Nucynta 100 milligrams. Nucynta (Tapentadol): Comprehensive Guide to Uses, Dosage, and Safety Precautions
What is Nucynta and how does it work. What are the potential side effects and risks associated with Nucynta. How should Nucynta be used safely and effectively. What precautions should be taken when using Nucynta. How does Nucynta compare to other pain medications. What are the long-term effects of Nucynta use. How can Nucynta abuse and addiction be prevented.
Understanding Nucynta: A Powerful Opioid Analgesic
Nucynta, also known by its generic name tapentadol, is a potent opioid medication used to manage moderate to severe short-term pain. As an extended-release (ER) formulation, it provides sustained pain relief for patients dealing with acute pain conditions, such as post-surgical discomfort or injury-related pain. Nucynta belongs to the class of drugs known as opioid analgesics, which work by altering the brain’s perception and response to pain signals.
How does Nucynta differ from other opioid medications? Unlike traditional opioids that primarily target mu-opioid receptors, Nucynta has a dual mechanism of action. It not only activates mu-opioid receptors but also inhibits norepinephrine reuptake. This unique approach may provide more effective pain relief with potentially fewer side effects compared to some other opioids.
Key Features of Nucynta
- Available as extended-release tablets (Nucynta ER)
- Classified as a Schedule II controlled substance
- Indicated for moderate to severe acute pain
- Dual mechanism of action for enhanced pain relief
- Requires careful monitoring and prescribing due to abuse potential
Nucynta Dosage and Administration Guidelines
Proper dosing of Nucynta is crucial for effective pain management while minimizing the risk of adverse effects. The dosage is typically individualized based on the patient’s pain severity, medical history, and response to treatment. Nucynta ER tablets are available in various strengths, including 100 milligrams, to allow for precise dosing adjustments.
What is the recommended starting dose for Nucynta ER? For opioid-naive patients, doctors usually initiate treatment with 50 mg taken twice daily, approximately 12 hours apart. The dose may be gradually increased under medical supervision to achieve optimal pain control. It’s important to note that Nucynta ER tablets should be swallowed whole and not crushed, chewed, or dissolved, as this can lead to rapid release of the medication and potential overdose.
Dosing Considerations
- Assess patient’s pain intensity and opioid tolerance
- Start with the lowest effective dose
- Titrate slowly to minimize side effects
- Monitor for signs of respiratory depression
- Adjust dosage for patients with renal or hepatic impairment
Potential Side Effects and Risks of Nucynta
While Nucynta can be an effective pain management tool, it comes with a range of potential side effects and risks that patients and healthcare providers must be aware of. Common side effects may include nausea, dizziness, constipation, and somnolence. However, more severe adverse reactions can occur, particularly with misuse or overuse of the medication.
What are the most serious risks associated with Nucynta use? The primary concerns include respiratory depression, addiction, and overdose. Respiratory depression, characterized by slow or shallow breathing, is a potentially life-threatening condition that requires immediate medical attention. Additionally, Nucynta carries a significant risk for abuse and addiction, which can lead to physical dependence and withdrawal symptoms upon discontinuation.
Managing Side Effects
- Regular monitoring of vital signs and pain levels
- Implementing strategies to manage constipation
- Gradual dose reduction to minimize withdrawal symptoms
- Education on recognizing signs of opioid overdose
- Consideration of naloxone prescribing for at-home emergency use
Nucynta and Pregnancy: Weighing Risks and Benefits
The use of Nucynta during pregnancy requires careful consideration and should only be undertaken when the potential benefits clearly outweigh the risks. Opioid medications, including Nucynta, can potentially affect fetal development and may lead to neonatal opioid withdrawal syndrome (NOWS) in newborns exposed to the drug during pregnancy.
How does Nucynta impact fetal development? Studies have suggested a slight increase in the risk of birth defects when opioids are used during the first trimester of pregnancy. Moreover, prolonged use of Nucynta in late pregnancy may result in respiratory depression or withdrawal symptoms in the newborn. Healthcare providers must carefully weigh these risks against the need for pain management in pregnant patients.
