Nucynta was is a schedule II narcotic that also has an SSNI effect and was FDA approved less than 6 months ago (23 Jun 08). As such I'd be very leery about taking something so new and unproven, not to mention probably wildly expensive.

While your doctor may mean well, it sounds like he is quite susceptible to the influence of BigPharma and their marketing tactic, prescribing the latest medication on the market instead of using well-known, well-studied preparations instead. There are many other better known and better studied Schedule II immediate release narcotics that are equally if not more effective and with very well known side effect profiles. By taking Nuncynt you will be the proverbial post-marketing guinea pig for Ortho-McNeil, who appears to have only tested Nucynta in a total of 2128 people before bringing the medication to market; a frightening low number of patients considering the prevalence of pain as a condition (the studies were short-term using predominantly knee surgery as the source of pain studied).

After much searching I was able to find the prescribing instructions for the medication, generic name tapentadol: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=10273 Please read the entire website, including the tabs and whole front page. The dosing instructions for pain are clear and based on how your doctor appears to have prescribed the medication, he has not read, nor followed the manufacturer's recommendations for even the first day (they are not to simply take up to 4 tablets per day as needed, but specifically to titrate up on the first day to achieve the necessary dose for pain relief and then remain at that dose from there on out).

There is a risk of seritonin syndrome when taking this medication with SSRIs or SNRIs, something that does not happen with traditional narcotics (tapentadol is remotely related to and/or has a comparable effect as Ultram, which can also cause seritonin syndrome), so please do not use it if you are already on any form of antidepressent or use triptans to treat migraines (it's essential to talk with your pharmacist and your doctor first and read them the part about the seritonin syndrome if need by, all too many doctors dismiss seritonin syndrome as something that's been "made up"; it's not and can be potaentially life-threatening. Do not use with any form of an MAOI; reactions can be life-threatening. The standard risks of respiratory depression and other CNS depressant effects that come with all schedule II narcotics hold true for Nucynta as well.

As a personal policy, and one all of my doctors agree with, I do not take any medication that has not been on the market for at least 7 years unless there is a life-saving reason to do otherwise (and I have yet to have that need). Most drugs are withdrawn from the market or get black box warnings for life-threatening complications and limited use restrictions within that time period.

I know you want pain relief and hydrocodone just isn't sufficient. But a drug that's been on the market for less than 6 months probably isn't the solution either. Morphine or oxycodone, with or without acetominophen, are much better options, well tested and well proven, and much, much less expensive as well (and are also schedule II narcotics).

Please consider talking with your PM doctor and GP/rheumatologist about an alternative to taking something brand new and basically untested.

Best wishes for pain relief.

AMEN to everything that ihavepkd said!!! I heard that Nucynta is nothing else but a synthetic morphine product, and not only that but it is WILDLY expensive! I would talk to your PM Doc and will tell him that you can not afford the Nucynta and to give you a medication that is less expensive and already proven in the market.

I agree with " ihavepkd", Taking something so new is like being a test pilot for this drug. I have always heard not to take a drug unless it has been on the market for at least 2 years. There is just not enough testing done on them yet. I would be very cautious and actually ask your doctor why he chose that drug oinstead of the regular ones most PM doctors prescribe.
I know alot od doctors out there are inclined not to prescribe these drugs either until there on the market longer. I mean look at alot of those anti-inflammatories that were recalled after people were dying from heart attacks after taking it. If I was you I would discuss this again with your PM doctor and see if you can try one of the old stand bys. I wish you the best of luck, just please be careful.

Yes, it is expensive and really new: my insurance outright denied it for me. My pharamacists didn't seem at all acquainted with it, either. I still have the script for an emergency, but I doubt that I will ever use it.

Just wanted to let everyone know I did fill the script and took the first one last night, and I'm feeling really pretty good. I slept well and it was a better painkiller for me than hydrocodone.

ihavepkd, I appreciate your post, but you misunderstood me. I have been taking three or four hydrocodone a day, one every 4-6 hours. I didn't mean that was the dosing for the Nucynta.

I'm well aware (through my own research and my doctor's words) that this is a new drug. It is certainly a morphine derivative, and that it also has an anti-depressant component, similar to ultram but stronger. My doctor recommended it as a first thing to try before I move to long-acting opiates. FYI, although of course hydrocodone and its short-acting opiate cousins have been around for a long time, they are also FDA approved only for acute pain and not for chronic use.

I understand the fear about being the first to try something new, but someone has to be brave or we'll never have any new drugs! I have rheumatoid arthritis on top of my spinal cord injury. New drugs for RA are coming out all the time, and if my trusted rheumatologist thought one would help me, I would try it. I'm very well educated and do know how to read drug studies.

Hi All!!

My PM doc put me on Nucynta 100 mg, dosing every 4 - 6 hrs, then a longer acting med three time per day. Last night was my first and I woke up this am at 4. I will look up all about it. Thank you - the person who gave all of the info. It had better be a better pain med than others I have been on, then yesterday he diagnosed me with arthritis of the hips, knees, and ankles. My life story!

I think all of us who are taking it should leave messages about how thery're doing on it.

It is EXTREMELY hard to find and expensive, but if helps with the pain and I have no side effects I will continue

I did read on the label paperwork last night that it can cause that syndrome. I have high BP and 25 yrs ago I was diagnosed with pseudo tumor cerebri, so this might not have been the best for me. 10 pills to try and eval before I get full RX ordered. Hope I can find it!!!

The doc told me to watch my BP regularly.

