Nucynta Tablet: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Nucynta Tablet contains tapentadol hydrochloride, an opioid analgesic used to manage moderate to severe pain. It is available as extended-release tablets for long-term, around-the-clock pain control and as immediate-release tablets for acute pain. Nucynta works by acting on nerve cells in the spinal cord and brain to reduce pain signals. It carries risks of addiction, misuse, and serious breathing problems, so it should be used exactly as prescribed.

What is Nucynta Tablet

Nucynta is a painkiller belonging to the class of medicines known as opioids, which includes codeine, fentanyl, morphine, and oxycodone. It relieves pain by acting on specific nerve cells of the spinal cord and brain.

Nucynta Tablet uses

• Management of pain severe enough to require daily, continuous, long-term opioid treatment (extended-release) that is opioid-responsive and for which alternative treatment options are inadequate
• Management of moderate to severe acute pain in adults (immediate-release)
• Management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate, in adults and pediatric patients 6 years and older weighing at least 40 kg (immediate-release tablets)

Benefits of Nucynta Tablet

• Provides pain relief for moderate to severe pain when other treatments are not adequate or tolerated
• Extended-release form provides around-the-clock continuous pain control for long-term opioid-responsive pain
• Immediate-release form provides relief of acute pain such as after surgery

How Nucynta Tablet works

Nucynta relieves pain by acting on specific nerve cells in the spinal cord and brain. It is thought to work as a mu-opioid receptor agonist and by blocking the reuptake of norepinephrine, both of which help reduce pain signals.

Nucynta Tablet dosage

Swallow tablets whole with enough liquid; do not cut, break, crush, chew, divide, or dissolve them, as this can release too much of the drug into your body at once and cause a dangerous or fatal overdose. Extended-release tablets can be taken with or without food and are usually taken about every 12 hours. Immediate-release tablets can be taken with or without food and are usually taken every 4 to 6 hours as needed for pain, exactly as prescribed. Do not take extra tablets or a double dose to make up for a missed dose. In elderly patients, treatment is usually started at the low end of the dosing range because of a higher chance of reduced liver, kidney, or heart function. Extended-release tablets are not recommended for use in patients under 18 years of age. Do not adjust your dose without talking to your doctor first. If you have been taking this medicine regularly, do not stop taking it suddenly without your doctor's guidance, since stopping abruptly can cause withdrawal symptoms.

Available forms and strengths

• Extended-release tablets (50 mg, 100 mg, 150 mg, 200 mg, 250 mg)
• Immediate-release tablets (50 mg, 75 mg, 100 mg)
• Oral solution (20 mg/mL)

Side effects of Nucynta Tablet

Common

• Nausea
• Dizziness
• Constipation
• Headache
• Somnolence (sleepiness)
• Vomiting
• Dry mouth
• Fatigue
• Insomnia
• Itching (pruritus)
• Sweating (hyperhidrosis)
• Decreased appetite
• Anxiety
• Hot flush

Serious

• Life-threatening or fatal respiratory depression (slow, shallow, or weak breathing)
• Allergic reaction/anaphylaxis (rash, hives, swelling of face, lips, tongue, or throat, difficulty breathing or swallowing)
• Seizures
• Serotonin syndrome (agitation, hallucinations, fever, fast heart rate, muscle stiffness, twitching, loss of coordination, diarrhea)
• Severe low blood pressure (dizziness, fainting, lightheadedness)
• Adrenal insufficiency (nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, low blood pressure)
• Bowel blockage (impaction) with abdominal pain, severe constipation, nausea
• Opioid withdrawal symptoms (nausea, vomiting, diarrhea, anxiety, shivering, body aches, sweating)
• Fast, slow, or irregular heartbeat (palpitations)
• Overdose symptoms (hallucinations, confusion, inability to walk normally, slow or weak breathing, extreme sleepiness, floppy muscles, cold and clammy skin)
• Neonatal opioid withdrawal syndrome in infants born to mothers who used this medicine during pregnancy

Warnings and precautions

• Even when taken as prescribed, Nucynta carries a risk of opioid addiction, abuse, and misuse that can lead to overdose and death.
• Serious, life-threatening breathing problems can occur, especially when starting the medicine or after a dose increase.
• Taking even one dose accidentally, especially by a child, can cause a fatal overdose.
• Using Nucynta with other opioids, benzodiazepines, alcohol, or other central nervous system depressants can cause severe drowsiness, breathing problems, coma, and death.
• Nucynta tablets must be swallowed whole; cutting, breaking, chewing, crushing, or dissolving them can cause a rapid, potentially fatal release of the drug.
• Taking Nucynta during pregnancy can cause life-threatening withdrawal symptoms in the newborn baby.
• Nucynta may increase the risk of seizures, particularly at higher than recommended doses or when combined with certain other medicines.
• Combining Nucynta with certain antidepressants or migraine medications may cause serotonin syndrome, a rare but potentially life-threatening condition.
• Nucynta extended-release should not be used during pregnancy or before or during labor, as it may cause life-threatening withdrawal symptoms in the newborn. 
• The immediate-release form and oral solution may cause similar issues if used for an extended period during pregnancy.
• Breastfeeding is not recommended while taking Nucynta because the medicine may pass into breast milk and cause serious breathing problems in a nursing infant.
• Nucynta should not be used in people with severe kidney impairment. No dose adjustment is needed for mild or moderate kidney impairment.
• Nucynta should not be used in people with severe liver impairment, and should be used with caution and possibly a reduced dose in people with moderate liver impairment.
• Drinking alcohol while taking Nucynta should be avoided, as it can increase drowsiness and the risk of dangerous or fatal breathing problems.
• Nucynta can cause drowsiness, dizziness, or lightheadedness that may affect your ability to drive or operate machinery safely, especially when starting treatment or after a dose change.

Storage

• Store at 15-30°C (59-86°F)
• Keep in a dry place
• Keep out of the sight and reach of children and pets, and store under lock in a secure place to prevent theft, misuse, or accidental exposure
• Do not use this medicine in front of children, since they may copy this action
• Do not use after the expiry date
• Never dispose of unused or expired tablets in household trash; return them to a pharmacy for proper disposal, or flush unused medication down the toilet if a take-back option is not available

When to see a doctor

• Get emergency medical help right away if your baby shows signs of withdrawal after birth, such as breathing changes, being unusually hard to comfort, tremors, or increased stools, sneezing, yawning, vomiting, or fever.
• Stop taking the medicine and get immediate medical help if you have symptoms of an allergic reaction such as rash, hives, swelling of the face, lips, tongue, or throat, or difficulty breathing or swallowing.
• Stop taking the medicine and get immediate medical help for signs of an overdose, including hallucinations, confusion, trouble walking, slow or weak breathing, extreme sleepiness, floppy muscles, or cold and clammy skin.
• Get immediate medical help for signs of respiratory depression such as slow, shallow, or weak breathing.
• Stop taking the drug and seek medical help right away if you have a seizure while on this medicine.
• If you think you have taken too much Nucynta, contact your healthcare professional, hospital emergency department, or your local poison control center immediately, even if there are no symptoms.
• Seek medical attention if you experience symptoms of serotonin syndrome, including fever, sweating, shivering, diarrhea, muscle twitching or stiffness, fast heartbeat, confusion, or agitation.

Alternatives

• Oxycodone controlled-release
• Acetaminophen
• Ibuprofen
• Tramadol
• Nucynta IR (immediate-release)