- Mu-opioid receptor agonism: It binds to pain receptors in the brain to block the perception of pain.
- Norepinephrine reuptake inhibition (NRI): It increases the levels of the neurotransmitter norepinephrine in the brain, which helps interrupt pain signaling pathways.
- Nucynta IR (Immediate-Release): Approved for the management of moderate-to-severe acute pain in adults and children 6 years of age or older (weighing at least 40 kg). It is typically taken every 4 to 6 hours as needed.
- Nucynta ER (Extended-Release): Reserved for managing chronic pain severe enough to require around-the-clock, long-term opioid treatment. This includes neuropathic pain associated with diabetic peripheral neuropathy. It is usually taken every 12 hours and is not intended for as-needed acute pain.
- Acute Pain: Nucynta IR is used for sudden, severe pain, such as pain following surgery or an injury.
- Chronic Pain: Nucynta ER is designed for continuous pain that requires daily treatment.
- Diabetic Neuropathy: Nucynta ER is one of the few opioids specifically indicated for managing the nerve pain associated with diabetic peripheral neuropathy.
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- Addiction, Abuse, and Misuse: Even when taken exactly as prescribed, taking opioids puts patients at risk for substance use disorder, abuse, and addiction.
- Life-Threatening Respiratory Depression: Taking Nucynta can cause dangerously slow or shallow breathing, which can be fatal. The risk is highest during the initiation of treatment or following a dose increase.
- Accidental Exposure: Accidental ingestion of Nucynta, especially by children, can result in a fatal overdose.
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- Severe asthma, breathing problems, or chronic obstructive pulmonary disease (COPD).
- A known or suspected gastrointestinal obstruction, including paralytic ileus.
- Used a monoamine oxidase inhibitor (MAOI) within the last 14 days.
- Nausea and vomiting
- Constipation (though studies suggest this may be less severe than with traditional opioids)
- Dizziness and drowsiness (somnolence)
- Headache
- Dry mouth
- Itching (pruritus) or increased sweating
- Slow or stopped breathing: Look for blue-colored lips, fingernails, or skin.
- Severe allergic reactions: Symptoms include swelling of the face, tongue, or throat, hives, and severe difficulty breathing.
- Signs of serotonin syndrome: Agitation, hallucinations, fever, fast heartbeat, muscle twitching, or shivering.
- Signs of adrenal insufficiency: Extreme fatigue, nausea, vomiting, or low blood pressure.
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- Nucynta IR (Immediate-Release): The usual starting dose for adults is 50 mg to 100 mg every 4 to 6 hours. The maximum dose on the first day is 700 mg, and 600 mg on subsequent days.
- Nucynta ER (Extended-Release): The initial dose is typically 50 mg taken every 12 hours. Dosage adjustments are made to achieve an adequate balance between pain relief and tolerability. The ER tablets must be swallowed whole and should not be crushed, broken, or chewed, as this can lead to a fatal release of the medication.
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