Tapentadol

Tapentadol (Oral Route)

Overview

Your doctor may prescribe Tapentadol if you require strong pain relief, for example if you have recently undergone surgery or have a major injury, or if you have a long term condition which is not alleviated by milder pain killers. Tapentadol is available on prescription only, and you must take it exactly in accordance with the instructions from your doctor. It can affect your breathing, and will not usually be prescribed if you have a history of asthma or lung disease.

Tapentadol is an opioid medication. Opioids are synthetic chemicals which act like opium. They work to relieve pain by attaching to the opioid receptors in the brain, and blocking the transmission of signals sent to the brain, thereby reducing the sensation of pain. Tapentadol interacts with the brain’s natural chemical, noradrenaline, a neurotransmitter. When neurodrenaline comes into contact with Tapentadol, it cannot be absorbed into the brain cells, so instead remains active, which has the effect of providing pain relief. Opioids mimic the action of naturally occurring endorphins. generating an increased sense of well-being, which is why they can become habit-forming.

One of the traits of opioids is tolerance. This means that over time the effect on the body is dulled, so a patient may eventually need to take a higher dose in order to get the same level of pain relief. Assessing tolerance and increasing dosage must always be managed by your doctor.

Tapentadol is sold under the brand names Nucynta and Nucynta ER (Extended Release), and Palexia.

Conditions treated

Moderate to severe pain from:

  • Major injury
  • Nerve damage caused by diabetes
  • Osteoarthritis
  • Surgery (e.g. abdominal or orthopaedic)

Type of medicine

  • An opioid medication for pain relief.
  • Narcotic analgesic
  • Benzenoid class

Side effects

Tapentadol is a strong form of pain relief. It can have some severe, and potentially life-threatening side effects, so must only be taken exactly as your doctor prescribes.

When you first start taking Tapentadol you will need to be watchful for any signs of side effects. You will also need to look out for symptoms early on if your dose is increased. The first 24-72 hours are when side effects are most likely to become evident.

Side effects which require urgent medical attention:

  • Agitation
  • Chest pain
  • Difficulty breathing
  • Feeling faint
  • Hives
  • Hoarseness
  • Hallucinations
  • Rash

Breathing

Tapentadol can stop or slow down your breathing. If you have breathing difficulties or have a history of pulmonary disease you must inform your doctor before you start a course of Toptentadol. Your doctor may choose to prescribe an alternative form of pain relief if he or she feels that Topentadol would not be suitable for your condition.

Drowsiness

In some cases, this medication can cause drowsiness. Until you have established whether Tapentadol has this effect on you, it is not safe for you to operate machinery or drive. You should avoid doing these things and any activities which might put you and others at risk. After a few days, side effects such as drowsiness will usually have presented themselves. If you do experience drowsiness, speak to your doctor about how you can best manage the situation. You will also need to advise your employer if it will affect your work.

Addiction

There is a risk that you could develop an addiction to Tapentadol if you take it for a long period of time. It is essential that you take Tapentadol precisely as instructed by your doctor to avoid either a physical or psychological addiction.

Adrenal insufficiency

When adrenal insufficiency occurs, the adrenal glands are unable to produce enough of the adrenal hormones such as cortisol and aldosterone. These hormones are responsible for important body functions such as:

  • maintaining blood pressure
  • controlling the inflammatory response of the immune system
  • regulating the metabolism

Symptoms of adrenal insufficiency include abdominal pain, chronic fatigue, nausea, vomiting, and weight loss. If symptoms are not addressed and are aggravated by a stressful event such as surgery or injury, they can result in adrenal crisis, which has more severe side effects and can have fatal consequences.

Dry mouth

Dry mouth, also known as xerostomia, occurs when the glands produce insufficient saliva. It can make it more difficult for you to speak, eat and to digest food. If you experience a dry mouth for more than two weeks it is important to get medical help, as it can lead to serious conditions, such as malnutrition, throat disorders and anxiety.

Nausea

If you experience nausea while on a course of Tapentadol, you may find you can get relief from it by taking the medication with food. It can also be helpful to lie down for an hour after taking Tapentadol, and avoid moving your head as much as possible.

Other

Other side effects

  • Constipation
  • Dizziness
  • Fatigue
  • Hypotension
  • Irregular menstruation
  • Itching
  • Reduced fertility (in both men and women)

Your doctor will be able to give you advice on how to manage these side effects. For example, if you encounter dizziness, you may be advised to get up more slowly from sitting or lying down.