Considerations for Pregnant Women
- Discuss alternative pain management strategies
- Use the lowest effective dose for the shortest duration
- Monitor for potential fetal effects during pregnancy
- Prepare for potential neonatal withdrawal symptoms
- Develop a comprehensive postpartum pain management plan
Drug Interactions and Contraindications
Nucynta can interact with various medications and substances, potentially leading to enhanced side effects or reduced efficacy. Understanding these interactions is crucial for safe and effective pain management. Certain combinations may increase the risk of respiratory depression, sedation, or other adverse effects.
Which medications should be avoided when taking Nucynta? Concurrent use of benzodiazepines, other central nervous system depressants, or monoamine oxidase inhibitors (MAOIs) can significantly increase the risk of severe side effects. Alcohol consumption should also be strictly avoided while taking Nucynta due to the potential for dangerous interactions.
Key Drug Interactions
- Benzodiazepines (e.g., diazepam, alprazolam)
- Other opioid medications
- Alcohol and sedatives
- Monoamine oxidase inhibitors (MAOIs)
- Certain antidepressants and antipsychotics
Preventing Nucynta Abuse and Addiction
Given the high potential for abuse and addiction associated with Nucynta, implementing strategies to prevent misuse is paramount. Healthcare providers play a crucial role in educating patients about the risks and proper use of the medication. Patients, in turn, must adhere strictly to prescribed dosages and usage instructions.
How can the risk of Nucynta addiction be minimized? Employing a multi-faceted approach that includes careful patient screening, regular monitoring, and implementation of abuse-deterrent strategies can help reduce the likelihood of addiction. This may involve using prescription drug monitoring programs, implementing opioid contracts, and providing comprehensive patient education on the risks and proper use of Nucynta.
Addiction Prevention Strategies
- Thorough patient assessment before prescribing
- Regular follow-up appointments to evaluate efficacy and risks
- Use of prescription drug monitoring programs
- Implementation of opioid contracts or agreements
- Provision of secure storage and disposal instructions
Long-Term Effects and Considerations for Chronic Use
While Nucynta is primarily indicated for short-term pain management, some patients may require extended use for chronic pain conditions. Long-term use of opioid medications like Nucynta can lead to various physiological and psychological effects that need to be carefully monitored and managed.
What are the potential consequences of long-term Nucynta use? Prolonged use may result in tolerance, requiring higher doses to achieve the same pain-relieving effect. This can increase the risk of side effects and dependence. Additionally, long-term opioid use has been associated with hormonal imbalances, immunosuppression, and an increased risk of falls and fractures, particularly in older adults.
Managing Long-Term Use
- Regular reassessment of pain management goals
- Monitoring for signs of tolerance or hyperalgesia
- Implementing opioid rotation strategies when appropriate
- Addressing potential hormonal and immune system effects
- Considering adjunct therapies to reduce opioid requirements
Tapering and Discontinuation of Nucynta
When it’s time to discontinue Nucynta, whether due to the resolution of pain or the need to switch to alternative treatments, a carefully planned tapering process is essential. Abrupt discontinuation can lead to withdrawal symptoms, which can be uncomfortable and potentially dangerous.
How should Nucynta be tapered to minimize withdrawal symptoms? A gradual dose reduction, typically over several weeks or months, allows the body to adjust to decreasing levels of the medication. The specific tapering schedule should be individualized based on factors such as the duration of use, dosage, and patient characteristics.
Tapering Guidelines
- Develop a personalized tapering plan
- Reduce dosage by 10-25% every 1-4 weeks
- Monitor for withdrawal symptoms and adjust as needed
- Provide support for managing breakthrough pain
- Consider adjunct medications to manage withdrawal symptoms
In conclusion, Nucynta (tapentadol) is a powerful opioid analgesic that offers effective pain relief for moderate to severe acute pain. However, its use comes with significant risks and responsibilities for both healthcare providers and patients. Proper dosing, careful monitoring, and adherence to safety guidelines are essential for maximizing the benefits of Nucynta while minimizing the potential for adverse effects and addiction. As with all opioid medications, the decision to use Nucynta should be made after thorough consideration of the individual patient’s needs, risks, and alternative treatment options.
