Tapentadol Extended-Release Tablets (Nucyreta)

Primary uses of Nucyreta Tablet ER

Moderate to severe pain

Uses of Nucyreta Tablet ER

Nucyreta Tablet ER is used for moderate to severe pain.

How Nucyreta Tablet ER works

Nucyreta 50mg Tablet ER decreases the perception of pain by blocking the transmission of pain signals to the brain.

Product Description
NUCYRETA ER Tablets, 50mg extended release tablets
NUCYRETA ER Tablets, 100mg extended release tablets
NUCYRETA ER Tablets, 150mg extended release tablets
NUCYRETA ER Tablets, 200mg extended release tablets

The full name of your medicine is ‘NUCYRETA ER Tablets, 50mg extended release tablets’.
Tapentadol – the active substance in NUCYRETA– is a strong painkiller which belongs to the class of opioids. NUCYRETA is used in adults for the treatment of moderate to severe pain of recent onset that can only be adequately managed with an opioid painkiller.

BEFORE YOU TAKE NUCYRETA

Do not take NUCYRETA TABLETS
• if you are allergic to tapentadol or any of the other ingredients of this medicine (listed in section 6)
• if you have asthma or if your breathing is dangerously slow or shallow (respiratory depression, hypercapnia)
• if you have no bowel movement as shown by severe constipation and bloating which may be accompanied by pain or discomfort in the lower stomach
• if you have poisoning with alcohol, sleeping pills, pain relievers or medicines that affect mood and emotions (see ‘Other medicines and
NUCYRETA ER 50’)

Warnings and precautions
Talk to your doctor or pharmacist before taking NUCYRETA if you:
• have slow or shallow breathing
• suffer from increased pressure in the brain or are not fully conscious
• have had a head injury or brain tumors
• have had an epileptic fit or if you are at risk of having epileptic fits
• suffer from liver or kidney problems (see ‘How to take NUCYRETA ER 50’)
• suffer from a pancreatic disease including inflammation of the pancreas (pancreatitis) or disease of the bile duct (biliary tract disease)
• are taking NUCYRETA with medicines referred to as mixed opioid agonist/ antagonists (e.g., pentazocine, nalbuphine) or partial mu-opioid agonists (e.g. buprenorphine)
• have a tendency to abuse medicines or if you are dependent on medicines, as NUCYRETA may lead to addiction. In this case, you should only take these tablets for short periods of time and under strict medical supervision.

Other medicines and NUCYRETA TABLETS
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Your doctor will tell you which medicines are safe to take with NUCYRETA ER 50.
• Your breathing may become dangerously slow or shallow (respiratory depression) if you are taking certain sleeping pills or tranquilizers (e.g. barbiturates, benzodiazepines), or pain relievers such as morphine and codeine (also as cough medicine) in combination with NUCYRETA ER 50.
If this happens tell your doctor.
• Your consciousness may be decreased, you may feel drowsier or feel you might faint, if you take NUCYRETAwith sedatives (such as benzodiazepines), antipsychotics (medicines that affect the state of mind or emotions), H1-antihistamines, opioids or alcohol. If this happens tell your doctor.
• If you are taking a type of medicine that affects serotonin levels (e.g. certain medicines to treat depression), speak to your doctor before taking NUCYRETA as there have been cases of “serotonin syndrome”.
Serotonin syndrome is a rare, but life-threatening condition. The signs include confusion, restlessness, fever, sweating, uncoordinated movement of arms, legs or eyes, uncontrollable jerking of muscles, muscle twitches and diarrhoea. Your doctor can advise you on this.
• NUCYRETA may not work as well if taken with opioid like medicines (e.g. those containing pentazocine, nalbuphine or buprenorphine).
Tell your doctor if you are currently being treated with one of these medicines.
• Taking NUCYRETA with products (e.g. rifampicin, phenobarbital or St John’s
Wort) that affects the enzymes required to remove NUCYRETA from the body, may affect how well NUCYRETA works or may cause side effects. The effects may occur especially when the other medication is started or stopped.
• NUCYRETAshould not be taken together with monoamine oxidase inhibitors (MAOIs – certain medicines for the treatment of depression).
Tell your doctor if you are taking or have taken MAO inhibitors during the last 14 days.
Please keep your doctor informed about all medicines you are taking.

