Usual Adult Dose for Pain:
Individualize therapy taking into consideration severity of pain, response to therapy, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse:
Immediate-Release:
Initial dose: 50 to 100 mg orally every 4 to 6 hours as needed for pain
-Day 1: A second dose may be administered as soon as 1 hour after the first dose if needed
-Subsequent dosing: 50, 75, or 100 mg orally every 4 to 6 hours; adjust dosing to maintain adequate analgesia with acceptable tolerability
Maximum dose: 700 mg on day 1; 600 mg/day on subsequent days
Comments:
-Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
-Monitor closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and with each dose increase.
-Due to risks of addiction, abuse, and misuse, even at recommended doses, reserve use for patients for whom alternative treatment options (e.g., non-opioid analgesics or opioid combination products) have not been tolerated, or are not expected to be tolerated, or have not provided adequate analgesia, or are not expected to provide adequate analgesia.
Usual Adult Dose for Chronic Pain:
Individualize therapy taking into consideration severity of pain, response to therapy, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse:
-Discontinue all other tapentadol and tramadol products prior to starting tapentadol extended-release tablets
EXTENDED RELEASE TABLETS:
Initial dose: 50 mg orally twice a day
-Individually titrate to a dose that provides adequate analgesia and minimizes adverse reactions; dose increases should not exceed 50 mg twice a day every 3 days
Maintenance dose: 100 mg to 250 mg orally twice a day
Maximum dose: 500 mg/day
CONVERSION from IMMEDIATE-RELEASE to EXTENDED-RELEASE:
-Provide same total daily dose of tapentadol divided into 2 equal doses and administered orally twice a day approximately 12 hours apart
CONVERSION from Other Opioids:
-As there are no established conversion ratios from other opioids, initiate at 50 mg orally every 12 hours
-Close observation and frequent titration are warranted until pain is controlled; monitor for signs and symptom of opioid withdrawal
-Provide rescue medication with an appropriate dose of an immediate-release analgesic as appropriate
Comments:
-For patients with breakthrough pain a rescue medication with an appropriate dose of an immediate-release analgesic may be needed.
-If the level of pain increases after dose stabilization, attempt to identify the source of increased pain before increasing dose.
-Because of the risks of addiction, abuse, and misuse even at recommended doses, use should be limited to patients for whom alternative treatment options (e.g. non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient pain management.
-This medicine is not for use as an as-needed analgesic.
 Detailed Nucynta dosage information
What happens if I miss a dose?
Since Nucynta is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Do not take extra medicine to make up a missed dose. Do not take more than your prescribed dose in a 24-hour period.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal, especially in a child or person using opioid medicine without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing.
Your doctor may recommend you get naloxone (a medicine to reverse an opioid overdose) and keep it with you at all times. A person caring for you can give the naloxone if you stop breathing or don't wake up. Your caregiver must still get emergency medical help and may need to perform CPR (cardiopulmonary resuscitation) on you while waiting for help to arrive.
Anyone can buy naloxone from a pharmacy or local health department. Make sure any person caring for you knows where you keep naloxone and how to use it.