Nucynta Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
Warnings:
Tapentadol has a risk for abuse and addiction, which can lead to overdose and death. Tapentadol may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of tapentadol that works, and take it for the shortest possible time. See also How to Use section for more information about addiction.
Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.
The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death. Be sure you know how to take tapentadol and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.
Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.
Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms.
Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn’t stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.
Warnings:
Tapentadol has a risk for abuse and addiction, which can lead to overdose and death. Tapentadol may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of tapentadol that works, and take it for the shortest possible time. See also How to Use section for more information about addiction.
Ask your doctor or pharmacist if you should have naloxone available to treat opioid overdose. Teach your family or household members about the signs of an opioid overdose and how to treat it.
The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.
Be sure you know how to take tapentadol and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.
Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.
Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time.
Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn’t stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.
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Uses
Tapentadol is used to help relieve moderate to severe short-term pain (such as pain from an injury or after surgery). It belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.
How to use Nucynta
Read the Medication Guide provided by your pharmacist before you start taking tapentadol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth as directed by your doctor. You may take this drug with or without food. If you have nausea, it may help to take this drug with food.
Ask your doctor or pharmacist about other ways to decrease nausea (such as lying down for 1 to 2 hours with as little head movement as possible).
The dosage is based on your medical condition and response to treatment. Do not increase your dose or use this drug more often or for longer than prescribed. Properly stop the medication when so directed.
Pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.
Suddenly stopping this medication may cause withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as restlessness, mental/mood changes (including anxiety, trouble sleeping, thoughts of suicide), watering eyes, runny nose, nausea, diarrhea, sweating, muscle aches, or sudden changes in behavior.
When this medication is used for a long time, it may not work as well.
Talk with your doctor if this medication stops working well.
Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.
Tell your doctor if your pain does not get better or if it gets worse.
Side Effects
See also Warning section.
Nausea, vomiting, constipation, dizziness, or drowsiness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.
To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects.
Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: confusion, interrupted breathing during sleep (sleep apnea), stomach/abdominal pain, difficulty urinating, signs of your adrenal glands not working well (such as loss of appetite, unusual tiredness, weight loss).
Get medical help right away if you have any serious side effects, including: slow/shallow breathing, fainting, seizures, severe drowsiness/difficulty waking up.
This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Precautions
Before taking tapentadol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: brain disorders (such as seizures, head injury, tumor), breathing problems (such as asthma, sleep apnea, chronic obstructive pulmonary disease-COPD), gallbladder disease, kidney disease, liver disease, mental/mood disorders (such as confusion, depression, thoughts of suicide), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), stomach/intestinal problems (such as blockage, constipation, diarrhea due to infection, paralytic ileus), disease of the pancreas (pancreatitis), difficulty urinating (such as due to enlarged prostate).
This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
Older adults may be more sensitive to the side effects of this drug, especially slow/shallow breathing, confusion, constipation, dizziness, and drowsiness.
During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. (See also Warning section.)
It is unknown if this medication passes into breast milk. It may have undesirable effects on a nursing infant. Tell the doctor right away if your baby develops unusual sleepiness, difficulty feeding, or trouble breathing. Consult your doctor before breast-feeding.
Interactions
See also Warning section.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist.
Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Some products that may interact with this drug include: certain pain medications (mixed opioid agonist-antagonists such as butorphanol, nalbuphine, pentazocine), naltrexone, samidorphan.
Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others.
The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as other opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
This medication may interfere with certain laboratory tests (amylase/lipase levels), possibly causing false test results.
Make sure laboratory personnel and all your doctors know you use this drug.
Does Nucynta interact with other drugs you are taking?
Enter your medication into the WebMD interaction checker
Overdose
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, give them naloxone if available, then call 911. If the person is awake and has no symptoms, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, slow heartbeat, seizures, coma.
Do not share this medication with others. Sharing it is against the law.
This medication has been prescribed for your current condition only. Do not use it later for another condition unless your doctor directs you to do so. A different medication may be necessary in that case.
If you miss a dose, take it as soon as you remember.
