What is tapentadol used for?

• Standard tablets or liquid are used for short-term relief of moderate to severe acute pain, for example pain following an operation or injury.
• Prolonged-release tablets are used to relieve chronic (long-term) moderate to severe pain, for example osteoarthritis, lower back pain, nerve pain or pain in cancer.

Key facts

• Tapentadol is suitable for adults aged 18 years and over. It's sometimes prescribed in hospital for children aged two years and over.
• Palexia tablets are usually taken every four to six hours. Palexia SR tablets are taken every 12 hours.
• Tapentadol can be addictive, but addiction is rare when it's taken as directed by a doctor to relieve pain.
• The most common side effects are headaches and feeling sick, dizzy or sleepy.
• Don't drink alcohol while taking tapentadol.

How does tapentadol work?

• Strong opioid painkillers like tapentadol relieve pain by mimicking the action of naturally occurring pain-reducing chemicals called endorphins. Endorphins are found in the brain and spinal cord and reduce pain by combining with opioid receptors.
• Tapentadol mimicks the action of our natural endorphins by combining with the same opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain and means that even though the cause of the pain may remain, less pain is actually felt.
• Tapentadol also enhances the activity of a neurotransmitter called noradrenaline in the brain. Neurotransmitters are chemical compounds that act as messengers between the nerve cells. Enhancing the effect of noradrenaline also helps relieve pain.

Is tapentadol addictive?

• It is possible to become dependent on tapentadol if you take it for a long time, but this is not usually a problem because withdrawal symptoms can generally be avoided by reducing treatment gradually.

Tapentadol is not suitable for:

• People with very slow, shallow breathing (respiratory depression).
• People with severe asthma or who are having an acute asthma attack.
• People with inactivity in the intestines, causing severe constipation or a blockage in the gut (paralytic ileus).
• People under the influence of (intoxicated with) alcohol, sleeping pills, painkillers or medicines or drugs that affect mood and emotions.
• People with raised pressure inside the skull (raised intracranial pressure).
• People with reduced levels of consciousness or who are in a coma.
• People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days.

Can I take tapentadol while pregnant or breastfeeding?

• If you are or think you could be pregnant you should get advice from your doctor before taking tapentadol, because its safety during pregnancy has not been established. Tapentadol is not normally used during pregnancy, unless it's considered essential by your doctor. It is not recommended for use during labour or delivery because it may cause breathing difficulties in the baby after birth.
• It's not known if tapentadol passes into breast milk. It should not be taken by women who are breastfeeding. Ask your doctor for further advice.

All forms of tapentadol can be taken either with or without food.

How do I take Palexia tablets?

• Palexia standard tablets start to work quickly and their effects wear off after a few hours. They may be prescribed to take only when needed to relieve pain, or on a regular basis, depending on the cause of your pain.
• The usual dose for a healthy adult is one 50mg tablet every four to six hours. If you still have pain your doctor may increase your dose up to a maximum of 600mg in 24 hours. Always follow the instructions given by your doctor.

How do I take Palexia SR tablets?

• Palexia SR tablets are taken every 12 hours. The dose prescribed by your doctor will depend on how severe your pain is, whether you have previously been taking other opioid painkillers and various other factors. Do not take more than the prescribed dose.
• Palexia SR tablets must be swallowed whole with a drink of water. Do not break, crush or chew them, as this will cause the whole dose to be rapidly absorbed into your body, which could result in an overdose.

Can I drink alcohol while taking tapentadol?

• No, it's best avoided. Drinking alcohol with tapentadol will make you more likely to feel sleepy, dizzy or confused, or get other side effects like blurred vision.

Can I drive while taking tapentadol?

• It may be an offence to drive while you are taking tapentadol. Do not drive if you think it affects your ability to drive safely, for example if it makes you feel sleepy, dizzy, confused, unable to concentrate or make decisions, or if you have blurred or double vision.

What are the side effects of tapentadol?

• Feeling sleepy.
• Feeling dizzy.
• Headache.
• Feeling sick or vomiting.
• Decreased appetite.
• Anxiety.
• Confusion.
• Hallucinations.
• Abnormal dreams.
• Tremor.
• Muscle spasms.
• Flushing.
• Constipation.
• Diarrhoea.
• Indigestion.
• Dry mouth.
• Rash.
• Itching.
• Sweating.
• Feeling weak or tired.

Can I take other medicines with tapentadol?

Painkillers

It's fine to take non-prescription painkillers like paracetamol, ibuprofen or aspirin with tapentadol (assuming these are appropriate for you). These are weaker painkillers, but as they work in a different way they can attack your pain from a different angle. 

Antihistamines

If you need an antihistamine it’s best to go for one that won’t make you sleepy, for example cetirizine or loratadine. 

You shouldn't take tapentadol if you have taken a monoamine oxidase inhibitor antidepressant (MAOI), for example the antidepressants phenelzine, tranylcypromine or isocarboxazid, in the last 14 days.

You're more likely to feel sleepy or have breathing problems with tapentadol if you take it with other medicines that can cause drowsiness, such as the following:

• antihistamines that cause drowsiness, eg hydroxyzine, promethazine
• antipsychotics, eg haloperidol
• barbiturates, eg phenobarbital, amobarbital
• benzodiazepines, eg diazepam, temazepam
• gabapentin
• muscle relaxants, eg baclofen
• nabilone
• other opioids, eg codeine, morphine, fentanyl
• pregabalin
• sleeping tablets, eg zopiclone
• tricyclic antidepressants, eg amitriptyline.

There may be an increased risk of a rare but potentially serious side effect known as the 'serotonin syndrome' if you take tapentadol with medicines or drugs that increase the levels or activity of serotonin in the nervous system. These include the following:

• dapoxetine for premature ejaculation
• mirtazapine
• selective serotonin reuptake inhibitor antidepressants (SSRIs) such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine or sertraline
• serotonin noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine or duloxetine
• tricyclic antidepressants, eg amitriptyline
• triptans for migraine such as sumatriptan.

If you're taking any of the medicines above you should tell your doctor if you experience symptoms such as confusion, agitation, tremor, muscle twitching, shivering, sweating, racing heartbeat or diarrhoea after taking tapentadol as well.

References:

https://www.netdoctor.co.uk/medicines/aches-pains/a6491/palexia-tapentadol/

https://www.hpra.ie/img/uploaded/swedocuments

https://www.medicines.org.uk/emc/product/5159/pil

https://www.medicines.ie/medicines/palexia-50-mg-film-coated-tablets-33283/patient-info