Tapentadol

Indications

  • Analgesia

Adverse effects

  • Adverse effects as per other opioids

Common

  • Constipation
  • Nausea and vomiting

Rare

  • Respiratory depression
  • Anaphylaxis
  • Severe itching

Dose

  • Immediate release tablet - start with 50 mg 4-6 hourly; a second 50 mg dose may be taken one hour after the first dose if needed. Adjust dose according to response. Maintenance dose 50-100 mg every 4-6 hours. Maximum daily dose 600 mg. In moderate hepatic impairment, start 50 mg every 8 hours, then titrate to response.
  • Controlled release tablet - start with 50 mg bd; increase dose by 50 mg twice daily every 3 days if necessary. Maximum daily dose 500 mg. Do not use for acute pain as slow onset and offset do not allow rapid and safe titration. In moderate hepatic impairment, start 50 mg once/day, then titrate to response.

Patient advice

  • The medication may make you feel drowsy and increase effects of alcohol. If you are affected, do not drive or operate machinery. Tell your doctor immediately if you have trouble staying awake or are very sleepy

Mode of action

  • Binds to mu opioid receptors and inhibits noradrenaline reuptake.

Precautions

Renal - if CrCl <10 mL/minute, use lower starting dose, consider increasing dosage interval

Hepatic - moderate hepatic impairment, reduce dose. Not recommended in severe hepatic impairment.

Available brands

  • Palexia IR® 50 mg tablets (non PBS)
  • Palexia SR® 50, 100, 150, 200, 250 mg tablets