If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. For more details, read the Medication Guide, or consult your pharmacist or local waste disposal company.
Images
Nucynta 50 mg tablet
Color: yellowShape: roundImprint: O-M 50
This medicine is a yellow, round, film-coated, tablet imprinted with “O-M” and “50”.
Nucynta 100 mg tablet
Color: orangeShape: roundImprint: O-M 100
This medicine is a yellow, round, film-coated, tablet imprinted with “O-M” and “50”.
Nucynta 75 mg tablet
Color: yellow-orangeShape: roundImprint: O-M 75
This medicine is a yellow, round, film-coated, tablet imprinted with “O-M” and “50”.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Nucynta Dosage Guide – Drugs.com
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Generic name: TAPENTADOL HYDROCHLORIDE 50mg
Dosage form: tablet, film coated
Drug class: Opioids (narcotic analgesics)
Medically reviewed by Drugs.com. Last updated on Mar 6, 2023.
Important Dosage and Administration Instructions
Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions (5)].
Initiate the dosing regimen for each patient individually, taking into account the patient’s severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see Warnings and Precautions (5.1)].
Monitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy and following dosage increases with NUCYNTA and adjust the dosage accordingly [see Warnings and Precautions (5.3)]
Patient Access to Naloxone for the Emergency Treatment of Opioid Overdose
Discuss the availability of naloxone for the emergency treatment of opioid overdose with the patient and caregiver and assess the potential need for access to naloxone, both when initiating and renewing treatment with NUCYNTA tablets [see Warnings and Precautions (5.
3), Patient Counseling Information (17)].
Inform patients and caregivers about the various ways to obtain naloxone as permitted by individual state naloxone dispensing and prescribing requirements or guidelines (e.g., by prescription, directly from a pharmacist, or as part of a community-based program).
Consider prescribing naloxone, based on the patient’s risk factors for overdose, such as concomitant use of CNS depressants, a history of opioid use disorder, or prior opioid overdose. The presence of risk factors for overdose should not prevent the proper management of pain in any given patient [see Warnings and Precautions (5.1, 5.3, 5.5)].
Consider prescribing naloxone if the patient has household members (including children) or other close contacts at risk for accidental ingestion or overdose.
Initial Dosage
Initiating Treatment with NUCYNTA Tablets
Initiate treatment with NUCYNTA tablets in a dosing range of 50 mg to 100 mg every 4 to 6 hours as needed for pain.
On the first day of dosing, the second dose may be administered as soon as one hour after the first dose, if adequate pain relief is not attained with the first dose. Subsequent dosing is 50 mg, 75 mg, or 100 mg every 4 to 6 hours and should be adjusted to maintain adequate analgesia with acceptable tolerability.
Daily doses greater than 700 mg on the first day of therapy and 600 mg on subsequent days have not been studied and are not recommended.
NUCYNTA tablets may be given with or without food [see Clinical Pharmacology (12.3)].
Conversion from NUCYNTA Tablets to NUCYNTA ER
Patients can be converted from NUCYNTA tablets to NUCYNTA ER using the equivalent total daily dose of NUCYNTA tablets and dividing it into two equal doses of NUCYNTA ER separated by approximately 12-hour intervals. As an example, a patient receiving 50 mg of NUCYNTA tablets four times per day (200 mg/day) may be converted to 100 mg NUCYNTA ER twice a day.
Dosage Modifications in Patients with Hepatic Impairment
The safety and efficacy of NUCYNTA tablets has not been studied in patients with severe hepatic impairment (Child-Pugh Score 10-15) and use in this population is not recommended [see Warnings and Precautions (5.
16)].
Initiate treatment of patients with moderate hepatic impairment (Child-Pugh Score 7 to 9) with 50 mg no more frequently than once every 8 hours (maximum of three doses in 24 hours). Further treatment should reflect maintenance of analgesia with acceptable tolerability, to be achieved by either shortening or lengthening the dosing interval. Monitor closely for respiratory and central nervous system depression [see Clinical Pharmacology (12.3)].
