Talk:Tapentadol/Archive 1

Archive 1

initial assessment

This article is clearly a stub, as it is very short. I am placing it at 'high' importance for now, since it has a novel mechanism of action and appears to be the first of its class.

Much work needs to be done to bring this up to wiki standards. I would suggest that editors start by looking at the manual of style, as well as the medical manual of style, with respect to the format of drug & pharmacology-related topics. It is also very important for information in wikipedia to be verifiable, so I would recommend taking a look at WP:CITE for information on how to cite sources using inline citations. WP:EL can help with how/when to include external links in articles as well. Finally, as the article progresses, you should consider getting the article to meet the Good Article criteria, and ultimately, the Featured Article criteria (but these steps will take considerable time to reach). Cheers! Dr. Cash 19:13, 20 September 2007 (UTC)

As a second thought, since the article was created within the last five days, it is eligible for consideration in the Did You Know? section of the main page, if we can improve it enough and provide some useful information for it. Dr. Cash 19:17, 20 September 2007 (UTC)

I've expanded a little bit. The article is still very short—165 words of body text, just over a tenth of the recommended minimum length. Fvasconcellos (t·c) 21:58, 20 September 2007 (UTC)

Unique?

Well, it seems not to be all so unique; the short dynamic profile given is comparable to O-desmethyltramadol. However, good we'd have a new opioid analgesic.--84.163.96.19 03:06, 29 September 2007 (UTC)

Issues about the scheduling by the FDA

While the explanation of the current delay in market introduction of tapentadol is significant to an extent, it needs to be sourced and verified in my opinion for such a large part of the article. There is too much speculations which are supposely an issue of current negotiations between Johnson&Johnson/Gruenenthal and the FDA; as of now, in my opinion, some of these speculations are not verifiable since they are subject of an ongoing confident debates. Maybe it should be reduced to verifiable facts and expanded over time, as the positions and results of these discussions become clear and public. Any ideas? --84.163.112.152 (talk) 09:19, 22 April 2009 (UTC)

Seizure Thresholds

Any sources to verify whether Tapentadol lowers seizure thresholds synonumous to Tramadol?--94.193.135.142 (talk) 03:08, 8 May 2009 (UTC)

Tapentadol is starting to be used for Chronic Pain

I am not sure if the part about off-label use for Chronic pain should be changed, but I think would be better worded as "Pain Management doctors have started to prescribe Tapentadol for chronic pain, although its use for chronic pain is still off label at the current time".

I am prescribed to take 1-2 tablets every 6 hours. There is a significant difference between the 50 mg dosage and 100 mg in that the pain relief increases on a curve, and the euphoric effects are significantly more noticable at the 100 mg level. In other words, 50 mgs of Tapentadol has an effect similiar to about 5 - 7.5 mgs of oxycodone, whereas 100 mgs of tapentadol has an effect of about 15 to 20 mgs of oxycodone in terms of pain relief.

Its abuse potential is limited due to the Norephenrine effects causing undesirable side effects. However, it should be noted that on the liking scale, it was compared to hydromorphone (source: FDA).

Also, from personal experience tolerance to this medication builds extremely slowly. According to the Nucynta homepage, in the course of using the medication for 90 days, a significant number of participants did not experience withdraw. —Preceding unsigned comment added by 216.81.94.72 (talk) 10:17, 5 July 2010 (UTC)

Tapentadol's molecular structure more like a monoamine than a traditional closed triple carbon chain opioid morphinan

It looks more similar in two dimensions to serotonin or dopamine than to morphine or oxycodone, I wonder if this might help ebb a clue to the dependence liability and habituation inherent in the possible similarity between monoamine indirect agonists like cocaine and methamphetamine and opioid mu receptor direct agonists such as heroin and the former mentioned compounds. Nagelfar (talk) 21:14, 22 July 2010 (UTC)

