Drug interaction occurs when two medications are taken together, and one medication affects the activity of another. Such interaction can cause changes in the effectiveness, either enhancing or reducing it or causing unanticipated side effects.
Tapentadol can interact with 377 medications, causing 185 major, 191 moderate, and 1 minor drug interactions. It can also interact with alcohol and 14 known health conditions.
Tapentadol has emerged as an effective treatment option for people suffering from moderate to severe body pain. However, like many medications, Tapentadol is not without its complexities. Patients and healthcare professionals need to consider possible drug interactions when starting Tapentadol medication. These drug interactions occur when Tapentadol interacts with other substances or medications, thus altering its effectiveness or causing unexpected side effects.
Summary of Tapentadol & Its Interactions
Tapentadol is an opioid pain medication with a dual mechanism of action that helps manage acute to chronic body pain within 30 minutes of intake. This medication is prescribed when the first line of pain treatment does not provide effective relief.
Generic Tapentadol is retailed only under brand names such as Nucynta, Aspadol, and Palexia.
Tapentadol can interact with 376 drugs, causing 185 major, 191 moderate, and 1 minor drug interactions [1].
Major Drug Interaction Of Tapentadol
Taking Tapentadol with any of these medications may cause central nervous system depression. It can also cause-
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Dizziness
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Drowsiness
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Impaired judgment or confusion
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Motor incoordination
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Blood pressure changes or Increased heart rate
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Fever or Sweating
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Blurry vision
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Nause or vomiting
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Diarrhea
Major drug interactions can lead to serious side effects, including coma, respiratory distress, and even death in severe cases.
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A |
B |
|---|---|
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Acetylcarbromal Alfentanil Almotriptan Alprazolam Amitriptyline Amobarbital Amoxapine Amphetamine Aripiprazole Asenapine |
Baclofen Benzphetamine Brexanolone Brexpiprazole Buprenorphine Bupropion Buspirone Butabarbital Butalbital Butorphanol |
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C |
D |
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Cannabis Cariprazine Carisoprodol Chloral Hydrate Chlordiazepoxide Chlormezanone Chlorphenesin Chlorpromazine Chlorzoxazone Citalopram Clobazam Clomipramine Clonazepam Clorazepate Clozapine Codeine Cyclobenzaprine |
Dantrolene Daridorexant Desipramine Desvenlafaxine Dexfenfluramine Dextroamphetamine Dextromethorphan Dezocine Diazepam (Valium) Diethylpropion Dihydroergotamine Dolasetron Doxepin Doxepin Topical Duloxetine |
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E |
F |
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Eletriptan Ergotamine Escitalopram Esketamine Estazolam Eszopiclone Ethchlorvynol |
Fenfluramine Fentanyl Fluoxetine Fluphenazine Flurazepam Fluvoxamine Frovatriptan Furazolidone |
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G |
H |
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Gabapentin Gabapentin Enacarbil Granisetron |
Halazepam, Haloperidol Heroin, Hydrocodone, Hydromorphone Hydroxyzine |
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I |
L |
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Iloperidone Imipramine Iobenguane I 131 Iohexol Iomeprol Iopamidol Isocarboxazid |
Lasmiditan Lemborexant Levomethadyl Acetate Levomilnacipran, Levorphanol Linezolid, Lisdexamfetamine Lithium, Lorazepam, Lorcaserin, Loxapine Lumateperone, Lurasidone |
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M |
N |
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Ma Huang, Mazindol, Meperidine Mephobarbital, Meprobamate, Mesoridazine Metaxalone, Methadone, Methamphetamine Methocarbamol, Methylene Blue, Metrizamide Milnacipran, Mirtazapine, Molindone, Morphine Morphine Liposomal |
Nalbuphine Naltrexone Naratriptan Nefazodone Nortriptyline |
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O |
P |
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Olanzapine Oliceridine Ondansetron Orphenadrine Oxazepam Oxycodone Oxymorphone |
Paliperidone, Palonosetron Paraldehyde, Paroxetine, Pentazocine Pentobarbital, Perphenazine, Phendimetrazine Phenelzine, Phenobarbital, Phentermine Phenylpropanolamine, Pimavanserin Pimozide, Pregabalin, Primidone Procarbazine, Promazine, Propiomazine Propoxyphene, Protriptyline |
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Q |
R |
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Quazepam Quetiapine |
Ramelteon, Rasagiline, Remifentanil Remimazolam, Risperidone, Rizatriptan |
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S |
T |
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Safinamide Secobarbital Selegiline Sertraline Sibutramine Sodium Oxybate St. John's Wort Sufentanil Sumatriptan Suvorexant |
Tasimelteon Temazepam Thioridazine Thiothixene Tizanidine Tramadol Tranylcypromine Trazodone, Triazolam ,Trifluoperazine Triflupromazine, Trimipramine Tryptophan |
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V |
Z |
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Venlafaxine Vilazodone Vortioxetine |
Zaleplon Ziprasidone Zolmitriptan, Zolpidem |
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5-Hydroxytryptophan |
Tapentadol and Cannabis
Studies show that taking cannabis with Tapentadol can have a therapeutic effect in managing chronic pain. Both substances have depressant effects. Hence, when combined, they can cause extreme sedation, decreased brain function, low blood pressure, and death [2].
