Slow release tapentadol is set to join oxycodone CR and tramadol SR listings on the PBS for the treatment of chronic severe disabling pain unresponsive to non-narcotic analgesics.

Tapentadol is a synthetic opioid similar in structure, dose, and effect to tramadol. Efficacy is also similar to oxycodone, although reports are less common for constipation (13.6% vs 31.5%), nausea (19.5% vs 36.1%), and vomiting (7.4% vs 19.8%).

The Pharmaceutical Benefits Advisory Committee found that:

  • 1mg tapentadol SR is equivalent to 1mg tramadol SR, and
  • 5.3mg tapentadol SR is equivalent to 1mg oxycodone CR.

Consider all patient variables when changing between analgesics, as discussed in Rhona Selkirk’s article Opioid Conversions.

Adverse events, like efficacy, are dose related, the most significant being nausea, dizziness, vomiting, somnolence, constipation and pruritus.

Tapentadol is not recommended for people with severe renal or hepatic impairment, respiratory depression, or in combination with monoamine oxidase inhibitors or drugs that may contribute to serotonin toxicity. It should also be used cautiously in patients with a history of seizures. Interactions with drugs metabolised by cytochrome P450 are unlikely, as it is mainly conjugated with glucuronic acid.

Dose titration can be individualised using a choice of five slow release presentations that should be taken twice daily with or without food.

Please review full product information before prescribing.

References:

  1. Pharmaceutical Benefits Advisory Committee. November 2013 PBAC Outcomes – Positive Recommendations.
  2. Tapentadol. Australian Prescriber 2013; 36: 105-7.
  3. Palexia (tapentadol hydrochloride) Australian approved product information. Parkville: CSL Ltd. Approved 24 December 2010, amended 26 June 2013.

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