Article severely underdate

First off this article is in severe need of updates by someone well versed in using wiki, but here is what I know. Nagel is right, atleast by wiki standards. In the Tramadol article, Effexor (An SSNRI)is considered to be the most chemically similiar medication to tapentadol on the market. Although trials indicate an efficiacy similiar to but just slightly weaker than oxycodone; there is no up to date information concerning its Mu opiod binding stregnth, except that it has more opiod activity than Tramadol. Its supposedly 18 times weaker than morphine in Mu receptor binding power, puting its actually opiod efficiancy comparable to but slightly less than that of hydrocodone. However, its strong NE properties provide for atleast 1/2 of the pain relief provided by the medication, as well as increasing the euphoria factor. This is indicated by the fact that the FDA made Tapentadol a schedule 2 due to having a liking factor comparable to hydromorphone in animal studies (this has not been confirmed in humans). Phase 3 testing did correctly assign tapentadol to the schedule 3 recommendation, as human traisl concluded this is where the medication should have been placed so this article is correct in indicating that the medication is over scheduled. To further this claim, there are no claims of significant abuse or diversion, and this medication has been out for out a year now. (Keep in mind hydrocodone overall is weaker in efficiancy towards treating pain, and pure hydrocodone is a schedule 2. Therefore another argueable reason that tapentadol is a scehdule 2 is that it is not available as being mixed with APAP, which the FDA might possibly rate a combination product as a schedule 3.) —Preceding unsigned comment added by 216.81.94.73 (talk) 09:31, 2 August 2010 (UTC)

Nucynta is still a schedule 2 and will continue to be for some time

The article is incorrect. Nucynta is NOT being changed to a schedule III and there are no articles to support that it is being officially considered by the FDA/DEA for downgrade. It has been and will continue to be a schedule II drug as it is considered to have a liking factor comparable to another schedule II drug. It is true that evidence so far suggests that tapentadol is abused less than oxycodone, and it is possible that in a few years, a new study will be conducted in light of this evidence. Also, it was removed, but at one point this article had evidence suggesting that Nucynta doesn't activate MOR receptors. Nucynta activates mainly the MOR receptors, but also activates KOR receptors with a lower affinity, and may be selective in which MOR receptors it activates as Tramadol is. For now, I am only removing the portion concerning the class III scheduling, as that is the only 100 percent factually wrong data in this article. —Preceding unsigned comment added by 68.50.133.82 (talk) 00:55, 9 February 2011 (UTC)

Personal Experiences

Because the article was a bit more technical than I was interested in reading, and contradicted my own experience, I thought it would be good to have a personal experiences section.

• After knee surgery specifically a partial patellectomy, I had been on two different doses of hydrocodone, neither of which was adequately controlling my pain, at which point the surgeon switched me to Nucynta. It controlled my pain much better than the hydrocodone, but the side effects were rougher (I've been on hydrocodone three other times in my life). I dried out, inside and out (e.g., constipation, dry skin, constant thirst), suffered from mania (which is eventually what prompted me to stop) and had extreme memory loss (e.g., I don't remember most things that happened for the two weeks that I was taking 75mg or more at every 5 or less hours). I'm glad it was made available, and am equally glad I've reached a point that I don't need it anymore! —Preceding unsigned comment added by 166.70.223.116 (talk) 03:36, 26 October 2010 (UTC)

I am not sure if this is the place to put this, but I thought I'd include my personal experience as well. I am a 26 year old male that has had chronic upper back pain for years. For many years I went without treatment and about two years ago I began seeking treatment. Last May was put on Nucynta 50mg 3 times a day, (after having been on oxycodone, coming off of that was no problem for me by the way) over the course of the next 10 month my dosage was adjusted, the most recent being 75mg 4-5 times a day. I did at one point try Nucynta ER but it was very difficult for my Pharmacy (or any pharmacy in the area) to get, though my insurance did cover it at a copay cost of 30$ a month. I transitioned from the Nucynta to Hydrocodone/acetaminophen 10/325 (Norco) up to six times a day though I typically take 3-5, I am also taking Opana ER 7.5mg at night. The reason for my transition was because I was deeply disturbed with how sedated it made me, I would take it for example, at 12pm, within an hour I'd be incredibly sedated and remain that way until approximately 3 or 4. I would then have 2-3 hours of pain free lucidity but then need the medicine again. Furthermore, in February of 2012 I went away for a few days and forgot my medicine, so I figured I'd be fine for the most part. I realize that I was likely to experience withdrawal, however I had gone on and off of Ativan, Effexor, and Wellbutrin in the past and figured I would be fine. The pain and horrible symptoms I experienced were nothing like I have ever felt, worse then having the swine flu, worse then any other previous medication discontinuation, worse then breaking my nose and wrist, it was simply awful and I thought I was dying. I had to actually be taken to an ER and my doctor called them and they were able to give me a short term Rx. I did find this medication to be effective in pain control, more so then my Norco but, the sedation was more then I could tolerate. Furthermore, I found the withdrawal to to be horrible, while this could have been a result of how long I was on it, I have heard from others that they had similar experiences with coming off of the medicine, and I believe this could be a result of it acting as an SSNRI as well as an opioid antagonist. It makes me wonder if there was sufficient research into its dependency potential and I definitely agree that it was correctly placed in Schedule II of the Controlled Substances Act. Anyway that's my personal experience, I hope it helps someone. — Preceding unsigned comment added by Fjf1085 (talk • contribs) 04:22, 24 April 2012 (UTC)

