Considerations with Respect to Tapentadol

Quintero Castellanos, Jose Manuel

doi:10.5554/rca.v39i4.262

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Colombian Journal of Anestesiology

Print version ISSN 0120-3347

Rev. colomb. anestesiol. vol.39 no.4 Bogotá Oct./Dec. 2011

https://doi.org/10.5554/rca.v39i4.262

Carta al Editor

Considerations with Respect to Tapentadol

Jose Manuel Quintero Castellanos*

* Medico Cirujano Universidad Nacional de Colombia. Medico Anestesiologo Universidad del Bosque. Master en Manejo y Estudio del Dolor Universidad Rey Juan Carlos. Master en Educación Universidad Carlos V. Clínicas de la Escuela de Medicina de la Universidad de Puerto Rico Reparto Metropolitano Shoping Center.

San Juan, Puerto Rico. Interventional Pain Fellowship. Department of Anesthesiology. University of Puerto Rico. Correspondencia a: Caminos Verdes 844. Apto 1210 San Juan PR 00926. Puerto Rico. Correo elctrónico: manuelquinteromd@yahoo.com

In the previous issue of this Journal, Dr. Leotau (1) presents a review on tapentadol. In my opinion, there are certain aspects that require clarification in order to gain a deeper insight regarding this topic.

First of all, it has not been proven that tapentadol is of any use in fibromyalgia. It has not been studied either in situations of chronic pain and less still in this disease, although one could hypothesize that it might be involved because of its mechanism of action (2).

On the other hand, as pertains to the risk of seizures with tramadol, the cases described included high doses of tramadol used in combination with other drugs. Jick et al. (3) conducted a study to determine the possibility of the occurrence of this adverse effect between 1994 and 1996. Over a 90-day period, they followed 10 916 patients who received this medication and none of them had seizures when exposed only to tramadol. Consequently, no increased risk of seizures was found with the use of this drug.

Tapentadol is better than tramadol in certain aspects, but there are issues that need to be clarified such as its ability to produce serotoninergic syndrome or to induce physical and psychological dependence, aside from other adverse effects. There is no information on its efficacy and tolerability in situations of chronic pain, and no clinical data are available in elderly patients or on specific details regarding the potential drug-drug interactions (4).

REFERENCES

1. Leotau MA. Tapentadol. Rev. Colomb. Anestesiol. 2011;39(3): 375-85.

2. Smith HS, Bracken D, Smith JM. Pharmacotherapy for fibromyalgia. Front pharmacol 2011;2(17):1-14.

3. Jick H, Derby LE, Vasilakis C, Fife D. The risk of seizures associated with tramadol. Pharmacotherapy 1998;18(3):607-11.

4. Guay DR. Is tapentadol an advance on tramadol? Consult Pharm 2009 Nov;24(11):833-40.

Replica

Considerations Regarding Tapentadol

Mario Andrés Leotau Rodríguez*

* Cirujano, Universidad Industrial de Santander. Correspondencia: Carrera 24 No. 156-106 Centro Médico Carlos Ardila Lulle, torre B piso 9 módulo 61, Aliviar Clinica de Dolor y Cuidado Paliativo, Bucaramanga, Colombia. Correo electrónico: ma.leotau@alumnos.urjc.es, leotau@gmail.com.

Regarding the Letter to the Editor sent by Quintero JM (1), and as relates to the paper in question (2), it is important to clarify that Tapentadol is approved by the FDA and the European Medicines Agency. There are articles in the medical literature demonstrating its therapeutic effectiveness for the treatment of both acute and chronic pain (2).

As concerns the possibility of seizures resulting from the use of Tramadol, the study by Quintero (reference 12) is not conclusive as to whether this medication is or is not responsible for their occurrence. Nevertheless, different studies have shown a clear association between Tramadol at high doses and the occurrence of seizures (3,4,5).

I would like to finish by adding that Tapentadol is a new medication and, as such, it lacks sufficient study and follow-up and, consequently, there is no absolute certainty regarding its therapeutic and side effects. However, given its pharmacological profile and the results of the pre-clinical and clinical trials so far, the outlook is quite promising.

REFERENCIAS

1. Quintero JM. Consideraciones acerca del tapentadol. (Letter to the Editor). Rev. Colomb. Anestesiol. 2011;
39(4):611-2.

2. Leotau Rodríguez MA. Tapentadol, una nueva opción terapéutica. Rev. Colomb. Anestesiol. 2011;39(3):375-85.

3. Jick H, Derby LE, Vasilakis C, Fife D. The risk of seizures associated with tramadol. Pharmacotherapy. 1998;18(3):607-11.

4. Jovanovic-Cupic V, Martinovic Z, Nesic N. Seizures associated with intoxication and abuse of tramadol. Clin Toxicol (Phila). 2006;44(2):143-6.

5. Taghaddosinejad F, Mehrpour O, Afshari R, Seghatoleslami A, Abdollahi M, Dart RC. Factors related to seizures in Tramadol poisoning and its blood concentration. J Med Toxicol. 2011 Jul 7.

1. Leotau MA. Tapentadol. Rev. colomb. anestesiol. 2011;39(3): 375-85. [ Links ]

2. Smith HS, Bracken D, Smith JM. Pharmacotherapy for fibromyalgia. Front pharmacol 2011;2(17):1-14. [ Links ]

3. Jick H, Derby LE, Vasilakis C, Fife D. The risk of seizures associated with tramadol. Pharmacotherapy 1998;18(3):607-11. [ Links ]

4. Guay DR. Is tapentadol an advance on tramadol? Consult Pharm 2009 Nov;24(11):833-40. [ Links ]