Dual-action painkiller launched, as alternative to oxycodone
A new oral, dual-action painkiller is available this week for the treatment of adults with severe chronic pain, such as osteoarthritis (OA), lower back and cancer pain, which can only be adequately managed with opioid analgesics. Tapentadol prolonged release (Palexia SR) is a centrally acting analgesic that works as a µ-opioid receptor agonist and through noradrenaline reuptake inhibition. It is being marketed by Grünenthal as a Schedule 2 Controlled Drug.
Tapentadol prolonged release (Palexia SR) is a centrally acting analgesic that works as a µ-opioid receptor agonist and through noradrenaline reuptake inhibition. It is being marketed by Grünenthal as a Schedule 2 Controlled Drug.
In phase III trials of 3,000 patients with chronic OA or low back pain, twice daily tapentadol PR 100-250mg had comparable analgesic efficacy to twice daily oxycodone CR 20-50mg, but had better gastrointestinal tolerability (constipation, nausea and vomiting). Fewer patients in the tapentadol group discontinued treatment than in the oxycodone group (43.5 per cent vs 61.7 per cent).
According to Grünenthal, the cost of tapentadol PR is comparable to oxycodone CR at usual daily doses.
Roger Knaggs, advanced pharmacy practitioner in anaesthesia and pain management, at Nottingham University Hospitals NHS Trust, predicted that, in patients who do not respond sufficiently to morphine, or experience unacceptable side effects, tapentadol will be a useful alternative second-line treatment to oxycodone and fentanyl.
“In non-cancer pain indications, side effects tend to be a bigger issue with opioid analgesics than lack of efficacy, as patients may need treatment for long periods. The side effect data with tapentadol are quite persuasive. But we now need health economic data to show whether the lower level of gastrointestinal effects leads to cost savings from reduced need for anti-emetics and laxatives which are commonly prescribed for patients on strong opioids,” explained Mr Knaggs.
The Scottish Medicines Consortium is expected to issue advice on the use of tapentadol in June 2011, but no guidance in currently in development from the National Institute for Health and Clinical Excellence.
Action: Strong analgesic with µ-agonistic opioid and additional noradrenaline reuptake inhibition properties.
Dose: Tapentadol SR should be started with single 50mg doses administered orally twice daily, approximately every 12 hours in patients who are not taking another opioid analgesic. Tapentadol film-coated tablets should be given in 50mg doses administered orally every 4–6 hours.
NHS list price: Tapentadol SR: 50mg x 28, £12.46; 50mg x 56, £24.91; 100mg x 56, £49.82; 150mg x 56, £74.73; 200mg x 56, £99.64; 250mg x 56, £124.55.