Tapentadol(tah pen’ tah dohl)
Nucynta, Nucynta CR (CAN)DNC, Nucynta ERDNC
PREGNANCY CATEGORY C
CONTROLLED SUBSTANCE C-II
Drug Classes
Norepinephrine reuptake inhibitor
Opioid receptor analgesic (mu specific)
Therapeutic Actions
Binds to and activates mu-opioid receptors in the CNS, inhibiting transmission of pain at the spinal cord, and affects activity in parts of the brain that control how pain is perceived; analgesic properties are enhanced by the blocking of norepinephrine reuptake at the nerve synapse, increasing concentration of norepinephrine in the synaptic cleft.
Indications
Relief of moderate to severe pain in patients 18 yr and older (immediate-release)
Management of moderate to severe chronic pain in adults when continual, round-the-clock opioid use is needed for an extended period (ER forms)
NEW INDICATION: Relief of pain of diabetic peripheral neuropathy (Nucynta ER)
Contraindications and Cautions
Contraindicated with known hypersensitivity to any component of the drug, increased intracranial pressure, impaired consciousness or coma, significant respiratory depression, acute or severe bronchial asthma, hypercapnia, paralytic ileus, within 14 days of MAOI use, pregnancy.
Use cautiously with elderly or debilitated patients, asthma, COPD, severe obesity, sleep apnea syndrome, myxedema, CNS depression, lactation, pancreatic or biliary tract disease, hepatic or renal impairment, seizure disorders.
Available Forms
Tablets—50, 75, 100 mg; ER tabletsDNC—50, 100, 150, 200, 250 mg
Dosages
Adults
50–100 mg (immediate-release) PO every 4–6 hr. On first day; may give second dose within 1 hr if pain control is not adeguate. Maximum dose, 700 mg/day on first day, 600 mg/day thereafter. ER forms—100–250 mg PO bid. Reduce initial dose by 50 mg in analgesic-naïve patients. Maximum dose, 500 mg/day.
Diabetic peripheral neuropathy: 50 mg/day PO bid (Nucynta ER)
Pediatric patients
Safety and efficacy not established.
Geriatric or debilitated patients
Use caution. Start with the smallest dose and evaluate response.
Patients with moderate hepatic impairment
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