Tapentadol For Chronic Pain

What is Tapentadol?

Tapentadol is a strong pain killer and it is classed as an opioid.  Other types of opioid include morphine, oxycodone, methadone and buprenorphine.

Tapentadol can be tried when other pain killers have not been useful for managing certain types of pain conditions.

How do I take it?

Tapentadol is formulated into a modified-release tablet so the medication slowly releases from the tablet once it is taken. It is taken twice a day.

Tablet strengths are 25mg, 50mg, 100mg, 150mg and so on. 

MR or SR may also be written on the label to show it is a modified-release version.

Starting Tapentadol

The starting dose is usually 25-50mg MR twice a day.  After 2 weeks this is usually increased to 50-100mg MR twice a day. 

Your prescriber will describe the regime and how to change the dose and when.  This will also be explained by your dispensing pharmacy.  Your copy of the clinic letter should also detail how the dose is to be changed. 

It is important to stick to the plan as these are made to reduce risks of experiencing side effects.  If there are any questions the specialist nurse telephone number is written below.

Further dose changes depend on lots of factors like your response, any side effects as well as potentially your other medications and reason for being prescribed Tapentadol.

How long will it take to work?

Tapentadol has morphine- like actions working to stimulate the body’s own opioid system.

In chronic pain the more useful effect seems to be Tapentadol’s action to stimulate the noradrenaline chemical pathways within the brain and spinal cord. The second effect can take 5 to 6 weeks to fully develop once you have reached a stable dose of Tapentadol.

Most opioid medications for chronic non cancer pain need to show a reduction in your pain of one third to justify the risks of side effects and complications to continue taking it long term.

These medications are not a cure. They are aimed at improving your pain so you can function better.

How should I store my Tapentadol?

In a cool place securely away from children, pets or vulnerable adults.

Any excess or old medication should be taken to your pharmacy for safe disposal.

What are the side effects?

When you first start or increase a dose side effects are more likely. These include;

• Excessive tiredness and sleepiness
• Lack of energy
• Sickness
• Constipation
• Headache
• Abnormal dreams
• Difficulty with sleep
• Difficulty concentrating
• Dry mouth

A full list is given in the pack information sheet in the medication box.

Some of these your body may develop some tolerance to and these settle after a week or two.

Serious effects or reactions include seizures, agitation, hallucinations, fever, sweating, confusion, muscle stiffness or twitching, loss of coordination and fast heart rate.   If any of these are experienced we would urge you to seek advice from a doctor the same day, either your GP or A&E.

How long can I continue to take Tapentadol? 

Some patients are able to take a stable dose of Tapentadol for months and years with good effect and no issues. 

Annual medication reviews are important for anyone taking medication in the longer term to ensure you are taking medication that is useful and effective.  This may be with your GP or The Walton Centre Opioid Service.

What are the long-term side effects and risks?

Side effects taking any opioid medication for months and years can be:

• Reduced fertility
• Low sex drive
• Irregular periods for women
• Erection problems in men
• Reduced immunity so less ability to fight infections
• Increased pain levels

Risks include developing tolerance where the benefit in terms of pain relief may reduce.  This can be an issue for all opioid medications.

Physical dependency is when withdrawal effects develop if a dose is delayed or missed.  Withdrawal effects include agitation, hot sweats, shaking and cramps.

Addiction is the need to continue taking a substance for the feeling of pleasure even though it is causing harm.  This is different to taking a substance to manage chronic pain.  It is still a risk but that risk is thought to be low for patients taking it to manage chronic pain.

Can I work and drive?

On starting Tapentadol or changing a dose, generally side effects are more likely.  These can impair your ability to function clearly and react quickly.  Skilled tasks such as driving or caring for others such as children particularly may be affected.

Changing a dose may be better timed when you have additional support to help or take over these tasks, or a period where you are not in work such as weekends for some.

Driving law makes it an offence to drive if you feel affected such as feeling dizzy, drowsy, unable to concentrate and slower reaction times.  You are responsible for your own fitness to drive.  There is a clear link between prescription opioid use in drivers and increased odds of road traffic accidents.

If you feel well enough to function and particularly once on a stable dose many of our patients are able to work and drive.

https://www.gov.uk/drug-driving-law

Can I drink alcohol?

Alcohol has similar effects to opioids and Tapentadol can also increase these effects.  It is advised that you do not drink alcohol whilst taking Tapentadol.

What do I do if I miss a dose?

As Tapentadol is a slow-release preparation, just skip the missed dose and take the next at the usual time.

How do I get another prescription of Tapentadol?

When you are being started and changing the dose we usually issue the prescriptions.  We will call you with approximately a week to go before your next prescription is due.

Once your response to Tapentadol has been checked and it is sufficiently beneficial, we ask your GP to take over repeat prescriptions.

Who should I contact if I have problems with Tapentadol?

Specialist Nurses for advice or prescription requests 0151 556 3368

This may be an answerphone at times so please leave a message with your contact details, telephone number and an identification number, such as your Walton Centre patient number so we can contact you back.  

We need a minimum 3 working days to respond as we are quite a small team.

Pain Relief Team Secretaries (for appointment questions) 0151 556 3390

Other resources:

Faculty of Pain Medicine, further detailed information on using of opioid medications for pain management

www.fpm.ac.uk/category/opioids-aware