Tapentadol and Valium
One of the common major drug interactions is taking Tapentadol and Valium together, which may result in serious central nervous system depression, coma, respiratory distress, and death in severe cases.
Tapentadol and 5-Hydroxytryptophan
Taking 5-Hydroxytryptophan with Tapentadol is not recommended as co-administering them together can increase the risk of Serotonin syndrome. This condition occurs when serotonin levels increase, causing rapid heartbeat, confusion, muscle stiffness, sweating, and shaking. In severe cases, it can lead to seizures, coma, or even death.
(5-Hydroxytryptophan or 5-HTP are natural substances made in the body from protein building blocks called Tryptophan. 5-HTP medications help the brain to produce serotonin that is responsible for regulating sleep, mood, depression, or anxiety.)
Tapentadol and Monoamine oxidase inhibitors
Furthermore, when Tapentadol is used with antidepressants or Monoamine oxidase inhibitors (MAOIs), it can cause Serotonin Syndrome. A minimum gap of 14 days should be maintained before starting Tapentadol dosage.
Activities requiring mental alertness and awareness, such as operating heavy machinery and driving, are not advisable while taking Tapentadol.
Moderate Drug Interaction
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A |
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Acrivastine, Albuterol, Aldesleukin Amifampridine, Apomorphine Apraclonidine Ophthalmic Arformoterol, Atropine Azatadine, Azelastine Nasal |
Using Tapentadol with any of these medications can cause dizziness, difficulty concentrating, confusion, and drowsiness. Elderly people may further experience impairment of motor coordination, thinking, and judgment ability. On the other hand, taking Arformoterol with Tapentadol seems to increase heart rate and blood pressure in particular. |
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B |
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Baricitinib, Belladonna, Benztropine Biperiden, Bitolterol, Brimonidine Ophthalmic Brimonidine Topical, Brivaracetam Bromocriptine, Brompheniramine |
Taking Tapentadol with Baricitinib can increase the risk of gastrointestinal perforation(a condition where a hole is formed in the stomach or intestine). Other moderately interacting medications, when taken with Tapentadol, can cause drowsiness, dizziness, dry mouth, constipation, difficulty urinating, and abdominal cramping. |
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C |
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Cannabidiol, Carbamazepine, Carbetapentane, Carbinoxamine, Cenobamate, Cetirizine, Chlophedianol, Chlorcyclizine, Chlorpheniramine Clemastine, Clidinium, Clonidine, Clopidogrel, Cyclizine, Cyproheptadine |
Tapentadol may lower the effectiveness of Clonidine when taken together. Thus, it may require frequent monitoring and dosage adjustment. Tapentadol may further reduce the potency and blood level of Clopidogrel. |
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D |
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Darifenacin, Desmopressin, Deutetrabenazine Dexbrompheniramine, Dexchlorpheniramine, Dexmedetomidine Dicyclomine, Difelikefalin, Dimenhydrinate, Diphenhydramine Dipivefrin Ophthalmic, Divalproex Sodium, Dobutamine Dopamine, Doxylamine, Dronabinol, Droperidol |
Tapentadol can increase the effects of Desmopressin, thus increasing the risk of water retention and hyponatremia ( a condition caused by an abnormal decrease in sodium concentration). Dipivefrin ophthalmic, when taken with Tapentadol, can increase the risk of higher blood pressure and heart rate. Coadministration with Tapentadol can also cause unsteadiness, falls, and somnolence. |
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E |
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Eluxadoline, Entacapone, Ephedrine, Ephedrine Nasal, Epinephrine, Epinephrine Ophthalmic, Epinephrine Topical, Eslicarbazepine, Ethanol, Ethosuximide, Ethotoin, Ezogabine |
Taking Tapentadol with Eluxadoline can increase the risk of constipation and other gastrointestinal complications. |
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F |
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Felbamate, Fesoterodine, Flavoxate, Flibanserin, Formoterol, Fosphenytoin |
Dizziness, Drowsiness, Confusion, and Difficulty Concentrating. |
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G |
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Ganaxolone, Ginkgo, Glycopyrrolate |
Along with common health risks, taking Tapentadol with Ginkgo biloba can cause seizures. |
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H |
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Hydroxyamphetamine Ophthalmic, Hyoscyamine |
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I |
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Ifosfamide Indacaterol Indocyanine Green, Iobenguane I 123 Isoetharine, Isoproterenol |
Tapentadol can also decrease the absorption of indocyanine green (the dye used in medical diagnostics) thus affecting the result of your test. Iobenguane I-123 is a radioactive agent used to find cancer cells in the body. Its use with Tapentadol can interfere with its imaging studies. Thus, it is important to inform your doctor before scheduling an imaging procedure. |
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K |
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Kava Ketamine |