Taking NUCYRETA with food, drink and alcohol
Do not drink alcohol whilst you are taking NUCYRETA ER 50, because some side effects such as drowsiness may be increased. You can take NUCYRETA with or without food.

Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Do not take NUCYRETA ER 50:
• if you are pregnant, unless your doctor has instructed you to do so
• if you become pregnant during treatment with NUCYRETA ER 50. Check with your doctor.
• during childbirth, as it could lead to dangerously slow or shallow breathing (respiratory depression) in the newborn
• if you are breast-feeding, as it may pass into the breast milk.

Driving and using machines
If you feel drowsy, dizzy, have blurred vision or a slow reaction time whilst taking NUCYRETA ER 50, then do not drive, use tools or machinery.
Any such effects are more likely to occur when you start taking NUCYRETA ER 50, when the dose of NUCYRETAis changed, or when you drink alcohol or take tranquilizers.
Please ask your doctor before driving a car or using machinery.

NUCYRETAcontains lactose.
Lactose is a type of sugar. If you have been told by your doctor that you have intolerance to some sugars, talk to your doctor before taking this medicine

HOW TO TAKE NUCYRETA

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Your doctor will change the dose and time between doses of NUCYRETA according to your pain level and your needs. Generally, the lowest pain relieving dose should be taken.
Adults
The usual dose is 1 tablet every 4 to 6 hours.
Daily doses greater than 700 mg tapentadol on the first day of treatment and daily doses greater than 600 mg tapentadol on the following days of treatment are not recommended.
Your doctor may prescribe a different, more appropriate dose or timing of dosing, if this is necessary for you. If you feel that the effect of these tablets is too strong or weak, talk to your doctor or pharmacist.
How and when should you take NUCYRETA ER 50
NUCYRETAis for oral use.
Swallow the tablets with a glass of water. You may take the tablets either on an empty stomach or with food.
How long should you take NUCYRETA ER 50
Do not take the tablets for longer than your doctor has told you.
Elderly patients
In elderly patients (above 65 years) usually no dose adjustment is necessary. However, your doctor may adjust your dose or time between doses if required.
Patients with liver or kidney problems (insufficiency)
Do not take NUCYRETA if you have severe liver or kidney problems.
If you have moderate liver problems, your doctor will adjust your dose or time between doses.
If you have mild liver problems or mild to moderate kidney problems, a dose adjustment is not required.
Children and adolescents
NUCYRETA is not recommended for children and adolescents below the age of 18 years.
If you take more NUCYRETA than you should
Taking too much NUCYRETA may be life-threatening.
Immediate medical advice should be sought in the event of an overdose, even if you feel well.
Very high doses of NUCYRETA may cause the following:
• pin-point pupils in the eyes
• being sick (vomiting)
• drop in blood pressure
• fast heart beat
• altered consciousness, collapse or deep unconsciousness (coma)
• epileptic fits
•dangerously slow or shallow breathing or stopping breathing

If you forget to take NUCYRETA TABLETS
If you forget to take the tablets, your pain is likely to return. Do not take a double dose to make up for a forgotten dose; simply continue taking the tablets as before.
If you stop taking NUCYRETA ER 50
If you interrupt or stop treatment too soon, your pain is likely to return.
If you wish to stop treatment, please tell your doctor first before stopping treatment.
Generally there will be no withdrawal effects when treatment is stopped.
However, on uncommon occasions, people who have been taking the tablets for some time may feel unwell if they suddenly stop taking them.
Symptoms may be:
• feeling restless, irritable, anxious, weak or sick (nausea), loss of appetite, being sick (vomiting), diarrhoea
• watery eyes, runny nose, increase in size of the pupils in the eyes (dilated pupils)
• difficulty in sleeping, yawning
• sweating, shivering
•muscle or joint pain, backache, abdominal cramps
• increase in blood pressure, breathing or heart rate.
If you experience any of these complaints after stopping NUCYRETA ER 50, please contact your doctor.
Do not stop taking this medicine unless your doctor tells you to. If your doctor wants you to stop taking your tablets, he/she will tell you how to do this. This may include a gradual reduction of the dose.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

