Preventing prescription drug abuse and overdose is a major health concern in the United States. The Centers for Disease Control and Prevention (CDC) states that "100 people die from drug overdoses every day in the United States" and that deaths from drug overdoses have more than tripled since 1990. Furthermore, according to the CDC, for every one death from an overdose there are 130 people who abuse prescription pain medications (the drugs have caused significant problems-at work or home, for example) or are dependent on them (have tried unsuccessfully to quit), and there are 825 nonmedical users (those using drugs not prescribed to them or only for the feeling they provide). Sustained-release opioids are extremely popular because of the high concentrations of drug in each pill. When a pill is crushed and then snorted or injected, the high dose is administered immediately, instead of over 12 to 24 hours, producing feelings of euphoria. The rapid onset of high doses of opioids can also be fatal.

In response to this growing epidemic, an extended-release narcotic that combines oxycodone and naloxone has been developed and was recently approved by the Food and Drug Administration (FDA). The combination drug, Targiniq ER, is expected to reduce the possibility of abuse of the drug by snorting or injecting because the naloxone will block the euphoric effects of oxycodone. Although the combination of naloxone (which blocks opioid receptors) and oxycodone (which stimulates the receptors) is designed to minimize the desire to abuse Targiniq ER, oral overdosage (intentional or accidental) can still be fatal.

Targiniq ER should only be prescribed to those who need long-term, daily, around-the-clock management of severe pain. It's not to be used as an as-needed analgesic. Targiniq ER carries risks similar to those associated with combinations of oxycodone and other narcotics: fatal respiratory depression, central nervous system depression, and hypotension.

Targiniq ER is highly metabolized by an isoenzyme in the cytochrome P-450 (CYP) enzyme system; drugs that alter the activity of the CYP3A4 isoenzyme can produce changes in the plasma levels of oxycodone. Drugs that inhibit CYP3A4, such as macrolide antibiotics (erythromycin, for example), azole antifungals (such as ketoconazole), and protease inhibitors (such as ritonavir), will increase plasma levels of oxycodone and prolong the opioid's effects. Drugs that induce CYP3A4 and other CYP isoenzymes (such as rifampin, carbamazepine, and phenytoin) increase the clearance of Targiniq ER, lowering its circulating levels. Pain control can be lost as a consequence of this drug interaction, or if physical dependence has developed from long-term use, the patient may exhibit withdrawal symptoms.

Nurses should take a thorough drug history to confirm that patients aren't taking drugs that will interact with Targiniq ER. As with all opioid analgesics, nurses should provide education to patients regarding safe handling and storage, possible adverse effects, and symptoms of narcotics overdosage. It's important to emphasize to patients that they shouldn't increase the dose of Targiniq ER independently because of the risk of accidental overdosage.

For complete FDA prescribing information, see http://1.usa.gov/1pq0fDe.