Nucynta ER (Page 4 of 10)
5.13 Withdrawal
Avoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who have received or are receiving a course of therapy with a full opioid agonist analgesic, including NUCYNTA ER. In these patients, mixed agonists/antagonists and partial agonist analgesics may reduce the analgesic effect and/or may precipitate withdrawal symptoms [see Drug Interactions (7)].
When discontinuing NUCYNTA ER, gradually taper the dose [see Dosage and Administration (2.3)]. Do not abruptly discontinue NUCYNTA ER [see Drug Abuse and Dependence (9.3)].
5.14 Risks of Driving and Operating Machinery
NUCYNTA ER may impair the mental or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery. Warn patients not to drive or operate dangerous machinery unless they are tolerant to the effects of NUCYNTA ER and know how they will react to the medication [see Patient Counseling Information (17)].
5.15 Risk of Toxicity in Patients with Hepatic Impairment
A study with an immediate-release formulation of tapentadol in subjects with hepatic impairment showed higher serum concentrations of tapentadol than in those with normal hepatic function. Avoid use of NUCYNTA ER in patients with severe hepatic impairment. Reduce the dose of NUCYNTA ER in patients with moderate hepatic impairment [see Dosage and Administration (2.4) and Clinical Pharmacology (12.3)]. Closely monitor patients with moderate hepatic impairment for respiratory and central nervous system depression when initiating and titrating NUCYNTA ER.
5.16 Risk of Toxicity in Patients with Renal Impairment
Use of NUCYNTA ER in patients with severe renal impairment is not recommended due to accumulation of a metabolite formed by glucuronidation of tapentadol. The clinical relevance of the elevated metabolite is not known [see Clinical Pharmacology (12.3)].
6 ADVERSE REACTIONS
The following serious adverse reactions are described, or described in greater detail, in other sections:
- Addiction, Abuse, and Misuse [see Warnings and Precautions (5.1)]
- Life-Threatening Respiratory Depression [see Warnings and Precautions (5.3)]
- Neonatal Opioid Withdrawal Syndrome [see Warnings and Precautions (5.4)]
- Interaction with Benzodiazepine or Other CNS Depressants [see Warnings and Precautions (5.5)]
- Serotonin Syndrome [see Warnings and Precautions 5.7]
- Adrenal Insufficiency [see Warnings and Precautions (5.8)]
- Severe Hypotension [see Warnings and Precautions (5.9)]
- Gastrointestinal Adverse Reactions [see Warnings and Precautions (5.11)]
- Seizures [see Warnings and Precautions (5.12)]
- Withdrawal [see Warnings and Precautions (5.13)]
6.1 Clinical Trial Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
Commonly-Observed Adverse Reactions in Clinical Studies with NUCYNTA ER in Patients with Chronic Pain due to Low Back Pain or Osteoarthritis
The safety data described in Table 1 below are based on three pooled, randomized, double-blind, placebo- controlled, parallel group, 15-week studies of NUCYNTA ER (dosed 100 to 250 mg BID after a 50 mg BID starting dose) in patients with chronic pain due to low back pain (LBP) and osteoarthritis (OA). These trials included 980 NUCYNTA ER-treated patients and 993 placebo-treated patients. The mean age was 57 years old; 63% were female and 37% were male; 83% were White, 10% were Black, and 5% were Hispanic.
The most common adverse reactions (reported by ≥10% in any NUCYNTA ER dose group) were: nausea, constipation, dizziness, headache, and somnolence.
The most common reasons for discontinuation due to adverse reactions in eight Phase 2/3 pooled studies reported by ≥1% in any NUCYNTA ER dose group for NUCYNTA ER- and placebo-treated patients were nausea (4% vs. 1%), dizziness (3% vs. <1%), vomiting (3% vs. <1%), somnolence (2% vs. <1%), constipation (1% vs. <1%), headache (1% vs. <1%), and fatigue (1% vs. <1%), respectively.