Tarpentadol is a narcotic pain relief and as such is not safe to use in conjunction with alcohol. You should not consume any alcohol if you are taking Tapentadol. You should check food labels carefully to make sure they do not contain alcohol. Similarly, you will need to read labels closely for any other medicines you are taking at the same time, to check whether they are free of alcohol. Alcohol and Tapentadol must not be combined as they can result in dangerous side effects, even death.

Withdrawal

As an opioid medication, Tapentadol can create a form of dependency. It is very important that withdrawal from treatment with Tapentadol is managed carefully by your doctor.

Dosage

The dosage required will depend on your particular circumstances, and you must always take exactly the amount prescribed by your doctor. In general, patients are usually given no more than 500 mg Tapentadol per day. Where this is in tablet form, it is taken every 12 hours. For patients who are prescribed a solution instead of tablets, the average dosage is 2.5 mL (50 mg) to start with increasing to a maximum of 5 mL (100 mg), taken every 4 – 6 hours.

Tapentadol is available in immediate and extended-release formats. Your doctor will prescribe the most suitable option for you. Standard tablets are used for acute pain, i.e. pain which is expected to have a limited duration and will eventually go away when the underlying cause is treated. Examples include pain from major trauma or surgery.

Extended release tablets are designed to release your dosage gradually over several hours, offering longer-term pain relief. This form of medication is used for treating people who are expected to need pain relief on an ongoing basis, for example, patients who have nerve injury caused by diabetes. It is extremely important that you do not crush, pierce, break, chew or dissolve the extended release tablets, as this could release too much of the medication into your bloodstream straight away, with potentially fatal consequences. If you are taking extended release tablets, you must stop taking any other round-the-clock pain relief medication before you start your course of Tapentadol.

Tapentadol may be taken with or without food. Swallow your tablet(s) whole and quickly with a glass of water. If you are prescribed the liquid version of Tapentadol, you must always use the exact amount as prescribed. You should be provided with a marked syringe for administering your dose. Measure the liquid accurately to ensure you get the correct amount.

Always follow precisely the dosage instructions from your doctor. If you forget to take your medication on time, take it as soon as possible afterwards. However, if you don’t remember until close to the time when you are due to take the next tablet, you will need to leave the forgotten dose and go straight to taking the next dose due. Taking a forgotten tablet too soon before the next dose is due is very dangerous, as it can lead to excessively high levels of narcotic pain relief in the bloodstream. Dispose of unneeded tablets responsibly, so that they do not present a danger to others.

Misusing your medication can lead to addiction, overdose or death. Over 2 million adults in the US are addicted to prescription opioid medication. In 2015, overdose on prescription pain relief drugs accounted for over 20,000 deaths in the US.

You should not stop using Tapentadol suddenly, as this can cause severe withdrawal symptoms, particularly if you have been using this medication for a long time. Always seek your doctor’s advice on how to stop using Tapentadol safely. This will usually involve gradually reducing your dosage over a period of time. If you experience any withdrawal symptoms as your dosage is decreased, contact your doctor straight away. Withdrawal symptoms can include:

  • Anxiety
  • Chills
  • Diarrhea
  • Hallucinations
  • Insomnia
  • Irritability
  • Loss of appetite
  • Muscle or joint pain
  • Nausea
  • Runny nose
  • Shivering
  • Stomach cramps
  • Sweating
  • Uncontrollable shaking
  • Vomiting
  • Watery eyes
  • Widening of the pupils

Tolerance

As your body becomes used to processing this medication, it may become less effective over time. If you find you are experiencing less pain relief from the same dose you need to discuss this with your doctor. You must never alter the dosage of Tapentadol yourself – this must only be done on the instructions of your doctor. If you increase the dose without your doctor’s approval, you are at risk of an overdose. Your doctor may increase your dose of Tapentadol on a trial basis, with regular monitoring to ensure that the increased dosage is effective and does not result in harmful side effects. In some cases, taking more of the medication will still not provide the pain relief needed, if the tolerance level has become too high. Some people experience the pain relief needed, but may have an adverse reaction to an increased amount of Tapentadol. If it is not suitable for you to have an increased dose of Tapentadol, your doctor will recommend an alternative form of pain relief to help you, and will manage your withdrawal from this medication.

Interactions

You must not take Tapentadol if you are currently using any form of MAO inhibitor, or have used MAO inhibitors in the last 14 days.

