![]() ![]() Wow, this was an interesting read! I'm currently on Tramadol, and I've been for nearly 2 years for chronic pain with 2 herniated discs in my neck (C4/C5, C5/C6), impingement syndrome in my left shoulder and so forth. This article is adapted from Dr Casey Parker’s blog, Broome Docs. We just don’t know the full risk/benefits in 2018.Īnd don’t be fooled by the ‘less abuse potential’ argument it is a new drug and the same statement was made about oxycodone many moons ago. It has a more predictable pharmacology, but the evidence is not yet in. ![]() Which is akin to stating it is funnier than the MIMS – it’s a low bar. Tapentadol is probably better than tramadol. This is definitely one to watch carefully when prescribing. The risk of developing tolerance and potential for abuse or diversion is likely to be similar to other opiates once the word gets out. Tapentadol side effects are predictable: constipation, nausea and vomiting with some dizziness in up to a third of patients. It needs to be avoided for at least two weeks after ceasing monoamine oxidase inhibitors (MAOIs) such as moclobemide (though this is rarely used in Australia). We need to see some real-world safety data and clinical outcome studies to say exactly how much benefit this drug has.Īs with any potent opioid, tapentadol is to be used with caution in patients with respiratory failure, other sedatives or noradrenergic agents. In the trials used to get it registered, the drug was only just better than a placebo for chronic pain. The biggest issue is that there is just not enough data available about the safety or efficacy of tapentadol. But there must be a catch, right? There always is. A cleaner, direct-acting opioid with fewer side effects. there are no active metabolites yet known – so that sounds cleaner, too.it has noradrenaline reuptake inhibitory effects, but not much effect on serotonin reuptake, which makes it a little cleaner.it has a strong mu-opioid receptor agonist effect, similar to oxycodone.So it is what it says on the box – an opioid analgesic. Tapentadol is not a prodrug – it does not rely on metabolism to get it working. So, how is the new kid on the block different? It’s the new and improved version of tramadol, which is arguably not hard to do. Now let’s introduce tapentadol, first released in 2008. Patients with little metabolism to M1 take more and more doses to achieve analgesia and end up with a bunch of the SNRI metabolites in their systemsĪll in all, a tricky drug to use, since different patients may have a totally different experience with the drug.Combining it with other serotonin norad-active drugs like antidepressants leads to a double whammy.Older patients or people with renal/liver disease don’t clear metabolites and they build up.Then then there is the risk of serotonin syndrome and seizures. The most common reply is along the lines of, ‘Oh, the drug that made me spew’. In my experience, you get pretty clear likes or aversion to tramadol. To some extent, you can ask a patient what effects they felt if they had a dose of tramadol previously. a whole bunch of other receptors, such as N and M acetylcholine, direct serotonin agonists, and the list goes on.some venlafaxine, which is a serotonin/noradrenaline reuptake inhibitor (SNRI).a bunch of destramadol (aka M1), which has a strong mu-opioid receptor affinity and acts like morphine.Depending on the makeup of your cytochromes, you may get: It gets metabolised in the liver by the cytochrome p450 enzymes into a few active chemicals.īut here is the problem – the actual amounts of each of the active metabolites is a bit of a genetic lottery. That means, on its own it doesn’t do much of anything. But it’s unpredictable, with a lot of side effects, and often just doesn’t provide much relief. Tramadol is possibly one of the most maligned medications in a GP’s toolbox. These drugs are very similar, so it’s worth comparing them. When I saw the name tapentadol, I immediately assumed that it was a new version of tramadol, but with more letters to confuse the chaps over at the patent office. If you’re like me (as a rural GP), you probably started noticing a trickle – and then a flood – of patients being discharged from big city hospitals on this new drug tapentadol. Tapentadol versus tramadol: Which is better to prescribe? Dr Casey Parker examines which is best to prescribe. ![]()
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