Many hugs to all

Terri

Caren and Terri,
Is good to know that Nucynta is working for the two of you. Just keep this thread current as you go along, so that way you gals can help the next ones that will come around asking questions about this new drug. Congratulations to both of you, and I hope that the pain relief is long lasting! Hugs,

I'm finding that Nucynta doesn't work for me. I was on hydrocodone (lortab 10-325) and oxycodone (5-325) for a time (3x day each) and that wasn't cutting it.

I complained about pain, said I wanted to try something new, so I got recommended to nucynta 5mg tablets 3x day. This was just a joke, as I noticed after a few days it was doing nothing. I called the Dr and was allowed to go to 10mg 3x day. This is still not cutting it, and I have a hard time believing that 10mg of nucynta can compare to the other drugs I was taking. I don't consider nucynta powerful at all, and certainly not at this dosage. I appreciate the comments before about "titrating up to acheive the necessary dosage for pain relief".

Too bad my "pain management clinic" does not have this mindset. They are extremely cautious about medications, and treat that everyone with chronic pain is a drug junkie. So I doubt I'll ever get to the point where my pain is accurately or wisely "managed".

This weekend I was stupid. I was down to a few nucynta and was putting off calling in for a refill. (I was running out much faster because during the prescription I had switched from 3 a day to 6 a day.) So I ran out earlier than I thought I would, called it in on a Friday morning. There was this whole dance about whether it was a refill that they could call in, and it was decided by the doctor and the pharmacy that it could not, because it was a schedule 2 drug. You'd think they'd know this, both of them being in their professions. Anyway, because of the wasted time in that dance, and the delay in getting the request to the doctor for the written prescription, I now have to drive 45 minutes on Monday, going Saturday and Sunday without any pain medication (I have zanaflex and neurontin to hope with), and then spend my Monday morning which I should be working.... to get that prescription filled.

I'm pretty sure that at the dosage that I'm on, it's not doing anything, and certainly not enough... especially considering my previous dosages of hydrocodone and oxycodone.

Can anyone recommend a safe good drug that actually eliminates pain, and has less of a narcotic effect? Right now I'm finding that the pain medications I receive either do nothing, or try to mask the pain with a narcotic effect.

Hi Everyone,
I am new here, I have tried Nucynta and it did not work for me, it also gave me the chills and I felt ill, my doc said I got the seratonin syndrome from it.
I am glad it helps others but it is still very expensive and most insurance wont cover it.
I do not take any anti depressants either, so I really believe you can get the syndrome just from the Nucynta itself.
Thanks Sabb

Nucynta is the best medication I've taken. Period! Everything from Loratab's to percocet's gives me very bad constipation and it takes way to much to help. We all are different.

OK..I've read all the posts above now. For me the Nucynta works so different than Morphine and others like, Lorab, Opana, Dilaudid etc....
The only comparison I can give is, maybe, Percocet. Yes it's a very new drug and no one really knows the long term effects. Remember that great anti-inflammatory, Vioxx? I was taking that at the time for my DSD and knee pain. It worked great! Now we're seeing all the damage it caused to people's bodies.
I only hope Nucynta is not going to be one of these as it really helps me and I can go to the bathroom without Miralax and other laxatives. I don't sweat while taking it either. The only real side effect I have is,"Itching," but the others did that to me as well.
I agree with Tipper, those who take Nucynta need to keep others up to-date on our progress with it.
Ralph

I've been having horrible migraines and tension headaches for a couple years, so when I finally got insurance I started seeing a doctor in March of this year (2012). They started me on Fioricet and Lorcet (10 mg hydrocodone) at first. After a while, it started taking more and more of the medicine to get the same effect. The doctor that originally treated me for the headaches ended up leaving the clinic, so I was forced to see another doctor. He freaked out about me getting so much hydrocodone for a couple months, and told me that I don't need to be on so much pain medication. He started me on Nucynta 75 mg to take every 6 - 8 hours. This medicine worked WONDERS! It was the only one that actually got rid of my pain without any side effects. If I took it on an empty stomach I would get a little drowsy/dizzy/loopy, but if I took it after eating it would knock out my headache with no side effects. However, my doctor still insisted I go to a neurologist, because he didn't feel he was the one to treat my headaches and he wanted to make sure there wasn't something deeper going on.

I started seeing a neurologist about a couple weeks ago. He gave me Nortriptyline 25 mg (antidepressant) as a preventative for my migraines and Imitrex to take at the onset of a migraine. I don't know why he wouldn't give me Nucynta, but I didn't want to push the issue. My headaches have gotten much worse since I stopped taking Nucynta, and the antidepressant doesn't seem to be doing much. I took the Imitrex twice and both times it made my head hurt so bad that I was immobile with pain (I don't know why so many people call it a migraine miracle drug and all it did to me was make me curl up in a dark room for 3 hours crying). I really wish I could get back on the Nucynta, but the doctor that originally prescribed it to me would rather me stick to seeing the neurologist. I even called my neurologist to tell him that Imitrex made my head feel 10 times worse, but all they did was prescribe me a new med in the same family (Relpax). I'm so scared of going through that pain again that I'm too afraid to take Relpax. I know everyone is different, and I must be intensely different if I can take hydrocodone and not feel anything, take Imitrex and get a worse headache, and take Nucynta and feel awesome.

I hope everyone can find what helps them with their pain. Don't let other posts scare you off from this drug, though. Everyone has a different reaction to medicines, so it might do you a lot of good like it did for me. I really wish I could use it again for my head, because I never even got a tolerance to it after using it for two months.

Well I'm happy to see so many posts on this drug. I posted about a week ago asking about this one, but got only 1 or so replies.

I'm curious, have any of you that have had luck with this drug had luck with Tramadol? From what I understand, it is from the same makers of Tramadol. I'm sure their hoping for another home run with Nucynta.

I'm wanting to know if it would be the next step up from Tramadol?