Xtampza ER is an extended-release form of oxycodone, a powerful opioid pain reliever. It comes as a capsule taken every 12 hours and is prescribed for chronic pain severe enough to require daily, around-the-clock opioid treatment when other options haven’t worked. What sets it apart from other extended-release oxycodone products (like OxyContin) is a built-in abuse-deterrent technology that makes the medication harder to misuse.
How Xtampza ER Works
Like all oxycodone products, Xtampza ER works by binding to opioid receptors in the brain and spinal cord, changing how your body perceives and responds to pain. The “ER” stands for extended release, meaning the capsule is designed to slowly deliver oxycodone over a full 12-hour window rather than all at once. This provides steady pain control throughout the day with just two doses.
It must be taken with food. Each capsule contains tiny microspheres (small wax-coated beads) that release the medication gradually as they pass through your digestive system. For people who have difficulty swallowing capsules, the capsule can be opened and the contents sprinkled onto soft food or administered through a feeding tube, which is not an option with most other extended-release opioids.
What Makes It Different From OxyContin
The key distinction is Xtampza ER’s abuse-deterrent design, called DETERx technology. The microspheres inside the capsule have three properties that resist common forms of tampering. First, their waxy coating causes them to smear rather than break apart when crushed, which limits how quickly the drug can be released. Second, the formulation is water-repellent and distributes the active drug evenly across all the beads, making it difficult to extract the oxycodone using liquid. Third, the beads are so small (about 300 micrometers) that crushing them doesn’t meaningfully change their surface area, so crushing has little effect on how fast the drug enters the body.
If someone tries to heat crushed Xtampza ER for injection, the mixture turns thick and viscous, making it difficult and dangerous to inject. Because of these properties, Xtampza ER is the only extended-release opioid that does not carry a boxed warning against crushing or chewing. That said, it still carries serious risks. It is a Schedule II controlled substance, the same classification as OxyContin, morphine, and fentanyl.
Xtampza ER is not bioequivalent to other oxycodone extended-release products. Patients switching from OxyContin or another oral oxycodone formulation can generally use the same total daily dose, split into two doses taken 12 hours apart with food, but close monitoring is needed during the transition. Patients converting from a different opioid altogether typically start at the lowest available dose.
Common Side Effects
In a Phase 3 clinical trial of 740 patients, the most frequently reported side effects during the initial dose-adjustment period were:
- Nausea: 16.6%
- Headache: 13.9%
- Constipation: 13.0%
- Drowsiness: 8.8%
- Itching: 7.4%
- Vomiting: 6.4%
- Dizziness: 5.7%
Many of these side effects improved once patients settled on a stable dose. During the maintenance phase of the trial, nausea dropped to about 11%, constipation to around 5%, and drowsiness and dizziness both fell below 2%. Constipation is the one opioid side effect that typically does not improve over time, so many patients on long-term Xtampza ER use a stool softener or laxative alongside it.
Serious Risks
Xtampza ER carries the same life-threatening risks as all opioid medications. The most dangerous is respiratory depression, where breathing slows to a dangerously low rate. This risk is highest when first starting the medication, after a dose increase, or if the drug is taken by someone it was not prescribed for. Accidental ingestion by children can be fatal even with a single dose.
Combining Xtampza ER with benzodiazepines (like Xanax or Valium), other sedatives, or alcohol significantly increases the risk of extreme sedation, slowed breathing, coma, and death. Pregnant individuals taking the drug can cause their newborn to experience opioid withdrawal after birth. Long-term use leads to physical dependence, meaning stopping suddenly can trigger withdrawal symptoms. Any dose reduction needs to be gradual and supervised.
Who Should Not Take It
Xtampza ER is not appropriate for everyone. It is contraindicated in people with significant respiratory depression, severe or acute asthma in an unmonitored setting, known or suspected bowel obstruction (including paralytic ileus), and anyone with a known allergy to oxycodone. It is also not intended for occasional or as-needed pain relief. It is strictly reserved for patients who need continuous opioid therapy and who have already tried and failed to get adequate relief from non-opioid treatments or immediate-release painkillers.
How It Is Taken
Xtampza ER is taken by mouth every 12 hours, always with food. Taking it without food can reduce how much of the drug your body absorbs, potentially leaving pain undertreated. Available capsule strengths include 9 mg, 13.5 mg, 18 mg, 27 mg, and 36 mg. Prescribers typically start at the lowest effective dose and adjust upward gradually based on pain control and tolerability.
For patients who cannot swallow capsules, the contents can be opened and sprinkled directly onto soft food like applesauce. The beads should not be chewed or dissolved before swallowing. This flexibility is a practical advantage for older adults, people with certain neurological conditions, or anyone using a gastrostomy tube for feeding.