Xtampza ER is an extended-release version of oxycodone. Oxycodone is a powerful pain reliever that’s derived from codeine. It is ingested orally and is formulated to be gradually released into the body in small doses over the course of 12 hours.
Xtampza ER is indicated for the management of moderate to severe pain. Xtampza ER should not be taken by patients who are not already opioid-tolerant. Xtampza ER is not indicated for the management of acute pain. When initiating treatment with Xtampza ER, the lowest possible dose of 9 mg should be provided. If this dose proves ineffective, the dose may be gradually increased.
Patients should be monitored closely for the onset of severe respiratory depression, especially during the first 24 to 72 hours following initial treatment. Respiratory depression is the primary risk factor associated with Xtampza ER. In the event of an overdose, supporting the patient’s breathing should be the primary concern.
The amount of Xtampza ER necessary to overdose varies greatly among patients depending on various metabolic factors. Some patients are hypersensitive to Xtampza ER and may experience the onset of histamine-based reactions including flushed, itchy skin. Other individuals are significantly more tolerant of high and frequent doses of the drug.
Pinpoint pupils, severe respiratory depression, and significantly decreased level of consciousness are the primary symptoms of Xtampza ER overdose. Clinically significant decreased level of consciousness is different than simply being drowsy. All opioids tend to result in a relaxing type of euphoria that’s associated with feelings of calm. Xtampza ER overdose, however, is characterized by extreme lethargy and somnolence that rapidly progresses to stupor, coma, and death. The individual may one moment be able to reply in full sentences and several minutes later be unresponsive even when called by name.
“Pinpoint” pupils mean that the pupils are maximally constricted to the smallest possible diameter. This is a common symptom in nearly all opioid overdose cases except in cases with a few obscure partial/mixed opioid agonists. As the overdose progresses and the patient’s oxygen supply deteriorates to critical levels, the pinpoints will likely transition to full dilation (the opposite of pinpoint).
Pinpoint pupils, decreased level of consciousness, and severe respiratory depression are referred to as the “opioid overdose triad.” It’s these three symptoms that doctors look for first when identifying an overdose of Xtampza ER. Xtampza ER is a powerful central nervous system depressant. It acts on the brainstem to depress the patient’s autonomic urge to breathe.
Under normal conditions, the brainstem monitors carbon dioxide levels in the blood. When carbon dioxide levels are too high, the brainstem triggers the lungs to breathe. Xtampza ER inhibits this process, potentially leading to toxic carbon dioxide levels and oxygen deprivation to the cells. Other signs of Xtampza ER overdose include cold/clammy skin, blue lips and fingernails, general weakness, poor coordination, and muscle flaccidity.
The amount of Xtampza necessary to overdose varies according to each patient’s age, weight, body fat percentage, liver/kidney health, overall physical status, genetic predispositions, and opioid tolerance.
Xtampza ER comes in doses of 9 mg, 13.5 mg, 18 mg, 27 mg, and 36 mg. The maximum daily dose of Xtampza ER is 288 mg per day, which correlates to eight 36 mg capsules. Xtampza ER recommended daily doses are slightly smaller than those of standard oxycodone hydrochloride oral tablets, which have a maximum daily dose of 320 mg per day. Single doses of 36 mg are only indicated for patients who have a pre-established strong opioid tolerance. Opioid-tolerant is defined as receiving the equivalent of at least 60 mg of oral morphine per day for a week or longer. Xtampza ER is intended to be administered twice daily at 12-hour intervals to maintain consistent plasma concentrations of the drug.
Xtampza ER overdose is treated by securing and maintaining the patient’s airway, supporting ventilation, and administering an opioid antagonist. Ventilations are assisted with a bag-valve-mask if the patient remains conscious. If the patient loses consciousness, they may require an endotracheal tube to be inserted to secure the airway. Oxygen therapy may be administered to address pulmonary edema, and vasopressors may be used to manage cardiovascular depression.
An opioid antagonist such as naloxone will be administered in the event of clinically significant respiratory depression. Naloxone rapidly reverses the effect of Xtampza ER by breaking the drug’s bonds to opioid receptors in the body.
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