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The switch from buprenorphine to tapentadol: is it worth?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
2016 (English)In: Romanian Journal of Anaesthesia and Intensive Therapy, ISSN 2392-7518, Vol. 23, no 2, p. 133-139Article, review/survey (Refereed) Published
Abstract [en]

Opioid analgesia continues to be the primary pharmacologic intervention for managing acute pain and malignant pain in both hospitalized and ambulatory patients. The increasing use of opioids in chronic nonmalignant pain is more problematic. Opioid treatment is complicated with the risks raised by adverse effects, especially cognitive disturbance, respiratory depression but also the risk of tolerance, opioid abuse and drug–disease interactions. Despite the growing number of available opioids within the last years, adequate trials of opioid rotation are lacking and most of the information is anecdotal. This article reviews the clinical evidence surrounding the switch from transdermal buprenorphine to tapentadol in malignant and non-malignant pain. Tapentadol acts on both the µ-opioid receptors (MOR) and on the neuronal reuptake of noradrenaline with a limited usefulness in acute pain management while buprenorphine is a mixed agonistantagonist, and both present some advantages over other opioids. Both drugs show particular pharmacodynamic and pharmacokinetic properties which reduce the risks of development of tolerance, opioid abuse, diversion and determine fewer hormone changes than the “classical opioids” making these opioids more attractive than other opioids in long term opioid treatment. However, in the absence of powered clinical trials, the evidence to support the method used for transdermal buprenorphine rotation to tapentadol is weak.

Place, publisher, year, edition, pages
2016. Vol. 23, no 2, p. 133-139
Keyword [en]
chronic pain, tapentadol, buprenorphine, opioid tolerance, opioid rotation
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-337386DOI: 10.21454/rjaic.7518/232.bupOAI: oai:DiVA.org:uu-337386DiVA, id: diva2:1169348
Available from: 2017-12-24 Created: 2017-12-24 Last updated: 2018-01-04Bibliographically approved

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