| NUCYNTA ER 50 to 250 mg BID † (n=980) | Placebo (n=993) | |
|---|---|---|
| Nausea | 21% | 7% |
| Constipation | 17% | 7% |
| Dizziness | 17% | 6% |
| Headache | 15% | 13% |
| Somnolence | 12% | 4% |
| Fatigue | 9% | 4% |
| Vomiting | 8% | 3% |
| Dry mouth | 7% | 2% |
| Hyperhidrosis | 5% | <1% |
| Pruritus | 5% | 2% |
| Insomnia | 4% | 2% |
| Dyspepsia | 3% | 2% |
| Lethargy | 2% | <1% |
| Asthenia | 2% | <1% |
| Anxiety | 2% | 1% |
| Decreased appetite | 2% | <1% |
| Vertigo | 2% | <1% |
| Hot flush | 2% | <1% |
| Disturbance in attention | 1% | <1% |
| Tremor | 1% | <1% |
| Chills | 1% | 0% |
| Abnormal dreams | 1% | <1% |
| Depression | 1% | <1% |
| Vision blurred | 1% | <1% |
| Erectile dysfunction | 1% | <1% |
Commonly-Observed Adverse Reactions in Clinical Studies with NUCYNTA ER in Patients with Neuropathic Pain Associated with Diabetic Peripheral Neuropathy
The types of adverse reactions seen in the studies of patients with painful diabetic peripheral neuropathy (DPN) were similar to what was seen in the low back pain and osteoarthritis trials. The safety data described in Table 2 below are based on two pooled, randomized withdrawal, double-blind, placebo-controlled, 12-week studies of NUCYNTA ER (dosed 100 to 250 mg BID) in patients with neuropathic pain associated with diabetic peripheral neuropathy. These trials included 1040 NUCYNTA ER-treated patients and 343 placebo- treated patients. The mean age was 60 years old; 40% were female and 60% were male; 76% were White, 12% were Black, and 12% were “Other”. The most commonly reported ADRs (incidence ≥10% in NUCYNTA ER-treated subjects) were: nausea, constipation, vomiting, dizziness, somnolence, and headache.
Table 2 lists the common adverse reactions reported in 1% or more of NUCYNTA ER-treated patients and greater than placebo-treated patients with neuropathic pain associated with diabetic peripheral neuropathy in the two pooled studies.
| NUCYNTA ER 50 to 250 mg BID † (n=1040) | Placebo ‡ (n=343) | |
|---|---|---|
| ||
| Nausea | 27% | 8% |
| Dizziness | 18% | 2% |
| Somnolence | 14% | <1% |
| Constipation | 13% | <1% |
| Vomiting | 12% | 3% |
| Headache | 10% | 5% |
| Fatigue | 9% | <1% |
| Pruritus | 8% | 0% |
| Dry mouth | 7% | <1% |
| Diarrhea | 7% | 5% |
| Decreased appetite | 6% | <1% |
| Anxiety | 5% | 4% |
| Insomnia | 4% | 3% |
| Hyperhidrosis | 3% | 2% |
| Hot flush | 3% | 2% |
| Tremor § | 3% | 3% |
| Abnormal dreams | 2% | 0% |
| Lethargy | 2% | 0% |
| Asthenia | 2% | <1% |
| Irritability | 2% | 1% |
| Dyspnea | 1% | 0% |
| Nervousness | 1% | 0% |
| Sedation | 1% | 0% |
| Vision blurred | 1% | 0% |
| Pruritus generalized | 1% | 0% |
| Vertigo | 1% | <1% |
| Abdominal discomfort | 1% | <1% |
| Hypotension | 1% | <1% |
| Dyspepsia | 1% | <1% |
| Hypoesthesia | 1% | <1% |
| Depression | 1% | <1% |
| Rash | 1% | <1% |
| Chills § | 1% | 1% |
| Feeling cold § | 1% | 1% |
| Drug withdrawal syndrome | 1% | <1% |
Other Adverse Reactions Observed During the Premarketing Evaluation of NUCYNTA ER
The following additional adverse drug reactions occurred in less than 1% of NUCYNTA ER-treated patients in ten Phase 2/3 clinical studies:
Nervous system disorders: paresthesia, balance disorder, syncope, memory impairment, mental impairment, depressed level of consciousness, dysarthria, presyncope, coordination abnormal
Gastrointestinal disorders: impaired gastric emptying
General disorders and administration site conditions: feeling abnormal, feeling drunk
Psychiatric disorders: perception disturbances, disorientation, confusional state, agitation, euphoric mood, drug dependence, thinking abnormal, nightmare
Skin and subcutaneous tissue disorders: urticaria
Metabolism and nutrition disorders: weight decreased
Cardiac disorders: heart rate increased, palpitations, heart rate decreased, left bundle branch block
Vascular disorder: blood pressure decreased
Respiratory, thoracic and mediastinal disorders: respiratory depression
Renal and urinary disorders: urinary hesitation, pollakiuria
Reproductive system and breast disorders: sexual dysfunction
Eye disorders: visual disturbance
Immune system disorders: drug hypersensitivity
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