The Medical letter on drugs and therapeutics
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The FDA has approved tapentadol hydrochloride (Nucynta--Ortho-McNeil Janssen) for oral treatment of moderate to severe acute pain in patients >18 years old. It has been classified as a Schedule II controlled substance. Tapentadol (Nucynta) is a centrally acting oral analgesic with opioid and adrenergic activity. In studies published to date, it was as effective as oxycodone or morphine with a lower incidence of gastrointestinal adverse effects, but until more data become available, older analgesics are preferred.
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Transdermal fentanyl (Duragesic, and others) offers a convenient delivery system for patients with chronic pain but it has some drawbacks. One is that exposing the patch to heat, either from an external source, increased exertion or possibly high fever, could increase release of the drug, which might lead to an overdose and fatal respiratory depression. A recent article in the NY Times about this problem may have aroused the concerns of some patients using the patches.