What is the role of tapentadol in the management of noncancer pain?
Jenny Legassie: Tapentadol is a relatively new option for analgesia. It is a dual-action medication, which has activity both as an opioid agonist on the mu-opioid receptors as well as inhibition of norepinephrine reuptake. It works both as an opiate and as a serotonin norepinephrine reuptake inhibitor (SNRI) although without as much serotonin activity. Its efficacy as an opiate does seem to be about on par with that of oxycontin and has been approved and shown very good success in management of musculoskeletal (MSK)-type pain. In terms of its neuropathic activity it does seem to be very effective in diabetic neuropathy. The other advantage of this medication is that it is not a prodrug, so it is the actual active medication. The metabolites which are produced in the liver are nonactive and are excreted in urine. It actually does provide a nice option for patients who may have challenges with opioid metabolites. Side effects are consistent with both opioids and the norepinephrine activity – sedation, constipation, delirium in high doses or in those who are quite sensitive, as well as headache, nausea, and sweating. It does seem to be well tolerated in most patients.
It is not highly used yet in North America, but we are seeing increasing use through Europe. Part of the challenge in North America is likely coverage, especially in Canada. But we are having some good success with it in the European countries. I think for that population that has both MSK pain as well as neuropathy – diabetics with Charcot foot and neuropathy – this is a great option.