Nucynta

[painfree23]

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inherited a patient on nucynta..100mg ER q12h and IR100mg q12h for breakthrough. Continued it last visit as it is helpful for him. Been on it for a year. Now patient says it's too expensive for him, how would transition him? Slow taper off and add tramadol at the same time? I don't want to escalate to norco or other narcotic, but if I did, what is the equivalent? Couldn't find much online about it

Thanks in advance

 

[DOctorJay]

I would rotate to tramadol as you are suggesting and have done this successfully in my practice


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[myrandom2003]

I would rotate to tramadol as you are suggesting and have done this successfully in my practice


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How would you taper/rotate to tramadol in this particular patient?

 

[kstarm]

I will have to consider the tramadol rotation. Just tapering has been really difficult for one of my patients, I'm currently trying to just reduce by changing some of her ER to IR and going down slowly.

 

[clubdeac]

Last I knew, 50mg Nucynta is comparable to 10mg oxydodone so Tramadol ain't gonna touch it

 

[DOctorJay]

as club mentions there's a significant change in comparable OME so I have weaned down the Nucynta and then flat out told the patient Tramadol is their only other option (this was a patient who had regular insurance and then had to switch to 'caid). he's doing fine.

 

[clubdeac]

When I was in pp I inherited a patient who was on oxycodone 10mg qid for chronic post traumatic headaches. I hated the fact that he was on oxy for this indication and finally got him to rotate to 100mg Nucynta tid. Still hated prescribing that and left the practice before I was able to wean him off. Private practice suuuuuuucked.....so many **** patients like this that I had to somewhat appease in order to keep my "numbers" up. Bull****....

 

[PapaDosh]

See if your state's medicaid will cover levorphanol for something of equal analgesic value with neuropathic coverage. I know NJ and DE are starting to, but you have to pretty much use mail order pharmacies as its otherwise is impossible for the patient to find it/get the PA for it.

 

[Ducttape]

In my experience it is the IR part that is not covered by Medicare or other insurances.

So if Medicare, switch to ER version, 200 mg twice daily.

If private insurance...
At the Nucynta website, have them download the savings card.

NUCYNTA® ER (tapentadol) extended-release tablets, CII | Co-pay Card


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[lobelsteve]

Nucynta mu binding is 1/50th of morphine in published data and 1/17th morphine in unpublished data.
The meq of 40Nucynta = 100ms04 is nonsense.

 

[IN2B8R]

Put on bid to tid low dose methadone and call it a day....


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[deleted472101]

I second the savings card