What Is Nucynta?
Nucynta (tapentadol) is an oral prescription drug used in adults to treat severe pain for a short period when other medication is ineffective or cannot be tolerated.
Nucynta is available as a tablet that is taken by mouth. There is also an extended-release form of Nucynta, called Nucynta ER, which is used long term in people who need consistent pain control.
Nucynta is in a drug class called opioid pain medications, or opioid analgesics. An analgesic is a drug that relieves pain. The exact way Nucynta works is not entirely understood, but it is thought to relieve pain by working on certain receptors in the brain.
Drug Facts
Generic Name: Tapentadol
Brand Name(s): Nucynta, Nucynta ER
Drug Availability: Prescription
Therapeutic Classification: Opioid analgesic (opioid pain reliever)
Available Generically: No
Controlled Substance: Schedule II
Administration Route: Oral
Active Ingredient: Tapentadol
Dosage Form(s): Tablet, extended-release tablet
What Is Nucynta Used For?
The Food and Drug Administration (FDA) approved Nucynta to manage acute (short-term) pain that is severe enough to need opioid pain medication and when other treatments are not effective or not tolerated.
Nucynta is classified as a controlled substance, meaning it has the potential for abuse and dependence, also known as addiction, which is now commonly referred to as substance use disorder. Substance use disorder is when alcohol or drug use leads to an inability to stop using the substance, as well as health issues and problems at home, school, or work.
Because of these risks, Nucynta should only be used when other non-opioid medications are not effective or not tolerated (or are not expected to be effective or tolerated).
How to Take Nucynta
Once you have received Nucynta from the pharmacy, read the prescription label and the information leaflet with your prescription. Consult your healthcare provider if you have any questions. Use Nucynta exactly as directed by your provider. Do not change your dose. Your healthcare provider will prescribe the lowest possible dose for the shortest time needed. Contact your healthcare provider if your Nucynta dose does not control your pain.
There are a few considerations to keep in mind when taking Nucynta, including the following:
- Once you start to take Nucynta regularly, do not stop taking Nucynta without consulting your healthcare provider.
- Nucynta can cause you to feel tired, dizzy, and light-headed. Do not drive or operate machinery until you know how Nucynta affects you.
- Using alcohol or products that contain alcohol with Nucynta can cause an overdose and death. Do not drink alcohol or use medications that contain alcohol, such as certain cough syrups. Ask your provider or pharmacist before taking any other medications.
- Talk to your healthcare provider about naloxone. Naloxone is a medication that works as an emergency treatment for an opioid overdose. You can get naloxone (such as Narcan nasal spray) at any pharmacy with or without a prescription. However, if you get a prescription for it, your insurance will usually pay for a portion of it.
- Do not take Nucynta with other opioid medications, anxiety medications, alcohol, or other central nervous system (CNS) depressants. The combination could cause severe drowsiness, breathing problems, coma, and death.
- Selling or giving away Nucynta is against the law. Never give anyone your medication. Someone else could die from taking even one dose of Nucynta.
Call 911 immediately if you take too much Nucynta.
Storage
Store Nucynta at room temperature, around 77 degrees Fahrenheit. Because it is a controlled substance, Nucynta should be securely stored and kept out of sight and out of reach of children and pets. Leaving Nucynta unsecured can be a deadly risk to anyone in the home.
Do not keep any extra Nucynta tablets once you finish your prescription. Just one dose can cause death in someone who uses this medicine accidentally or improperly. The best option is to find a drug take-back center. If that option is not available, flush the tablets down the toilet.
How Long Does Nucynta Take to Work?
A dose of Nucynta reaches its maximum levels in about one hour and 15 minutes. Nucynta is generally prescribed to be taken every four to six hours to maintain pain relief.
What Are the Side Effects of Nucynta?