No dosage adjustment is recommended in patients with mild hepatic impairment (Child-Pugh Score 5 to 6) [see Clinical Pharmacology (12.3)].
Titration and Maintenance of Therapy
Continually reevaluate patients receiving NUCYNTA tablets to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse [see Warnings and Precautions (5.1)]. Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration.
If the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing the NUCYNTA tablets dosage. If unacceptable opioid-related adverse reactions are observed, consider reducing the dosage. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions.
Safe Reduction or Discontinuation of NUCYNTA Tablets
Do not abruptly discontinue NUCYNTA Tablets in patients who may be physically dependent on opioids. Rapid discontinuation of opioid analgesics in patients who are physically dependent on opioids has resulted in serious withdrawal symptoms, uncontrolled pain, and suicide. Rapid discontinuation has also been associated with attempts to find other sources of opioid analgesics, which may be confused with drug-seeking for abuse. Patients may also attempt to treat their pain or withdrawal symptoms with illicit opioids, such as heroin, and other substances.
When a decision has been made to decrease the dose or discontinue therapy in an opioid-dependent patient taking NUCYNTA Tablets, there are a variety of factors that should be considered, including the dose of NUCYNTA Tablets the patient has been taking, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient.
It is important to ensure ongoing care of the patient and to agree on an appropriate tapering schedule and follow-up plan so that patient and provider goals and expectations are clear and realistic. When opioid analgesics are being discontinued due to a suspected substance use disorder, evaluate and treat the patient, or refer for evaluation and treatment of the substance use disorder. Treatment should include evidence-based approaches, such as medication assisted treatment of opioid use disorder. Complex patients with co-morbid pain and substance use disorders may benefit from referral to a specialist.
There are no standard opioid tapering schedules that are suitable for all patients. Good clinical practice dictates a patient-specific plan to taper the dose of the opioid gradually. For patients on NUCYNTA Tablets who are physically opioid-dependent, initiate the taper by a small enough increment (e.g., no greater than 10% to 25% of the total daily dose) to avoid withdrawal symptoms, and proceed with dose-lowering at an interval of every 2 to 4 weeks.
Patients who have been taking opioids for briefer periods of time may tolerate a more rapid taper.
It may be necessary to provide the patient with lower dosage strengths to accomplish a successful taper. Reassess the patient frequently to manage pain and withdrawal symptoms, should they emerge. Common withdrawal symptoms include restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other signs and symptoms also may develop, including irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate. If withdrawal symptoms arise, it may be necessary to pause the taper for a period of time or raise the dose of the opioid analgesic to the previous dose, and then proceed with a slower taper. In addition, monitor patients for any changes in mood, emergence of suicidal thoughts, or use of other substances.
When managing patients taking opioid analgesics, particularly those who have been treated for a long duration and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper.
A multimodal approach to pain management may optimize the treatment of chronic pain, as well as assist with the successful tapering of the opioid analgesic [see Warnings and Precautions (5.13), Drug Abuse and Dependence (9.3)].
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Nucynta vs. Oxycodone: Differences, Similarities & What’s Best for You – Drug Vs. Friend
Home >> Drug Vs. Friend >> Nucynta vs Oxycodone: Differences, Similarities & Which is Best for You
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Drug Overview and Key Differences | Conditions of treatment | Efficiency | Insurance coverage and cost comparison | Side effects | Drug Interactions | Warnings | FAQ
Nucynta and oxycodone are FDA approved. opioid prescription medications indicated for the treatment of severe, acute pain. They are typically used for pain that cannot be controlled with non-opioid medications or when the patient is intolerant of other alternatives. Both painkillers are classified as narcotic (Appendix II), which means they have a high potential for abuse or addiction.
How Nucynta works is not fully understood. Some studies have shown that Nucynta is a mu-receptor (nociceptor) agonist and norepinephrine reuptake inhibitor, resulting in pain relief.
Oxycodone works by binding to mu receptors in the brain, which dampens or blocks pain signals, resulting in pain relief.
Since both drugs are very strong, they are usually used in situations where pain relief is required when lighter (non-narcotic) pain medications would not be effective or would not be tolerated. Although both drugs are used for severe pain, they have many differences, which we will discuss below.