The following medications are MAO inhibitors:

  • Isocarboxazid
  • Linezolid
  • Methylene blue injection
  • Phenelzine
  • Rasagiline
  • Selegiline
  • Tranylcypromine

You must inform your doctor if you are taking medication for any of the following conditions:

  • Depression
  • Mental illness
  • Migraines
  • Nausea / vomiting
  • Parkinson’s disease

Some medications for these conditions can interact with Tapentadol, resulting in serotonin syndrome, where extremely high levels of serotonin accumulate in the body. Serotonin syndrome can be mild in some cases, but in others it can be a very serious, in some cases fatal condition. Provided that your doctor is aware of all the medication you are taking, you are unlikely to be prescribed a combination of medicines which could cause serotonin syndrome. However, you should be aware of the potential symptoms so that you can take appropriate action if required. Symptoms of serotonin syndrome will usually present themselves soon after you start taking a new combination of medication. Mild symptoms may clear up by themselves within a day or two, but after this time you should seek medical advice. If you experience any severe symptoms, contact your doctor immediately.

Milder symptoms of serotonin syndrome include:

  • Agitation
  • Confusion
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Headache
  • High blood pressure and rapid heart rate
  • Loss of muscle coordination and twitching muscles
  • Muscle rigidity
  • Profuse sweating
  • Shivering

Severe symptoms which require urgent medical attention include:

  • Extreme fever
  • Irregular heartbeat
  • Seizures
  • Unconsciousness

It is important to ensure your doctor is aware if you have used or currently use sedatives such as:

  • Alprazolam
  • Ativan
  • Iorazepam
  • Klonopin
  • Restoril
  • Tranxene
  • Versed
  • Xanax

If you are already taking any of the following medicines, your doctor may either decide not to prescribe Tapentadol for you, or may choose to change your existing medicines. This is because Tapentadol may interact with these medicines and increase the risk of harmful side effects.

  • Brofaromine
  • Clorgyline
  • Furazolidone
  • Iproniazid
  • Isocarboxazid
  • Lazabemide
  • Linezolid
  • Moclobemide
  • Naltrexone
  • Nialamide
  • Pargyline
  • Phenelzine
  • Procarbazine
  • Rasagiline
  • Selegiline
  • Toloxatone
  • Tranylcypromine

It is not usually recommended to take Tapentadol in conjunction with the following medicines. If the doctor decides it is necessary for you to have this combination of medications, he may prescribe a lower dosage:

  • Acepromazine
  • Alfentanil
  • Almotriptan
  • Alprazolam
  • Amisulpride
  • Amitriptyline
  • Amobarbital
  • Amoxapine
  • Anileridine
  • Aripiprazole
  • Asenapine
  • Baclofen
  • Benperidol
  • Bromazepam
  • Bromopride
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Carbinoxamine
  • Cariprazine
  • Carisoprodol
  • Carphenazine
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Chlorzoxazone
  • Citalopram
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Codeine
  • Cyclobenzaprine
  • Dantrolene
  • Desipramine
  • Desvenlafaxine
  • Dexmedetomidine
  • Dezocine
  • Diacetylmorphine
  • Diazepam
  • Dichloralphenazone
  • Difenoxin
  • Dihydrocodeine
  • Diphenhydramine
  • Diphenoxylate
  • Dolasetron
  • Donepezil
  • Dothiepin
  • Doxepin
  • Doxylamine
  • Droperidol
  • Duloxetine
  • Eletriptan
  • Enflurane
  • Escitalopram
  • Estazolam
  • Eszopiclone
  • Ethchlorvynol
  • Ethopropazine
  • Ethylmorphine
  • Fentanyl
  • Flibanserin
  • Fluoxetine
  • Fluphenazine
  • Flurazepam
  • Fluspirilene
  • Fluvoxamine
  • Fospropofol
  • Frovatriptan
  • Granisetron
  • Halazepam
  • Haloperidol
  • Halothane
  • Hexobarbital
  • Hydrocodone
  • Hydromorphone
  • Hydroxyzine
  • Iloperidone
  • Imipramine
  • Isoflurane
  • Ketamine
  • Ketazolam
  • Ketobemidone
  • Levomethadyl
  • Levomilnacipran
  • Levorphanol
  • Lithium
  • Lofepramine
  • Lorazepam
  • Lurasidone
  • Meclizine
  • Melperone
  • Meperidine
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methohexital
  • Methotrimeprazine
  • Methylene Blue
  • Midazolam
  • Milnacipran
  • Mirtazapine
  • Molindone
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Naratriptan
  • Nefazodone
  • Nicomorphine
  • Nitrazepam
  • Nitrous Oxide
  • Nortriptyline
  • Olanzapine
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Paliperidone
  • Palonosetron
  • Papaveretum
  • Paregoric
  • Paroxetine
  • Pentazocine
  • Pentobarbital
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenobarbital
  • Pimavanserin
  • Pimozide
  • Piperacetazine
  • Pipotiazine
  • Piritramide
  • Prazepam
  • Primidone
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propofol
  • Propoxyphene
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Relpax
  • Remifentanil
  • Remoxipride
  • Risperidone
  • Rizatriptan
  • Safinamide
  • Secobarbital
  • Sertindole
  • Sertraline
  • Sodium Oxybate
  • Sufentanil
  • Sulpiride
  • Sumatriptan
  • Suvorexant
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Thiothixene
  • Tilidine
  • Tizanidine
  • Tolonium Chloride
  • Topiramate
  • Tramadol
  • Triazolam
  • Trifluoperazine
  • Trifluperidol
  • Triflupromazine
  • Trimeprazine
  • Trimipramine
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Zaleplon
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
  • Zopiclone
  • Zotepine