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
The most common side effects of Nucynta are:
- Stomach problems such as nausea, vomiting, constipation, and indigestion
- Dizziness
- Headache
- Sleepiness
- Dry mouth
- Itching
- Excess sweating
- Trouble sleeping or staying asleep
- Appetite loss
- Weakness
- Lack of energy and motivation
- Hot flashes
- Vertigo (dizzy, spinning sensation)
- Anxiety
Severe Side Effects
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
- Hypersensitivity reaction or anaphylaxis: Symptoms of a reaction to Nucynta can include trouble breathing, rash, hives, chest pain, fast heartbeat, and swelling of the lips, tongue, and face. These symptoms require emergency medical attention.
- Respiratory depression/respiratory arrest: Opioids such as Nucynta can cause your breathing to slow (respiratory depression) or stop (respiratory arrest). Your loved ones and/or caregivers should monitor you and give naloxone and get emergency medical help if you have slow breathing with long pauses in between breaths, blue lips, or if you are hard to wake up.
- Apnea: Call your healthcare provider if you are snoring or gasping during sleep. Sometimes a loved one will tell you that you stopped breathing in your sleep. Report these symptoms right away.
- Serotonin syndrome: This is a life-threatening condition that can occur from the buildup of excess serotonin. Symptoms include agitation, hallucinations, fever, fast heart rate, stiff muscles, twitching, nausea, diarrhea, or loss of coordination.
- Severely low blood pressure: Symptoms may include dizziness, light-headedness, or feeling like you may pass out.
- Bradycardia: This is a slowed heart rate. Symptoms may include chest pain, dizziness, or fatigue.
- Increased intracranial pressure: This is an increased pressure in the brain that can cause death. If you have symptoms of headache, vomiting, blurred vision, or weakness, get emergency help right away.
- Paralytic ileus: This is when the intestines are blocked and do not allow food to pass through. Symptoms include nausea, vomiting, bloating, and gas.
- Seizures
- Hallucinations
- Adrenal insufficiency: This is when the adrenal glands do not make enough hormones. Symptoms may include nausea, vomiting, appetite loss, tiredness, weakness, dizziness, and low blood pressure. Adrenal insufficiency will generally require treatment with steroid medicine.
- Substance use disorder
Long-Term Side Effects
While many people tolerate Nucynta well, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:
- Appetite and weight loss
- Anxiety
- Excess sweating
- Weakness
- Irritability
- Numbness and tingling
- Decreased sense of touch or sensation
- Cough
- Sore throat/infection
- Decreased libido (loss of interest in sex)
- Absence of monthly periods
- Reduced fertility (lower chances of getting pregnant)
Moderate long-term side effects can include:
- Constipation
- Slurred speech
- Memory problems
- Depression
- Impotence (inability to get or maintain an erection)
- Orthostatic hypotension (low blood pressure when standing up from a sitting or lying down position)
- Substance use disorder
- Infertility
- Low sodium levels
- Adrenal insufficiency
Severe long-term side effects may include:
- Seizures
- Neonatal opioid withdrawal syndrome
- Serotonin syndrome
- Suicidal thoughts
Report Side Effects
Nucynta may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Dosage: How Much Nucynta Should I Take?
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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
-
For oral dosage form (extended-release tablets):
-
For severe pain:
-
Patients switching from Nucynta® to Nucynta® ER:
- Adults—The tablet is given every 12 hours. The total amount of milligrams (mg) per day is the same as the total amount of regular tapentadol that is taken per day. The total amount per day will be divided and given as 2 divided doses during the day. However, the dose is usually not more than 500 mg per day.
- Children—Use and dose must be determined by your doctor.
-
Patients who are not taking narcotic medicines:
- Adults—At first, 50 milligrams (mg) 2 times a day (every 12 hours). Your doctor may adjust your dose as needed. However, the dose is usually not more than 500 mg per day.
- Children—Use and dose must be determined by your doctor.
-
Patients switching from other narcotic medicines:
- Adults—The tablet is given every 12 hours. The total amount of milligrams (mg) per day will be determined by your doctor and depends on which narcotic you were using. The total amount per day will be divided and given as 2 divided doses during the day. However, the dose is usually not more than 500 mg per day.
- Children—Use and dose must be determined by your doctor.
-
Patients switching from Nucynta® to Nucynta® ER:
-
For nerve pain caused by diabetes:
- Adults—At first, 50 milligrams (mg) 2 times a day (every 12 hours). Your doctor may adjust your dose as needed. However, the dose is usually not more than 500 mg per day.