What are the main differences between Nucynta and oxycodone?
Nucinta (tapentadol) is an opioid or narcotic pain reliever (pain reliever). It is available branded as both immediate-release and extended-release tablets. The extended release tablet is called Nucynta ER. The starting dose is 50 to 100 mg every four to six hours as needed for pain. The dose may be changed by your doctor and the maximum dose is 600 mg per day.
Oxycodone is also a general opioid analgesic (and immediate release oxycodone IR) and is available in branded form as OxyContin, an extended release tablet. Dosage varies, but a typical dose for immediate release oxycodone tablets is 5 to 15 mg every four to six hours depending on the pain.
| Main differences between Nucynta and oxycodone | ||
|---|---|---|
| Nucynta | Oxycodone | |
| Drug class | Opioid (narcotic) analgesic | Opioid (narcotic) analgesic |
| Brand/generic status | Brand | Brand and generic |
| What is generic/brand? | Generic: Tapentadol | Brand: OxyIR (immediate release), Oxycontin (long acting) |
| What form(s) does the drug come in? | Immediate-release tablet Extended-release tablet | Immediate-release tablet Immediate-release capsule Extended-release tablet Oral solution |
| What is the standard dosage? | Initial: 50 to 100 mg every 4 to 6 hours as needed.  If necessary, the dose can be adjusted by the doctor. Maximum 700 mg per day on the first day of treatment, then the maximum dose is 600 mg per day after the first day. | Immediate release tablet: 5-15 mg every 4-6 hours as needed Extended-release tablet: 20 mg every 12 hours |
| How long does a typical treatment last? | Short-term, may be used longer depending on the condition treated (eg chronic pain) and response | Short-term, may be used longer depending on the condition treated (eg chronic pain) and response |
| Who usually takes this medicine? | Adults | Adults |
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Conditions Treated by Nucynta and Oxycodone
Both Nucynta and Oxycodone have the same indication for treatment, which is to treat adult acute pain that is severe enough to require an opioid analgesic, and when alternative therapies are inadequate or intolerable.
| Condition | Nucynta | Oxycodone |
| yes | yes |
Nucynta or oxycodone more effective?
In a study comparing immediate release Nucynta with immediate release oxycodone in patients with moderate to severe acute back pain, both drugs were equally safe and effective in treating back pain as well as associated leg pain. Nucynta patients had fewer stomach-related side effects.
In a study comparing the potential for abuse in patients taking Nucynta or oxycodone, Nucynta was found to have less potential for abuse.
The most effective medicine for you should only be determined by your doctor, who will review your condition(s), medical history, and other medicines you are taking.
Coverage and Cost Comparison of Nucynta and Oxycodone
State law states that if you are taking an opioid pain reliever for the first time, it is likely that you will receive a small amount.
Insurance coverage varies by Nucynta. Because it is more expensive and only available under brand names, your copay may be higher or the drug may need prior authorization from your insurance company. Nucynta is generally not covered by Medicare Part D. Nucynta 50mg, 30 tablets usually cost around $250, but you can get it for as little as $211 with the SingleCare discount.
Oxycodone is usually covered by insurance and Part D. Medicare. The cash price of 30.5mg tablets can be around $100, but you can use a single coupon at participating pharmacies and get it from $36.
| Nucynta | Oxycodone | |
| Usually covered by insurance? | Varies | yes |
| Usually covered by Medicare Part D? | No | yes |
| Standard dosage | 50 mg, #30 tablets | 5 mg #30 tablets |
| Typical Medicare Part D copay | $95-482 | $2-56 |
| SingleCare cost | $211+ | $36-62 |
Common side effects of Nucynta versus oxycodone
Most common side effects The effects of Nucynta are nausea, vomiting, drowsiness, dizziness, constipation, dry mouth and itching.
Severe respiratory depression (slowed breathing, lack of oxygen) may occur, which can be life-threatening or fatal.