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L |
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Lamotrigine Levalbuterol Levetiracetam, Levmetamfetamine Nasal, Levocetirizine Levodopa, Lindane Topical, Lofexidine |
These, when taken with Tapentadol, can result in drowsiness, difficulty concentrating, dizziness, and confusion. Levalbuterol and Tapentadol together can cause hypertension and faster heartbeat. The risk of seizures with lindane topical can increase when taken with Tapentadol. |
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M |
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Maprotiline, Mebrofenin, Meclizine, Melatonin, Mepenzolate, Mephentermine, Mephenytoin, Metaproterenol, Metaraminol, Methdilazine, Methohexital, Methotrimeprazine, Methoxamine, Methscopolamine, Methsuximide, Metoclopramide, Metyrosine, Midazolam, Midodrine |
Mebrofenin is used in imaging techniques. Using Tapentadol with mebrofenin may interfere with the process, producing false reports. Tapentadol may reduce the dosage of methohexital, which is necessary to induce anesthesia. |
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N |
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Nabilone, Naloxone, Naphazoline Nasal Naphazoline Ophthalmic, Norepinephrine |
The use of naloxone can block the effects of Tapentadol, thus making the medication less effective. In long-term use, Naloxone can result in causing withdrawal symptoms. |
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O |
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Olodaterol, Olopatadine Nasal, Opicapone, Opium, Oxcarbazepine, Oxybutynin Oxymetazoline Nasal, Oxymetazoline Ophthalmic, Oxymetazoline Topical, Ozanimod |
Th intake of Tapentadol with Ozanimod can increase blood pressure, resulting in a condition called hypertensive crisis. It may also increase the risk of serotonin syndrome. |
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P |
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Paramethadione, Pegvisomant, Perampanel, Pergolide, Phenacemide, Phenindamine, Phensuximide, Phenylephrine, Phenylephrine Nasal, Phenylephrine Ophthalmic, Phenylephrine Topical, Phenytoin, Pirbuterol, Polyethylene Glycol 3350 With Electrolytes, Pramipexole, Prasugrel, Prochlorperazine, Procyclidine, Promethazine, Propantheline, Propylhexedrine Nasal, Pseudoephedrine, Pyrilamine |
Tapentadol intake can reduce the potency of pegvisomant. Further, it may reduce the concentration of pegvisomant in the blood. |
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R |
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Racepinephrine, Ritodrine, Ropeginterferon Alfa-2b Ropinirole, Rotigotine, Rufinamide |
Co-administering Tapetadol with anxiety medication such as Ropeginterferon Alfa-2b can increase the risk of the nervous system and psychiatric side effects. |
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S |
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Salmeterol, Scopolamine, Sodium Polystyrene Sulfonate Solifenacin, Solriamfetol, Stiripentol |
When Tapentadol and sodium polystyrene sulfonate are taken together, it commonly results in constipation, thus increasing the risk of intestinal problems such as ischemic colitis (inflammation of the intestine), bleeding, necrosis (death of cells and tissues in the intestine), and perforation. Additional risks include prematurity (infants), dehydration, and impaired kidney function. |
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T |
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Terbutaline, Tetrabenazine, Tetrahydrozoline Nasal, Tetrahydrozoline Ophthalmic, Thalidomide, Thiethylperazine, Thiopental, Tiagabine, Ticagrelor, Tirzepatide, Tofacitinib, Tolcapone, Tolterodine, Topiramate, Trihexyphenidyl, Trimeprazine, Trimethadione, Trimethobenzamide, Tripelennamine, Triprolidine, Trospium |
Tapentadol can reduce the dosage of thiopental in the body, which is needed to induce anesthesia. Tirzepatide can affect the absorption of Tapentadol in the body. This may further affect the time needed for Tapentadol to start working or become effective. Ingesting Tofacitinib with Tapentadol may increase the chances of experiencing gastrointestinal perforation. |
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U |
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Upadacitinib |
Risk of gastrointestinal perforation. |
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V |
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Valbenazine, Valerian, Valproic Acid, Vigabatrin. |
Tapentadol, when taken with these medications, can cause drowsiness, dizziness, difficulty concentrating, and confusion. |
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X |
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Xylometazoline Nasal |
Can increase heart rate and blood pressure. |
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Z |
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Ziconotide, Zonisamide, Zuranolone |
Increases the risk of sedation along with other common central nervous system side effects such as drowsiness, confusion, dizziness, and lack of concentration. |
Minor Drug Interaction Of Tapentadol
Tapentadol can cause minor drug interaction with evening primrose, a health supplement that is used to treat acne and high blood pressure. When administered together, it can cause central nervous system side effects such as dizziness and drowsiness.