- Children—Use and dose must be determined by your doctor.
-
For severe pain:
-
For oral dosage form (immediate-release tablets):
-
For moderate to severe pain:
- Adults—At first, 50 to 100 milligrams (mg) every 4 to 6 hours. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
-
For moderate to severe pain:
-
For oral dosage form (solution):
-
For moderate to severe pain:
- Adults—At first, 2.5 milliliters (mL) (50 milligrams [mg]), 3.75 mL (75 mg), or 5 mL (100 mg) every 4 to 6 hours. On the first day of dosing, the second dose may be given as soon as 1 hour after the first dose, if pain is not relieved with the first dose. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
-
For moderate to severe pain:
-
For oral dosage form (tablets):
-
For moderate to severe pain:
- Adults—At first, 50 to 100 milligrams (mg) every 4 to 6 hours. On the first day of dosing, the second dose may be given as soon as 1 hour after the first dose, if pain is not relieved with the first dose. Your doctor may adjust your dose as needed.
- Children—Use and dose must be determined by your doctor.
-
For moderate to severe pain:
Modifications
In some cases, your treatment regimen or dose with Nucynta may need to be changed. Healthcare providers may consider factors such as age, pregnancy, and certain health conditions when prescribing you this medication.
Age
Nucynta should be used with caution in older adults (65 years or older), especially in those with kidney problems. Dosing in older adults should be cautious and start on the lower end of the dosing range. Your healthcare provider may increase the dosage slowly and closely monitor you while doing so. Nucynta is not approved for use in children and teenagers under 18 years old.
Pregnancy or Breastfeeding
People who are pregnant should consult their healthcare provider. Using opioids such as Nucynta for a prolonged time during pregnancy can cause a life-threatening condition in the baby called neonatal opioid withdrawal syndrome. Speak with your healthcare provider if you are planning to become pregnant. Using opioids can affect fertility in women and men for some time, and it is unknown whether these effects are reversible after stopping the medication. People who are breastfeeding should consult their healthcare provider.
Kidney or Liver Problems
Nucynta should not be used in people with severe kidney or liver problems. People with moderate liver problems will generally require a lower dosage of Nucynta.
Missed Dose
Because Nucynta is used for pain, it is unlikely that you will miss a dose. However, if you do miss a dose, skip the missed dose if it is almost time for the next dose. Do not take extra medicine to try to make up a missed dose. Never take more than the prescribed dose in a 24-hour period.
Overdose: What Happens If I Take Too Much Nucynta?
Taking too much Nucynta can cause:
- Limp muscles
- Cold and clammy skin
- Constricted (abnormally small) pupils
- Slowed breathing
- Extreme sleepiness, which can progress to a coma
A Nucynta overdose may also cause:
- Swelling of the extremities
- Slow heart rate
- Low blood pressure
- Unusual snoring
- Difficulty breathing
- Death
What Happens If I Overdose on Nucynta?
If you think you or someone else may have overdosed on Nucynta, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Nucynta, call 911 immediately.
Precautions
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It is very important that your doctor check your progress at regular visits, especially within the first 24 to 72 hours of treatment. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for any unwanted effects.
This medicine may cause a serious allergic reaction called anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.
Do not use this medicine if you are using or have used an MAO inhibitor (MAOI) (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]) within the past 14 days.
This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.
If you think you or someone else may have taken an overdose of this medicine, get emergency help at once. Your doctor may also give naloxone to treat an overdose. Signs of an overdose include: change or loss of consciousness, cold, clammy skin, coughing that sometimes produces a pink frothy sputum, difficult, fast or slow, irregular, shallow, or trouble breathing, increased sweating, pale or blue lips, fingernails, or skin, pinpoint pupils of the eyes, skin, sleepiness or unusual drowsiness, swelling in the legs and ankles, or yellow eyes. .
This medicine may cause sleep-related breathing problems (eg, sleep apnea, sleep-related hypoxemia). Your doctor may decrease your dose if you have sleep apnea (stop breathing for short periods during sleep) while using this medicine.
