new opioid analgesic called Nucynta (new-SINN-tah, tapentadol)

You'll see ads for a new opioid analgesic called Nucynta (new-SINN-tah, tapentadol)...for moderate to severe acute pain.

It's an opioid agonist and norepinephrine reuptake inhibitor...similar to tramadol (Ultram, etc).

But Nucynta is stronger and will be a C-II controlled substance.

Nucynta 100 mg works about as well as oxycodone 15 mg...but with a slightly different side effects profile.

Expect Nucynta to cause at least as much drowsiness and dizziness as oxycodone...but probably less constipation, nausea, and vomiting.

Also expect Nucynta to cause fewer drug interactions than tramadol...because it isn't metabolized by CYP2D6 or CYP3A4.

Nucynta has warnings about serotonin syndrome...but explain this is mainly just theoretical. Be watchful if Nucynta is combined with serotonergic drugs such as SSRIs, SNRIs, and triptans.

On the other hand, Nucynta DOESN'T have the same seizure warnings as tramadol. But it has not been studied in patients at risk for seizures...so be careful when using it in these patients.

Nucynta comes in 50, 75, and 100 mg tablets. Recommend starting at 50 mg every 4 to 6 hours for most patients.

Advise patients that if the first dose isn't adequate they can take another tablet an hour afterwards. But tell them not to take more than 700 mg on the first day or 600 mg/day thereafter.

Nucynta will cost about the same as other BRANDED opioids...and significantly more than generic oxycodone or tramadol.

Consider Nucynta in special situations...for patients who need a stronger opioid like oxycodone but can't tolerate the GI effects.

• Other: New Drug: Nucynta (Tapentadol)