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

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

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).