This medicine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the medicines listed above while you are using this medicine.
This medicine may cause some people to become dizzy, lightheaded, faint, drowsy, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Getting up slowly from a lying or sitting position may also help.
This medicine may cause a serious condition called serotonin syndrome when taken with certain medicines. Check with your doctor first before you take any other medicines. Call your doctor right away if you have a fever, confusion, restlessness, loss of coordination, or diarrhea.
This medicine may cause adrenal gland problems. Check with your doctor right away if you have darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.
Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. Also, lying down for a while may relieve dizziness or lightheadedness. If this problem continues or gets worse, check with your doctor right away.
Do not change the dose or suddenly stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help reduce the possibility of withdrawal symptoms, including anxiety, restlessness, fever or chills, joint pain, nausea or vomiting, loss of appetite. runny nose, stomach cramps, sweating, tremors, or trouble with sleeping.
Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.
Using this medicine while you are pregnant may cause serious unwanted effects, including neonatal withdrawal syndrome in your newborn baby. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant while using this medicine.
For nursing mothers:
- Talk to your doctor if you have any questions about taking tapentadol or about how this medicine may affect your baby.
- Call your doctor if you become extremely tired and have difficulty caring for your baby.
- Your baby should generally nurse every 2 to 3 hours and should not sleep for more than 4 hours at a time.
- Check with your doctor or hospital emergency room immediately if your baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, difficulty breathing, or limpness. These may be symptoms of an overdose and need immediate medical attention.
Using too much of this medicine may cause infertility (unable to have children). Talk with your doctor before using this medicine if you plan to have children.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn’t Take Nucynta?
Nucynta is not appropriate for everyone. You should not take this medication if you are allergic to tapentadol or any of the inactive ingredients in Nucynta.
You should also avoid Nucynta if you:
- Have taken a drug in the monoamine oxidase inhibitor (MAOI) drug class within 14 days
- Drink alcohol
- Have severe respiratory depression
- Have severe asthma
- Have gastrointestinal (GI) obstruction (when a blockage stops foods and liquids from passing through the digestive tract)
- Have paralytic ileus
- Are in a coma or have impaired consciousness
- Have circulatory shock
- Have severe kidney problems
- Take opioid antagonists such as naloxone or naltrexone, or opioid partial agonists such as buprenorphine
Nucynta should never be abruptly discontinued. Your healthcare provider can help determine a schedule to taper (wean off) the drug, which helps avoid withdrawal symptoms.
Nucynta may be prescribed with caution in some people only if the healthcare provider determines it is safe. This includes people:
- Who are older (65 years or older) or in a weakened state
- With liver problems classified as Child-Pugh Class B or C
- With lung problems or sleep apnea
- Who have CNS depression or take another medicine that causes CNS depression
- Who are volume-depleted (a decreased volume of blood circulating in the body)
- Who have increased intracranial pressure
- With a head injury
- With a seizure condition
- With a condition that affects GI motility (movement of food through the body)
- With acute pancreatitis (inflammation of the pancreas)
- With biliary disease (a disease that affects the bile ducts and gallbladder)
- With genitourinary blockage
- With a history of substance use disorder (alcohol or drugs)
- With a history of mental illness
- Who are trying to conceive
What Other Medications May Interact With Nucynta?
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, and vitamins or supplements.