Tapentadol And Alcohol
Tapentadol should not be taken with alcohol as doing so can result in the following consequences.
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They suppress the central nervous system more than they alone.
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Taking Tapentadol with Alcohol increases the risk of sedation.
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Causes a decrease in heart rate and blood pressure.
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Combining them can result in respiratory depression.
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These interactions also increase the chance of experiencing dizziness, drowsiness, confusion, impaired coordination, and loss of consciousness.
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It further increases the risk of overdosing, which in severe cases can be fatal [3].
Tapentadol Disease Interactions
Tapentadol has fourteen disease interactions, as shown in the table below.
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Condition |
Severity of Interaction |
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Impaired GI motility |
Major Interaction Tapentadol can increase the smooth muscle tone in the gastrointestinal tract, thus increasing the risk of constipation, spasms, and intraluminal pressure. However, in patients with severe or acute inflammatory bowel disease, it can result in a toxic megacolon (colon dilation). |
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Infectious diarrhea |
Major Interaction Tapentadol can worsen diarrhea associated with infections that invade the intestinal mucosa. |
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Liver disease |
Major Interaction Since Tapentadol is metabolized in the liver, liver diseases may affect its metabolic activity and onset of action. |
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Prematurity |
Major Interaction The use of Tapentadol is not recommended for premature infants. |
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Acute alcohol intoxication |
Major Interaction Its use is contraindicated in people with alcohol intoxication as it may result in central nervous system depression. |
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Drug Dependence |
Major Interaction People with a history of drug dependency are at a higher risk of experiencing addiction to Tapentadol. It may also result in cross-tolerance with other agents in the same drug class. |
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Gastrointestinal Obstruction |
Major Interaction Its use is not recommended in patients with gastrointestinal obstruction, including paralysis of the intestines. |
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Hypotension |
Major Interaction Tapentadol use can induce vasodilation and hypotension when administered in a higher dosage. |
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Intracranial pressure |
Major Interaction Its use in patients with head injury or intracranial pressure is not advisable as it can affect the CNS functioning of the patient, especially affecting their pupillary changes, consciousness levels, and respiratory status. |
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Respiratory depression |
Major Interaction Tapentadol can cause severe respiratory depression when taken in higher doses. Thus, its use is not advisable for people with preexisting pulmonary impairment. |
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Biliary Spasm |
Moderate Interaction People suffering from Biliary Obstruction, acute pancreatitis, and Gallbladder disorder should take Tapentadol with medical supervision as they may suffer from biliary spasms. |
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Renal Dysfunction |
Moderate Interaction Suffering from renal impairment can affect the elimination rate of Tapentadol, thus resulting in drug accumulation and increased toxicity. Thus, renal patients must take the medication with caution. |
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Seizure disorders |
Moderate Interaction The use of Tapentadol may exacerbate the possibility of seizure in patients when taken at a higher dosage. |
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Urinary Retention |
Moderate Interaction Tapentadol may affect urine passage in elderly people. They also decrease the urine production. |
Strategies To Minimize The Risk
A few effective ways to minimize the risk of Tapentadol drug interaction include-
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Know your medication and understand the formulation list of Tapentadol and how it works to avoid interactions.
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Taking the prescribed Tapentadol dosage and avoiding misuse or overdosing on the medication.
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Refrain from taking other medications or supplements with Tapentadol without consulting a doctor.
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If you have any preexisting disease or health issues, consult with your healthcare professional before taking Tapentadol.
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Stay informed about the correct dosage and administration guidelines for taking Tapentadol.
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Avoid buying Aspadol or the other brand drugs of Tapentadol such as Nucynta and Palexia from unreliable sources.