Tapentadol

How it works

It combines mu-opioid receptor agonism with noradrenaline reuptake inhibition, providing analgesia through two complementary mechanisms.

Prescribing in practice

• As an opioid it can cause respiratory depression, dependence and overdose, with risk increased by concomitant benzodiazepines, alcohol or other CNS depressants.
• Because of its noradrenergic action it should be used with caution with serotonergic and other monoaminergic drugs owing to the risk of serotonin syndrome, and it is contraindicated with or close to monoamine oxidase inhibitors.
• It can lower the seizure threshold and should be used cautiously in patients with epilepsy or a history of seizures.

Monitoring

Monitor pain relief, sedation, respiratory status and for signs of tolerance or dependence during treatment.

Counselling the patient

• Do not drink alcohol while taking this medicine, and tell your team about any sedatives you use.
• It may cause drowsiness and affect your ability to drive or operate machinery.
• Do not stop suddenly after prolonged use; the dose should be reduced gradually.

Evidence & guidelines

Tapentadol is an established option for moderate to severe pain in current prescribing references.