Complete Guide On How To Taper Off Nucynta (Tapentadol)

Abrupt discontinuation of Tapentadol and other opioids has been associated with severe withdrawal symptoms, uncontrolled pain, and psychological distress. Thus, the key question remains about how to stop Tapentadol intake safely in different populations. Therefore, most interdisciplinary pain clinicians emphasize tapering opioids before completely discontinuing them. 

But does tapering off opiates work? This blog focuses on stopping Tapentadol use, will answer your question, and will give you insight into safe ways to wear off opiates. 

Tapentadol- An Overview

Tapentadol hydrochloride, available as Nucynta and Aspadol, is a novel centrally-acting analgesic with a dual mechanism of action. It is a well-tolerated potential opioid pain medication that is often prescribed for severe acute and chronic pain. It is a preferred choice of pain medication due to its significantly lower risks of gastrointestinal-related side effects. Tapentadol is used to treat post-surgical pain, diabetic neuropathy, fibromyalgia, and other causes of body pain. 

Tapentadol is a recently developed medication and is not available in a generic version. It is retailed only under brand drugs such as Nucynta, Aspadol, and Palexia, to name a few. Aspadol tablets from India are one of the most pocket-friendly brand drugs of Tapentadol while maintaining its efficacy and benefits. 

What Does Tapering Opioids Mean?

Tapering opioids involves gradually decreasing the dose of your pain medication to lower the occurrence of withdrawal symptoms. Tapering is advisable for people taking opioid analgesics for chronic pain for an extended period. 

It is done in various settings, including hospitals (inpatients) or at home (outpatients). However, outpatients require close monitoring by a physician over people undergoing treatment at medical facilities. 

Principles Of Tapering Opioids

The tapering mechanism is complex and more based on experience than scientific evidence. Some of the points to consider while prescribing detox for pain pill withdrawal are-

• Take the complete medical history of the patient

• Educate the patient about the benefits of tapering opioids 

• Prepare them for the upcoming medical changes 

• Evaluate the patient after each reduction of dose over a call or visit them in person.

• Watch for signs of depression, mood change, anxiety, and craving. 

• Prescribe non-opioid analgesic

• Use supportive therapy to avoid Tapentadol pain pill withdrawal. 

Why Taper Off Tapentadol or Nucynta Pain Medication?

Over time, the human body gets used to the compound and may cause withdrawal signs when the administration is stopped abruptly. These are also the frequently reported signs of opioid use disorder. 

Struggling with withdrawal often faces difficulties in managing their opioid intake and may not be able to stop even if they want to.  

Some potential reasons to opt for opioid tapering are [1]-

• Preventing serious adverse effects 

• Lowering the signs of abuse

• If there is a lack of improvement in the condition 

• When the patient requests to discontinue the opioid treatment. 

Who Does It Benefit?

People who should be often considered for tapering opioids are cancer patients and those with migraines and fibromyalgia. Cancer patients are more susceptible to a long-term risk of opioid therapy due to their prolonged use of opioid analgesics to treat various pain symptoms. 

Another population group at a higher risk of Tapentadol recreational use is after a surgical procedure. About 9 to 13% of patients undergoing surgeries are prescribed Tapentadol or other opioids for over 90 days [2]. 

Tapering off Nucynta dosage will also benefit people with a history of addiction and dependency. 

How To Taper Off Nucynta- Tapering Rate And Speed

There is no set rate of tapering determined by the FDA. Studies indicate that 25% of the dose taken the previous day helps prevent pain pill withdrawal symptoms. These calculations are often individualized based on the patient's total daily dose. However, the speed at which it is done can be classified into three parts- ultra-rapid (in 7 days), rapid (in 3 to 4 weeks), and slow, which may take months.

5 Steps To Opioid Tapering

The five steps to taper Nucynta or any other opioid medication are listed below. 

Step 1- Study The Patient's Expectations:

Since our topic of interest is Tapentadol tapering, let us take this opioid analgesic in the scenario. The physician must address their treatment expectations and concerns while exploring patients' readiness to lower their dose. 

Step 2- Review Pain Management Plans:

When the dose of the pain medicines is reduced, patients might experience intense pain. Therefore, effective pain management will help set meaningful goals for self-management, such as Cognitive behavioral therapy (CBT) and Physical therapy. 

Step 3- Develop A Tapering Plan:

When the patients agree to reduce their dose, developing a tapering plan is a primary goal. It should be made taking the patient's expectations, circumstances, and preferences into consideration.

Step 4- Expecting Some Withdrawal Symptoms:

Withdrawal signs while tapering are often visible with a rapid or sudden decrease in the dose. Opting for a gradual approach with regular appointments with a physician for follow-up can minimize the risk. 

Step 5- Seek support:

Tapering can be challenging, and often, patients wish to give up and suffer from relapse. The key reasons most people drop out of the tapering schedule are severe body pain, depression, and opioid use disorder. People at higher risk of dropping out should seek medical assistance to manage their conditions. 

Opioid Taper Calculator- 

The standard Tapentadol immediate-release (IR)  tablet dose is 100mg, which is recommended three to four times daily. It aggregates the total intake up to 300mg to 400mg daily. So, such people must taper off Tapentadol usage in the following way-

It is crucial to note that this calculation for tapering of Tapentadol is done for 400mg and may differ depending on the dose taken [3]. 

Note- You can calculate your tapering doses depending on the strength and the opioid analgesic by clicking on the third reference below. 

Manage Withdrawal Symptoms During Tapentadol Tapering

For managing the signs of Tapentadol withdrawal, using short-term oral medications is advisable. Guidelines recommend taking 0.1 to 0.2 mg of clonidine every 6 hours until the taper is complete. 

Enrolling in supportive therapy, too, is very effective in assisting such concerns. However, treating withdrawal signs with benzodiazepine or other opioids is not advisable.

• The physical withdrawal symptoms usually resolve within 5 to 10 days of dose reduction.

• It may cause psychological withdrawal symptoms such as insomnia and dysphoria.

Tapentadol Tapering Recommendations From Various Organizations

The timeline of tapering Tapentadol varies in people. The following are the tapering recommendations by several organizations [4]-

Department of Veterans Affairs and the Department of Defense-

• Slow dose reduction of 5 to 20% every four weeks.

• A daily reduction of 20 to 50% is recommended for faster tapering. 

Mayo Clinic-

For chronic users- decrease the dose to 10% every 5 to 7 days until 30% of the original dose is reached. Follow this by a weekly decrease of 10%.

CDC-

There is a 10% decrease in the dose per week for chronic users.