Nucynta ER

Should there be a section on Nucynta ER as well in this article? Fjf1085 (talk) 04:36, 24 April 2012 (UTC)

Abuse potential section has strong claims without sources

The only source regards simply the fact that tapentadol is placed into Schedule II... The rest of the large chunk of text is unsourced and makes strong, opinionated claims. Please, someone attend to this. I will if it is not fixed soon. Debollweevil (talk) 05:02, 12 May 2011 (UTC)

It was way worse at one point, but I deleted almost everything else, I would argue that the fact that the drug is in Schedule II suggests that it has a high abuse potential similar to the other drugs mentioned as those are the other drugs in that Schedule. What I mean to say is they are not opinionated when the very fact that it is in schedule II indicates that it has a similar abuse profile to the drugs listed, you only need to look at the criteria for being in schedule II and the other drugs in that schedule for evidence. (Fjf1085 (talk) 17:41, 16 May 2012 (UTC))

Seconded, and noting that there has been more than adequate time since Debollweevil's comment for it to be addressed. 99.91.174.127 (talk) 02:02, 18 November 2011 (UTC)

A new single from March 2012 study shows Tapentadol has low abuse as studied over an 18 month period. Can someone whose good with wiki editing please add the information from this article? http://www.drugs.com/clinical_trials/radars-study-indicates-low-rates-abuse-tapentadol-ir-13107.html — Preceding unsigned comment added by 69.140.109.68 (talk) 14:30, 25 March 2012 (UTC)

It is my opinion that this section needs attention from an expert or someone who understands this drug, ie a pharmacist or someone similar. There is still a lot of incomplete information. — Preceding unsigned comment added by Fjf1085 (talk • contribs) 04:25, 24 April 2012 (UTC)

The Nucynta Website is Limited

I suffer with chronic pain from an auto accident and am only 32 years old. I have been on Oxycodone 30mg for 5 years and at 210mg's daily, I suffer with a great deal of side affects. My doctor recommended I take a look at the Nucynta website; I found that the majority of the literature I required was "For Doctor's Only" and the live chat required some type of medical license. I RELY on the information I find on Wikipedia, and would hope that somebody could respond to this one question--Is this medication simply a combination of Tramadol & Cymbalta? --70.127.51.24 (talk) 20:18, 5 June 2010 (UTC)LynnIt'

It's a lot better now (Fjf1085 (talk) 18:03, 16 May 2012 (UTC))

Contraindications

I have added a contraindications section to the page and transfered the contraindications listed by the manufacturer, if anyone has an idea on how to condense them into one or two paragraphs then please take a crack at it. It is rather chunky at the moment. ~~SK~~

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I have also added information on "dosage and availability", and "mechanism of action". Some material from adverse affects has been moved into contraindications as it is more relevant to that topic. ~~SK~~

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If anyone can provide a secondary link regarding tapentadols MoA, as well as possibly beefing up the MoA section a bit, that would be greatly appreciated ~~SK~~

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Added a cost section including info on the manufacturers savings card ~~SK~~ — Preceding unsigned comment added by 65.128.98.95 (talk) 03:31, 9 December 2012 (UTC)

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Added a single paragraph under the new "indications" to keep article format in line with other medication articles ~~SK~~ — Preceding unsigned comment added by 65.128.98.95 (talk) 04:08, 9 December 2012 (UTC)

Conversion

If 1mg of i.v. morphine is equal to 1.8mg of tapentadol in-vitro, wouldn't tapentadol then be converted as [[morphine equivalent]=[tapentadol dose]/[1.8]x[0.32(bioavailability of 32%)]=[tapentadol dose]x[0.6] in vivo?. — Preceding unsigned comment added by 67.6.197.41 (talk) 04:09, 24 August 2017 (UTC)

Perhaps but we need a source that says that -- this is just how Wikipedia rolls. Jytdog (talk) 06:00, 24 August 2017 (UTC)