CNS Depressants
Drugs and substances that cause CNS depression can increase the risk of respiratory depression, sedation, coma, and death when combined with opioids such as Nucynta. If the combination cannot be avoided, your healthcare provider will prescribe the lowest dose for the shortest time and closely monitor you. Naloxone should be on hand for emergency treatment of an overdose. Examples of CNS depressants include:
- Alcohol, including alcohol found in cough and cold medications
- Benzodiazepines for anxiety such as Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam)
- Muscle relaxants such as Flexeril (cyclobenzaprine) and Skelaxin (metaxalone)
- Other opioids such as fentanyl, hydrocodone, oxycodone, and Ultram (tramadol)
- Sedative hypnotics such as Ambien (zolpidem)
Drugs That Affect Serotonin Levels
Drugs that affect serotonin levels can cause serotonin syndrome, a life-threatening condition caused by the buildup of excess serotonin when these medications are combined with opioids like Nucynta. Examples of drugs that increase serotonin levels include:
- MAOIs, such as Nardil (phenelzine) and Parnate (tranylcypromine)
- Muscle relaxants, such as Flexeril (cyclobenzaprine) and Skelaxin (metaxalone)
- Serotonin-norepinephrine reuptake inhibitor antidepressants (SNRIs), such as Cymbalta (duloxetine) and Effexor (venlafaxine)
- Selective serotonin reuptake inhibitor antidepressants (SSRIs), such as Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline)
- Tricyclic antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline)
- Triptans for migraines, such as Imitrex (sumatriptan) and Maxalt (rizatriptan)
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs, such as Nardil (phenelzine), Parnate (tranylcypromine), and Zyvox (linezolid), should not be used within 14 days of Nucynta. The combination could cause serotonin syndrome (see above) or opioid toxicity (resulting in respiratory depression and coma).
Other Drug Interactions
Examples of other drugs that interact with Nucynta include:
- Opioid antagonists (e.g., naloxone, naltrexone)
- Benadryl (diphenhydramine)
- Buprenorphine (found in drugs such as Subutex and Suboxone)
- Diuretics, such as hydrochlorothiazide and Lasix (furosemide)
- Recreational drugs
- Urinary antispasmodics, such as Detrol (tolterodine), Ditropan (oxybutynin), and Myrbetriq (mirabegron)
Other drug interactions may occur with Nucynta. Consult your healthcare provider for a complete list of drug interactions. Do not start any new medications while taking Nucynta unless approved by your healthcare provider.
What Medications Are Similar?
Nucynta is an opioid painkiller that contains the ingredient tapentadol. Nucynta ER is an extended-release formulation of tapentadol and is used for severe pain that requires around-the-clock (24 hours per day) pain management with an opioid.
Examples of other opioid drugs include:
- Demerol (meperidine)
- Dilaudid (hydromorphone)
- Duragesic (fentanyl)
- Methadone
- MS Contin (morphine)
- OxyContin (oxycodone)
- Percocet (oxycodone and acetaminophen)
- Tylenol with codeine (acetaminophen and codeine)
- Ultram (tramadol)
- Vicodin, Norco, Lorcet, Lortab (hydrocodone and acetaminophen)
How Can I Stay Healthy While Taking Nucynta?
Before starting Nucynta, discuss your health and medication history with your healthcare provider. When taking Nucynta, follow your healthcare provider’s instructions for use. Read the patient information leaflet that comes with your prescription and ask questions.
A very common side effect of opioid pain medications is constipation. While taking Nucynta, drink plenty of water and eat lots of fruits and vegetables. This will help increase your fiber intake. Regular exercise, such as brisk walks, can also help prevent constipation. If these measures do not help, consult your healthcare provider for the most appropriate treatment.
Everyone who takes an opioid medication should have naloxone on hand. It commonly comes in the form of Narcan nasal spray. Ask your pharmacist to show you how to use it, and then teach your loved ones and/or caregivers to use it (remind them to still call 911 after using it). Naloxone can save your life in the event of an opioid overdose. Many people think it will never happen to them, but an overdose can happen even when the medication is used as safely as possible.
While taking Nucynta, always take the time to secure your medication in a safe place that no one, including visitors to your house, can access. One pill can be enough to cause an overdose and death, especially in children.
When it is time to stop taking Nucynta, ask your healthcare provider for a tapering schedule. Abruptly stopping Nucynta can cause withdrawal symptoms, such as:
- Restlessness
- Chills
- Muscle and joint pain
- Irritability
- Anxiety
- Weakness
- Stomach cramps
- Insomnia
- Appetite loss
- Nausea and vomiting
- Diarrhea.
- Increased blood pressure and heart rate
You can prevent these unpleasant symptoms by following your tapering schedule. When you finish taking Nucynta, check the FDA website for a drug take-back location near you. If there is no location available to you, you can flush the pills down the toilet.
Medical Disclaimer
Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
