From the Guidelines
Tapentadol should not be used as a first- or second-line therapy for chronic neuropathic pain due to its high risk for addiction and safety concerns compared with the relatively modest pain reduction, as stated in the most recent study 1.
Indications and Usage
Tapentadol is a centrally-acting analgesic medication with dual mechanisms of action: it acts as a mu-opioid receptor agonist and also inhibits norepinephrine reuptake. It is primarily indicated for the management of moderate to severe acute pain and for chronic pain conditions, including neuropathic pain associated with diabetic peripheral neuropathy.
- Tapentadol is available in immediate-release formulations for acute pain and extended-release formulations for chronic pain management.
- The use of any opioids for management of chronic neuropathic pain carries the risk of addiction and should be avoided, as mentioned in 1 and 1.
Use in Elderly Patients
When considering use in elderly patients, caution is advised as they may be more sensitive to its effects.
- Dosage adjustments are typically recommended for elderly patients, starting with lower doses and titrating slowly based on response and tolerability.
- Patients with moderate hepatic impairment should receive reduced doses, while the medication is not recommended for those with severe hepatic or renal impairment.
Habit-Forming Potential
Regarding habit-forming potential, tapentadol is classified as a Schedule II controlled substance in the United States, indicating it has significant potential for abuse and dependence.
- Like other opioids, it can cause physical and psychological dependence with prolonged use.
- Common side effects include nausea, dizziness, constipation, headache, and somnolence, though it may cause fewer gastrointestinal side effects compared to traditional opioids.
- Due to its abuse potential, tapentadol should be prescribed cautiously, especially for patients with a history of substance abuse, as stated in 1 and 1.
From the FDA Drug Label
NUCYNTA (tapentadol) tablets are indicated for the management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate in adults.
NUCYNTA tablets exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death.
Elderly patients (aged 65 years or older) may have increased sensitivity to tapentadol. In general, use caution when selecting a dosage for an elderly patient, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy
Tapentadol is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
NUCYNTA tablets contain tapentadol, a Schedule II controlled substance.
NUCYNTA tablets can be abused and is subject to misuse, addiction, and criminal diversion [see Warnings and Precautions (5. 1)].
Tapentadol is a drug used for the management of acute pain in adults. Its indications include the treatment of pain that is severe enough to require an opioid analgesic.
- Key points about tapentadol:
- It is an opioid with a high potential for abuse and addiction.
- It can be used in elderly patients, but with caution and careful dose selection due to increased sensitivity and potential for adverse reactions.
- Habit formation is a risk, and patients should be monitored for signs of abuse and addiction.
- It is a Schedule II controlled substance 2, 2, 2.
From the Research
Overview of Tapentadol
- Tapentadol is a centrally acting analgesic with a dual mechanism of action as a μ-opioid receptor agonist and a noradrenaline reuptake inhibitor 3, 4, 5, 6, 7.
- It is approved by the US Food and Drug Administration for the management of moderate-to-severe acute pain and chronic pain in adult patients 3, 5, 6.
Indications of Tapentadol
- Tapentadol is indicated for the treatment of moderate-to-severe acute pain, including dental extraction pain, pain after bunionectomy surgery, osteoarthritis pain of the knee and hip, and low back pain 3, 6.
- It is also indicated for the treatment of chronic pain, including moderate-to-severe chronic osteoarthritis pain, low back pain, and pain associated with diabetic peripheral neuropathy 3, 5.
- Tapentadol has been shown to be effective in the treatment of both nociceptive and neuropathic pain due to its dual mechanism of action 5, 7.
Use in Elderly Patients
- There is no specific information available in the provided studies regarding the use of tapentadol in elderly patients.
- However, it is generally recommended to use caution when prescribing tapentadol to elderly patients due to the potential for increased sensitivity to the drug's effects and the presence of comorbidities 3, 4, 5, 6, 7.
Habit-Forming Potential
- Tapentadol has a potential for abuse and dependence, although it is considered to be lower than that of strong opioids such as oxycodone and morphine 7.
- The drug's dual mechanism of action and relatively moderate activity at the μ-opioid receptor and noradrenaline reuptake transporter may contribute to its lower potential for abuse and dependence compared to other opioids 7.
- However, tapentadol should still be used with caution and under close medical supervision to minimize the risk of abuse and dependence 3, 4, 5, 6, 7.