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 evidenced by a recent systematic review and meta-analysis 1.
Mechanism of Action and Uses
Tapentadol is a centrally-acting analgesic with a dual mechanism of action: it functions as a mu-opioid receptor agonist and also inhibits norepinephrine reuptake, providing both opioid and non-opioid pain relief pathways. This medication is primarily used for the management of moderate to severe acute pain and for chronic pain conditions, including diabetic peripheral neuropathy.
Indications and Contraindications
Common indications include post-surgical pain, traumatic injury pain, and chronic back pain. Tapentadol is contraindicated in patients with significant respiratory depression, acute or severe bronchial asthma in unmonitored settings, known or suspected gastrointestinal obstruction, and in those taking monoamine oxidase inhibitors (MAOIs) within the last 14 days due to risk of serotonin syndrome. It should be used cautiously in patients with head injury, increased intracranial pressure, impaired consciousness, hepatic or renal impairment, and in elderly patients.
Side Effects and Risks
Side effects include nausea, dizziness, constipation, headache, and somnolence, though it may cause less gastrointestinal side effects than traditional opioids. As with all opioids, tapentadol carries risks of dependence, tolerance, and respiratory depression, but its dual mechanism may provide effective analgesia with potentially fewer opioid-related adverse effects, as noted in studies such as 1 and 1.
Clinical Considerations
Given the potential risks and the availability of alternative treatments, the use of extended-release tapentadol is not generally recommended as a first- or second-line therapy for chronic neuropathic pain 1. Instead, other options like pregabalin, duloxetine, and non-opioid analgesics should be considered based on the patient's specific condition and medical history.
From the FDA Drug Label
Tapentadol is a centrally-acting synthetic analgesic. The exact mechanism of action is unknown. Although the clinical relevance is unclear, preclinical studies have shown that tapentadol is a mu-opioid receptor (MOR) agonist and a norepinephrine reuptake inhibitor (NRI). 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.
The mechanism of action of Tapentadol is as a mu-opioid receptor agonist and a norepinephrine reuptake inhibitor. The uses and indications of Tapentadol are for the management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate in adults. The contraindications are not explicitly stated in the provided text, but the label does discuss several warnings and precautions, including:
- Addiction, abuse, and misuse
- Life-threatening respiratory depression
- Accidental ingestion
- Neonatal opioid withdrawal syndrome
- Risks from concomitant use with benzodiazepines or other CNS depressants 2 2
From the Research
Mechanism of Action
- Tapentadol is a centrally acting synthetic analgesic that exerts its analgesic effects via two mechanisms of action: mu-opioid receptor agonism and norepinephrine reuptake inhibition 3, 4, 5, 6, 7
- The dual mechanism of action allows for effective analgesic effects with increased tolerability 6
Uses and Indications
- Tapentadol is approved for the relief of moderate to severe acute pain in patients aged ≥18 years 3
- Tapentadol extended-release is approved for the treatment of moderate to severe chronic pain, including diabetic peripheral neuropathy 4, 6
- Tapentadol is effective in treating various types of pain, including postorthopaedic surgical pain, musculoskeletal pain, chronic osteoarthritis pain, low back pain, and neuropathic pain 3, 4, 5
Contraindications
- There is no specific information on contraindications in the provided studies, but it is mentioned that tapentadol may cause gastrointestinal intolerance and central nervous system effects as major adverse events 4
- Tapentadol should be used with caution in patients with a history of substance abuse or dependence, as it is an opioid analgesic 6