Transition to Nucynta (Tapentadol) from Tramadol?

Hello,

I'm wondering if anyone here transitioned to Tapentadol from a long-term course of Tramadol? I have been on Tramadol, 200 mg/day, for over 1 year. I am curious on what your experience was with regards to any discontinuation effects (if any) you experienced and any protocols your doctor had you follow as you made the transition.

My doctor will be switching me over and I am well aware that Tapentadol is relatively new, i.e., there is not much data on the best ways to transition to it (even the prescribing information for doctors indicates this fact). I'm sure my doctor will have some ideas on the best way to do this, but I'd like to hear from others on their experiences.

I'm also aware that the two medications are very similar, but as with all medications, "being similar" does not necessarily mean that there aren't any pitfalls when switching over (e.g., discontinuation symptoms).

-j

j - why is the doc switching you over? Tramadol seems fine for long term, but tapentadol is only for short term use.

i have no experience to answer your question but i wanted to welcome you to the group.
I hope you will stay with us and let us know how you are doing.

Suzane

Tapentadol (Nucynta) just came out with an ER formulation -- and my cynicism makes me worried that your MD is just looking to cash in on some prescribing incentive.

I've used Ultram ER for 5 years, currently at 300mg and so you have quite a few years and a higher dose still available, assuming you've found some benefit from it.

It has been helpful for me, though lately I think I need something stronger. But that is after 5x your duration of use.

I tried tapentadol IR about a year ago and found it very different in effect from tramadol. The latter offers (or offered) me additional mental focus and energy (given its serotonin release). But the tapentadol made me drowsy and I felt very crummy the day after using it.

Of course we all differ, but it seems to me that if the tramadol has been helping, you might want to decline the switch.

If you do go forward with it, you can cross-taper. That may be the safest. Although the two drugs are supposed to be similar, they have very different effects on me. I have over the years tapered out of the Ultram in order to see what my pain state would be like. I did it by lowering from 300 to 200 in a week, then 200 to 100 in a week, then just to some 50mg IRs for a few days. I was able to do it over a 3 week period without significant side effects, but again, we're all different.

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C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Tapendtadol (nucynta) was originally only approved for short term use, most likely because it was new and there wasn't evenough data at the time to determine its abuse and dependancy liability. Testing was done for tapentadol ER vs oxycodone ER on a 90 day study. The results show that while both were effective for treating moderate to severe pain with comparable results for the first few weeks, tapentadol worked better than oxycodone as far as reducing pain at the 2-3 month marks than oxycodone did. The pain scores showed tapentadol went from being comparable to superior when the same doses were used long term. Furthermore, phase III testing demonstrated a reduced abuse liability compared to oxycodone and morphine which is why it was originally requested to be released as a C-III. The DEA required it to be a C-II because in one test, it acheived a liking score similiar to hydromorphone, so despite test results showing lower abuse potential, the DEA went with C-II.

I've successfully been on tapentadol long term and like tramadol, it builds tolerance much slower than traditional opioids similiar to tramadol. The difference is that Tapentadol is about 2 to 3 times as potent as tramadol in terms of pain relief, IMO.

According to its site, its Mu Opioid binding is 18 less affinity than morphine. However, this is still more potent than tramadol's metabolite, which is 30 times less binding affinity. It also has less SSRI action and stronger NRI action than tramadol. IMO, tapentadol is better suited for moderate severe pain than tramadol and seems to have less risk for seratonin syndrome.

I would assume the switch from one to the other would be more "tolerable" than switching from say oxyocodone to tapentadol as oxycodone has a higher Mu binding affinity which could result in mild withdraw. Tapentadol seems more "stimulating" than tramadol (its been years since ive been on tramadol), so the challenge would probably just be adjusting to the profile of the medication. They are fairly similiar though and both feel more like anti depressants than narcotics, though you can tell tapentadol has more narcotic activity (hard to explain).

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MRI revealed disc bulge and test injections revealed RA. Radio Freq procedures helped for months, but pain is up and im having the procedure done again. Currently on 75 mgs of Nucynta (tapentadol - A MOR + NRI) 2 to 3 time per day and Soma 350 as needed.

One note to add. Tapentadol does seem to have a few specific side effects, though some only occur at break through pain dose for me (150mgs - 2 75mg tablets). It seems to cause dehydration so be sure to drink an extra glass or two of water. Also, be careful not to take it right before bedtime. Take it 2 hours before bed and you should be fine. There are relatively few side effects at the 75mg dosing for me. I experience less side effects with this than medication than oxycodone and all in all very few side effects occur at the normal 75mg dose.

However, as I'm allowed for breakthrough levels of pain, I can take a second tablet. THIS is what generally causes any real side effects. Closed eye visuals, corner of eye illusions and slight auditory hallucinations have occured but they disipate in about 90 minutes and the pain relief if I'm hurting that bad is worth it. Just something to be aware of. ;)