Always check that your doctor has a complete up to date list of the medications you are currently taking, including over-the-counter medicines, as there may other products not shown in this list which can interact with Tapentadol.

Herbal products can have an impact on how Tapentadol works in your body, so it is essential that you inform your doctor if you are taking any dietary supplements, such as tryptophan or St John’s Wort.

In addition to having interactions with other medications and supplements, Tapentadol can also interact with illegal drugs and alcohol. Taking either drugs or alcohol while you are being treated with Tapentadol could have life-threatening consequences for you.

Warnings

You must not take Tapentadol if you suffer or have previously suffered from:

  • Asthma
  • Paralytic ileus (bowel obstruction)
  • Severe breathing difficulties

You must inform your doctor if you have ever suffered from:

  • Brain tumour
  • Drug or alcohol addiction
  • Gall bladder or pancreas problems
  • Head injury or any condition which increases pressure in the brain
  • Kidney disease
  • Kyphoscoliosis (severe curvature of the spine)
  • Liver disease
  • Lung disease (e.g. chronic obstructive pulmonary disease, chronic bronchitis)
  • Head injury
  • Mental illness
  • Seizures
  • Thyroid problems

Pregnancy

You must not take Tapentadol if you are pregnant or planning a pregnancy. If you find you are pregnant, contact your doctor immediately, so that you can be transferred onto another form of pain relief. Taking this medication while you are pregnant can have life-threatening consequences for the baby. There is a significant risk that your baby will become dependent on the drug during your pregnancy and will experience withdrawal symptoms after birth. These withdrawal symptoms can be life-threatening, and it can take weeks of treatment for the newborn to recover.

Breastfeeding

Studies have not ruled out the possibility of Tapentadol passing into breast milk, therefore it cannot be deemed safe, and you should not breastfeed while you are on a course of Tapentadol treatment.

Pediatric

Tapentadol must not be given to a child. This type of medication is suitable only for people of 18 years or above.

Geriatric

There is no evidence to indicate that Tapentadol has greater risks for older people. However, there are contraindications for certain conditions which are more common in the older population, for example kidney and liver disease.

Storage

As with all medicines, Tapentadol should be kept out of sight and reach of children. However, due to the potentially habit-forming nature of this medication, Tapentadol should also be kept away from other adults. Store your Tapentadol in a secure place which only you can access, and keep track of how much you have used, so that you will be immediately aware if anyone else takes some of your medication. It is illegal to give away or sell your personal prescription of Tapentadol to another person. If you have Tapentadol medicines which you no longer require, because you have completed your course of treatment, you should flush remaining tablets or liquid away in the toilet or return them to your doctor or medical centre. Do not store Tapentadol medication which you do not need to use. Continuing to store unneeded opioid medication increases the risk of the medicine being taken by and causing harm to another person.

Tapentadol is supplied in tablet format or a liquid medicine. Tablets are supplied in a packet with a use by date. Do not use tablets with an expiry date which has passed. If you are prescribed a liquid version of Tapentadol, it must be used within six weeks of opening, as well as within the use by date on the packaging. Store your medication away from moisture and direct light, and above freezing.

Summary

The opioid medication Tapentadol is used to provide relief from the severe acute pain which can follow majory injury, surgery. In its extended release form, it can also be used to manage pain from longer term conditions, such as osteoarthritis.

Tapentadol is beneficial for many people, bringing relief from moderate to severe pain. However, it can also have harmful side effects for some people, some of which can be life-threatening. When you start taking Tapentadol you will need to be alert to any signs of side effects, and report them to your doctor immediately. If you have breathing difficulties or lung disease, it is likely that this medication will be unsuitable for you. Because it is an opioid medication, Tapentadol it is possible for people to become dependent on it. Your doctor will monitor your health and manage your dosage to help avoid this. If you need to stop using Tapentadol, your doctor will plan your dosage to minimise the risk of withdrawal symptoms, which can be serious.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017