POSSIBLE SIDE EFFECTS

Like all medicines, this medicine can cause side effects, although not everybody gets them.
Important side effects or symptoms to look out for and what to do if you are affected:
• This medicine may cause allergic reactions including swelling beneath the skin, hives, and in severe cases difficulty breathing, a fall in blood pressure, collapse, or shock (rare). Symptoms may be wheeziness, difficulty breathing, swelling of the eyelids, face or lips, or rash or itching, which may cover your whole body.
• Another serious side effect is a condition where you breathe more slowly or weakly than expected (uncommon). It mostly occurs in elderly and weak patients.
If you are affected by these important side effects contact a doctor immediately.

Other side effects that may occur:
Very common
• feeling sick (nausea), being sick (vomiting)
• dizziness, drowsiness, headache.
Common
• decreased appetite, constipation, diarrhoea, indigestion
• anxiety, confusion, hearing, seeing or sensing things that are not really there (hallucinations), sleep problem, abnormal dreams
• trembling, feeling hot (flushing), dry mouth
• itching, increased sweating, rash
• muscle cramps, feeling of weakness, tiredness or exhaustion (fatigue), feeling of body temperature change.
Uncommon
• feeling depressed, very happy (euphoria), nervous, restless, or excitable (agitated), low awareness of time, place or identity (disorientation)
• lack of attention, forgetfulness, almost fainting, sedation, uncoordinated movements, muscle twitches, difficulty in speaking
• numbness, abnormal sensations of the skin (e.g. tingling, prickling)
• abnormal vision
• faster heart beat, palpitations, decreased blood pressure, less oxygen in the blood, shortness of breath
• stomach discomfort
• skin reactions (hives)
• feeling of heaviness
• delay in passing urine, passing urine more often than usual
• drug withdrawal effects (see ‘If you stop taking NUCYRETA ER 50’)
• water retention (oedema)
• feeling strange, drunk, irritable or relaxed.
Rare
• epileptic fits
•thinking abnormal, impaired consciousness, uncoordinated movements, slower heart beat
• delayed emptying of the stomach (impaired gastric emptying).
In general, the likelihood of having suicidal thoughts and behaviour is increased in patients suffering from chronic pain. In addition, certain medicines for the treatment of depression (which have an impact on the neurotransmitter system in the brain) may increase this risk, especially at the beginning of treatment. Although tapentadol also affects neurotransmitters, data from human use of tapentadol do not provide evidence for an increased risk.

HOW TO STORE NUCYRETA TABLETS

Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and the blister. The expiry date refers to the last day of that month.
This medicinal product does not require any special storage conditions.
Do not throw away any medicines via wastewater or household waste.
Ask your pharmacist how to throw away medicines you no longer use.
These measures will help protect the environment.

FURTHER INFORMATION

What NUCYRETA contains
The active ingredient is tapentadol.
One (1) tablet contains 50 mg tapentadol (as hydrochloride).
One (1) tablet contains 100 mg tapentadol (as hydrochloride).
One (1) tablet contains 150 mg tapentadol (as hydrochloride).
One (1) tablet contains 200 mg tapentadol (as hydrochloride).
The other ingredients are:
• Tablet core: microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, povidone K30, magnesium stearate.
• Tablet coat: polyvinylalcohol, titanium dioxide (E 171), macrogol 3350, talc.

What NUCYRETAlooks like and contents of the pack
NUCYRETA tablets are white round shaped film-coated tablets, marked on both the sides.
NUCYRETA tablets are packed in blisters.

 

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Taj Generics (Taj Pharma) provides a wide range of products to the Indian market, including an extensive range of generics and specialty products; Our products cover a vast array of therapeutic categories, and we offer an extensive range of dosage forms and delivery systems including oral solids, controlled-release, steriles, injectables, topicals, liquids, transdermals, semi-solids and high-potency products. Our Generics portfolio offers over 1500 products in the major therapeutic areas of gastro-intestinal, cardiovascular, pain management, oncology, anti-infectives, paediatrics and dermatology.