Is Tapentadol better than Tramadol?

Tapentadol ® is a new drug developed by Gruenenthal, the company who also developed Tramadol ® and Tramadol ER®. Tapentadol has now been registered and brought to the market (2009) and the question was raised if and in how far Tapentadol® is superior over Tramadol.

95859883-Vitoriaholdingsllc-Dreamstime-INP tramadolIn a mono-author review paper Dr Guay* reviewed the pharmaco dynamics, pharmaco kinetics, clinical efficacy, tolerability, dosing, and administration of Tapentadol. And compared these properties with the classical drug Tramadol, which was the first drug in this class.

The author states that oral Tapentadol hydro chloride (HCl) is the second combination mu-opioid-receptor agonist and monoamine-reuptake inhibitor approved by the Food and Drug Administration (FDA) for treatment of moderate-to-severe acute pain in adults.

Tapentadol was found to be active in a wide variety of pain states and behaved in similar fashion to morphine and hydromorphone in models of dependence.

After reviewing the data the conclusion of the author was:

Tapentadol overcomes some liabilities of Tramadol. However, it still has some liabilities: its potential to contribute to/precipitate serotonin syndrome and anti cholinergic/5-HT3 antagonist effects and to induce physical/psychological dependence (similar to schedule II opioids).

There is also a dearth of information in terms of efficacy/tolerability in chronic pain states, clinical data in frail elders, and details of drug-drug interaction potential vis-à-vis glucuronidation and quantitation of the risk of serotonin syndrome.[1]

The author did not mention the better tolerability profile of Tapentadol, as it emerged in positive way in a variety of trials were compared to classical opioids such as oxycodone.[2][3]

Institute for Neuropathic Pain (INP)

This site helps patients and treating physicians, neurologists, anesthesiologists and other pain specialists to find the best and most up to date research findings related to neuropathy and neuropathic pain and the treatment thereof.

In our Institute we are specialized in treating patients suffering from neuropathic pain and neuropathy following an Integrated Medicine concept. Part of our activities are within the field of consultation. We assist pharmaceutical companies in R&D strategies related to finding new drugs to treat neuropathic pain and neuropathy.

February 2010, Jan M. Keppel Hesselink, MD, PhD.
‘Is Tapentadol better than Tramadol?’

Fractalkine CX3CR1 and neuropathic pain

*= from the department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, USA.

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[1] Guay DR. | Is tapentadol an advance on tramadol? | Consult Pharm. | 2009 Nov;24(11):833-40.

[2] Wade WE, Spruill WJ. | Tapentadol hydrochloride: a centrally acting oral analgesic. | Clin Ther. | 2009 Dec;31(12):2804-18.

[3] Daniels S, Casson E, Stegmann JU, Oh C, Okamoto A, Rauschkolb C, Upmalis D. | A randomized, double-blind, placebo-controlled phase 3 study of the relative efficacy and tolerability of tapentadol IR and oxycodone IR for acute pain. | Curr Med Res Opin. | 2009 Jun;25(6):1551-61.

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