Tapentadol is a prescription narcotic analgesic for patients 18yrs of age and older suffering from moderate to severe acute pain for short term use. It should be avoided in patients with lung, certain gastrointestinal diseases, or patients taking certain medications such as antidepressant that inhibits monoamine oxidase (MAOI), or ANY medications that may make you sleepy –general anesthetics, sedatives, hypnotics, and phenothiazine tranquilizers. Patients who have recently sustained a head injury, have liver , gall bladder, pancreas or kidney problems , history of seizures must use caution with tapentadol. The drug should be avoided in patients with severe lung problems-asthma, COPD (chronic obstructive pulmonary disease, severe obesity, sleep apnea, kyphoscoliosis (abnormal spine curvature which restricts lung expansion) or certain motility diseases of the intestines.

Tapentadol exerts its centrally acting analgesic effect by Mu receptor agonist action and inhibition of norepinephrine reuptake at receptors, being 2-3 times less potent than morphine .in analgesia. It may be reversed by naloxone at the Mu receptor and norepinephrine modulation.

The dosage of 50, 75 or 100mg orally every 4-6 hours with or without food, should be individualized based upon patient pain intensity, and previous exposure/response to similar class analgesics. Patients with mild kidney or liver impairment do not require dosage adjustments. Side effects include respiratory depression, dizziness, nausea, vomiting, headache, dry mouth, gastric irritation, fatigue, flushing sensation, itching, rash, anxiety and excessive sweating. Tapentadol may lower blood pressure, cause urinary hesitation, restlessness, and agitation, sensation of heavy’ muscles, abdominal cramping fullness, increase or decrease in heart rate In the absence of adequate studies should be used with great caution in pregnancy only if the benefits outweigh fetal risks and not be used in nursing mothers.

The use of tapentadol in joint disease and joint surgery(bunionectomy-large toe joint restoration surgery) has proven to provide a 50% reduction in pain in a 48 hour period. The drug provides excellent well tolerated analgesic in properly selected patients with appropriate indications for short term use.

References

The Medication Guide, NUCYNTA, June 2010, Ortho-McNeil-Janssen Pharmaceuticals

MPR. MONTHLY PRESCRIBING GUIDE, 2011 EDITION, PAIN MANAGEMENT POCKET GUIDE

ADDITIONAL REFERENCES

Drugs.com

National Institutes of Health

MedlinePlus