The exact percentages of oxycodone are not reported, except that side effects were observed in more than or equal to 3% of patients. The most common side effects are nausea, constipation, vomiting, headache, itching (itching), insomnia, dizziness, weakness, and drowsiness. Serious adverse reactions may include respiratory depression, respiratory arrest (breathing arrest), cardiac arrest (sudden loss of heart, breathing, and consciousness function), low blood pressure, and/or shock.
Because of the serious risks, it is very important that if you are taking Nucynta or oxycodone, you take the drug exactly as prescribed and do not take extra doses. You should also monitor respiratory depression, especially when you start taking one of these drugs or during a dose change.
Other side effects may occur. Check with your healthcare provider for a complete list of side effects.
| Nucynta | Oxycodone | |||
| Side effect | 90 036 Applicable? | Frequency | Applicable? | Frequency |
| 8 | ||||
| Vomiting | yes | 18% 9 | ≥3% | |
| Constipation | yes | 8% | yes | ≥3% |
| Dry mouth | yes | 4% | yes | % not reported |
| Drowsiness | yes | fifteen% | yes | ≥3% |
| Dizziness | yes | 24% | ||
| Itching | yes | 5% | yes | ≥3% |
Source: DailyMed (Nucynta), DailyMed (oxycodone)
Drug interactions of Nucynta with oxycodone
Use of benzodiazepines or other CNS depressants, including other opioids, in combination with Nucynta or oxycodone may result in low blood pressure, respiratory depression, severe sedation, coma and/or death.
Combinations should be avoided. However, if no other option is available, the lowest dose of each drug should be used for the shortest period of time, and the patient should be closely monitored, especially at the start of treatment and any dose changes.
Taking Nucynta or oxycodone with drugs that increase serotonin levels may also increase the risk of serotonin syndrome, a life-threatening condition caused by the accumulation of too much serotonin. These drugs include antidepressants such as serotonin reuptake inhibitors, muscle relaxants, MAO inhibitors (MAO inhibitors should not be used within 14 days of taking Nucynta or oxycodone), and triptans for migraine.
Taking oxycodone with certain drugs that are metabolized by CYP3A4 or CYP2D6 may lead to drug interactions. These drugs are known as enzyme inhibitors and include macrolide antibiotics, azole antifungals, and protease inhibitors. Using them along with oxycodone can lead to high levels of the opioid, which can be very dangerous.
These drugs interact with oxycodone but not with Nucynta.
Other drugs, known as enzyme inducers, work in the opposite way to inhibitors, lowering opioid levels so that they are not as effective or may even cause withdrawal symptoms. Inducers may affect Nucynta or oxycodone.
Consult your healthcare professional for a complete list of drug interactions.
| Drug | Drug class | Nucynta | Oxycodone |
| Alprazolam Clonazepam Diazepam Lorazepam | Benzodiazepines | yes | yes |
| Alcohol | Alcohol | yes | yes |
| Codeine Fentanyl 9001 2 Hydrocodone Hydromorphone Methadone Morphine Tramadol | Opioids | yes | yes |
| Baclofen Carisoprodol Cyclobenzaprine Metaxalone Tizanidine | Muscle relaxants | yes | yes |
| Antidepressants | yes | yes | |
| Phenelzine Rasagiline Selegiline Tranylcypromine | MAO inhibitors | yes | yes |
| Furosemide Hydrochlorothiazide | Diuretics | yes | yes | Benztropine Diphenhydramine Oxybutynin Tolterodine | Anticholinergics | yes | yes |
| Almotriptan 900 12 Eletriptan Rizatriptan Sumatriptan Zolmitriptan | Migraine triptans | yes | yes |
| Clarithromycin Erythromycin Fluconazole Ketoconazole Ritonavir | CYP3A4 or CYP2D6 inhibitors | yes | |
| Carbamazepine Phenytoin | CYP3A4 inducers | yes | yes |
The use of opioids during pregnancy, for both medical and non-medical purposes, can cause physical dependence in the baby and can lead to opioid withdrawal in the newborn shortly after birth.
Nucynta may have a lower abuse potential. Talk to your doctor if Nucynta or oxycodone is right for you, if other pain medications haven’t worked or you can’t tolerate them.