal Symptoms

People struggling with managing Xtampza ER withdrawal symptoms should seek out a medically assisted detoxification program. In medical detox, the drug is safely eliminated from someone’s body while under medical supervision. These expert team members are available through the entire process to answer questions about withdrawal.

Withdrawal is different for everyone. So, don’t hesitate to ask for help during this challenging process.

Xtampza ER Addiction

People taking Xtampza ER responsibly are still at risk for developing a psychological addiction. Seek professional help as soon as possible if you believe someone in your life is misusing Xtampza ER. 

Signs of Xtampza ER Addiction

Signs pointing to an Xtampza ER addiction include

  • Becoming obsessed with finding and taking Xtampza ER
  • Losing interest in the hobbies you once found enjoyable
  • Suffering significant financial losses through efforts to obtain Xtampza ER
  • Performing poorly or irregularly at school or work

Treatment for Xtampza ER Addiction

If you or a loved one are struggling with Xtampza abuse or addiction, you are not alone. Xtampza addiction is not a life sentence, and there is hope for an Xtampza-free life. The Recovery Village has addiction professionals standing by who are eager to help you take a step toward recovery today.

Inpatient Xtampza Rehab

Inpatient Xtampza ER rehab means you stay at a treatment center as you recover. It’s helpful for those with severe Xtampza ER addiction or if it’s challenging to recover at home.

Outpatient Xtampza Rehab

Outpatient Xtampza ER rehab lets you live at home and visit a treatment center for appointments. You can start with inpatient Xtampza ER rehab and then switch to outpatient. Or, if your addiction is less severe, you can begin with outpatient treatment.

Xtampza ER Overdose

The amount of Xtampza ER needed to overdose varies among people due to differences in metabolism. Some may be highly sensitive and experience allergic reactions like itchy skin, while others can handle higher doses.

Xtampza ER Overdose

The amount of Xtampza ER necessary to overdose varies greatly among people based on various metabolic factors. Some people are hypersensitive to Xtampza ER and may experience allergic reactions such as flushed, itchy skin. Other individuals are significantly more tolerant of high and frequent doses of the drug.

Symptoms of Xtampza ER Overdose

Doctors check for pinpoint pupils, decreased consciousness and severe breathing problems. This is called the “opioid overdose triad.” These symptoms help doctors identify an Xtampza ER overdose. Xtampza ER is a potent central nervous system (CNS) depressant that affects the brainstem’s control of breathing.

Normally, the brainstem monitors carbon dioxide (CO2) levels in the blood and tells the lungs to breathe when CO2 levels are high. Xtampza ER disrupts this process, which can lead to high CO2 levels and reduced oxygen in the body’s cells.

Other signs of Xtampza ER overdose include

  • Cold or clammy skin
  • Blue lips and fingernails
  • General weakness
  • Poor coordination
  • Muscle flaccidity

Xtampza Overdose Treatment

To treat an Xtampza ER overdose, the person’s airway is secured, and their breathing is supported. An opioid blocker (antagonist) is also administered. If the person is conscious, they may receive help with a breathing mask. 

If they lose consciousness, a breathing tube may be inserted to secure their airway. Oxygen therapy can help with fluid in the lungs (pulmonary edema). Also, blood pressure medication (vasopressors) may be used to manage low blood pressure.

In clinically significant cases of slowed breathing (respiratory depression), an opioid blocker called naloxone is given. Naloxone quickly reverses Xtampza ER’s effects by disconnecting it from the body’s opioid receptors.

How Long Does Xtampza ER Stay in Your System?

The length of time Xtampza ER can be detected in the body depends on the drug test used. These tests include urine, blood, hair and saliva.

  • Xtampza ER can be detected in the urine between one to three days following the time of ingestion. 
  • Blood tests can detect Xtampza ER for up to six hours. 
  • Xtampza ER can be tested for in hair screenings for up to 90 days following the time of the last dose.
  • Saliva tests can detect Xtampza ER for up to 36 hours, depending on the person’sunique metabolic factors. 

Half-Life of Xtampza ER

The half-life of a drug refers to how long it takes for half a dose to be cleared from your system. The half-life of Xtampza ER is 5.6 hours following the time of administration. Steady-state plasma concentrations are typically achieved within 24 to 36 hours. 

Factors That Influence How Long Xtampza ER Stays in Your System

Several factors can affect how long Xtampza ER stays in the body. It takes elderly people 15% longer to eliminate Xtampza ER than it does for younger adults. Women tend to have higher Xtampza ER levels in their blood, around 20% more than men. Researchers are unsure why.

People with kidney problems also eliminate Xtampza ER more slowly. It takes about an hour longer than those with healthy kidneys. If the liver is impaired, elimination is 2.3 times longer.

Other factors influencing elimination times for Xtampza ER include a person’s weight, body fat, genetics and opioid tolerance. People who are used to synthetic opioids can process Xtampza ER more efficiently. Generally, larger individuals may need higher doses for pain relief compared to smaller ones.

Alternatives to Xtampza ER

Xtampza ER is one of many different long-acting opioid formulations. Even its active ingredient oxycodone is available as other drugs. Many other long-acting opioids exist, including:

  • OxyContin (oxycodone)
  • MS Contin (morphine)
  • Kadian (morphine)
  • Opana ER (oxymorphone)
  • Exalgo (hydromorphone)
  • Dolophine (methadone)
  • Nucynta ER (tapentadol)
  • Duragesic (fentanyl transdermal patch
  • Butrans (buprenorphine transdermal patch)
a woman with long brown hair smiling at the camera.
Editor – Abby Doty
Abby Doty graduated from Hamline University in 2021 with a Bachelor's in English and Psychology. She has written and edited creative and literary work as well as academic pieces focused primarily on psychology and mental health. Read more
a woman wearing glasses and a white robe.
Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more

Drugs.com. “Xtampza ER: Package Insert“>Xtampza […]ackage Insert.” March 7, 2023. Accessed October 7, 2023. 

Drugs.com. “Xtampza ER Drug Interactions“>Xtampza […] Interactions.” Accessed October 7, 2023. 

ClinCalc. “Opioid (Opiate) Equianalgesia Conversion Calculator“>Opioid ([…]on Calculator.” Accessed October 7, 2023. 

LabCorp. “Drug Test Summary for Urine Oral Fluid and Hair“>Drug Tes[…]luid and Hair.” Accessed October 7, 2023.

ARUP Laboratories. “Drug Plasma Half-Life and Urine Detection Window“>Drug Pla[…]ection Window.” September 2022. Accessed October 7, 2023.

American Society of Addiction Medicine. “National Practice Guideline for the Treatment of Opioid Use Disorder“>National[…] Use Disorder.” December 18, 2019. Accessed October 7, 2023.

Dolinak, David. “Opioid Toxicity“>Opioid Toxicity.” Academic Forensic Pathology, March 1, 2017. Accessed October 7, 2023.

Schiller, Elizabeth Y.; Goyal, Amandeep; & Mechanic,  Oren J. “Opioid Overdose“>Opioid Overdose.” StatPearls, July 21, 2023. Accessed October 7, 2023.

Food and Drug Administration. “List of Extended-Release and Long-Acting Opioid Products Required to Have an Opioid REMS“>List of […]n Opioid REMS.” November 24, 2017. Accessed October 7, 2023.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.