Overdose
Experience with NUCYNTA® overdose is very limited. Management of overdose should be focused on treating symptoms of mu-opioid agonism. Primary attention should be given to reestablishment of a patent airway and institution of assisted or controlled ventilation when overdose of NUCYNTA® is suspected. Supportive measures (including oxygen and vasopressors) should be employed in the management of circulatory shock and pulmonary edema accompanying overdose as indicated. Cardiac arrest or arrhythmias may require cardiac massage or defibrillation.
Due to its actions on norepinephrine, and to a lesser extent serotonin, a NUCYNTA® overdose may produce symptoms which are not typically present in opioid overdoses (symptoms of serotonin syndrome and adrenergic syndrome). This risk is greater if NUCYNTA® has been taken with other drugs of similar mechanisms. These additional symptoms should be addressed and treated symptomatically (after treating for mu-opioid agonism) if they are presented and must be taken into consideration prior to the administration of any medication. It may be necessary to treat the patients convulsions first in order to safely achieve intubation.
NUNCYNA® overdose is more likely to occur when it is combined with alcohol or other drugs. Alcohol administration has been demonstrated to increase the plasma levels of NUCYNTA®, thereby increasing the effect of the NUCYNTA® as well as acting synergistically with the depressant effects of alcohol. The concomitant use of NUCYNTA® and other depressants (including alcohol) significantly increases the risks of somnolence, hypotension, coma, and (potentially fatal) respiratory depression.
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