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Tapentadol oral standard release

Updated 2 Feb 2023 | Opioid analgesics


Standard release oral formulations of tapentadol (as hydrochloride).

Drugs List

  • PALEXIA 100mg/5ml oral solution
  • PALEXIA 50mg film coated tablets
  • PALEXIA 75mg film coated tablets
  • tapentadol 100mg/5ml oral solution sugar-free
  • tapentadol 50mg film coated tablets
  • tapentadol 75mg film coated tablets
  • Therapeutic Indications


    Pain - moderate to severe

    Moderate to severe acute pain that can only be controlled by opioid analgesics.


    Dosing should be individualised according to the severity of pain.


    50mg every 4 to 6 hours.

    On the first day of treatment, an additional dose may be taken after 1 hour and then titrated to a level which provides adequate analgesia.

    It is not recommended to exceed 700mg on the first day of treatment and 600mg daily for maintenance doses.

    Once a stable dose regimen is achieved and longer treatment is anticipated, switching to prolonged-release formulations should be considered.


    Oral solution (tablets are not licensed in children)
    Children aged 2 to less than 18 years: 1.25mg per kg every 4 hours. Maximum dose per day is 7.5mg per kg.

    The maximum dose for children and adolescents with a high BMI must not exceed the calculated maximum dose for a body weight at the 97.5 percentile for the given age.

    For children with a body weight of more than 16kg, doses may be rounded to aid administration, see product literature for more information.

    The duration of treatment should not exceed 3 days.

    Patients with Hepatic Impairment

    Aged 18 years and above with moderate hepatic impairment: Initiate at the lowest available dose strength (50mg for tablets, 25mg for oral solution) and do not administer more frequently than one every 8 hours. Doses may be increased balancing adequate analgesia with acceptable toxicity by adjusting the dose interval.

    Aged 2 years to 18 years: Not recommended for any level of hepatic impairment.


    The oral solution may be administered via external tubes, e.g. nasogastric or percutaneous endoscopic gastrostomy (PEG) tubes.


    Acute alcohol intoxication
    Children under 2 years
    Drug intoxication
    Impaired consciousness
    Risk of paralytic ileus
    Weight below 16kg
    Within 2 weeks of discontinuing MAOIs
    Acute asthma
    Head trauma
    Hepatic impairment in children under 18 years
    Paralytic ileus
    Raised intracranial pressure
    Renal impairment in children under 18 years
    Severe asthma
    Severe hepatic impairment
    Severe hypercapnia
    Severe renal impairment
    Severe respiratory depression

    Precautions and Warnings

    Children aged 2 to 18 years
    Predisposition to seizures
    Acute pancreatitis
    Biliary tract disorder
    Brain neoplasm
    Drug misuse
    Glucose-galactose malabsorption syndrome
    History of seizures
    Lactose intolerance
    Moderate hepatic impairment
    Respiratory depression
    Respiratory impairment

    Reduce dose and/or alter dose interval in patients with hepatic impairment
    Advise ability to drive/operate machinery may be affected by side effects
    Advise patient not to drive until they know how the medicine affects them
    Advise patient this medicine may be subject to driving restrictions
    Children under 18 years: For hospital use only
    Not all available products are licensed for all age groups
    Oral liquid contains propylene glycol
    Some formulations contain lactose
    May cause respiratory depression
    Monitor patients for signs and symptoms of Serotonin Syndrome
    Monitor patients with a history of alcoholism and drug abuse
    Monitor patients with pulmonary insufficiency
    Potential for drug abuse
    May cause dependence
    Avoid abrupt withdrawal
    Discontinue if paralytic ileus is suspected
    Maintain treatment at the lowest effective dose
    Advise patient to avoid alcohol during treatment
    Advise that effects are potentiated by CNS depressants (including alcohol)

    If dose related respiratory depression occurs it should be treated as any opioid induced respiratory depression.

    Paediatric patients with obesity should be extensively monitored and the recommended maximum dose for the age should not be exceeded.

    Pregnancy and Lactation


    Tapentadol is contraindicated in pregnancy.

    At the time of writing there is limited published information regarding use during pregnancy. The manufacturer recommends using tapentadol only when the potential benefit to the mother outweighs the risk to the foetus. Animal studies have not shown any teratogenic effect, however, delayed development and embryotoxicity were observed.

    The effect of tapentadol in labour and delivery in humans is unknown, therefore tapentadol is not recommended for use in women during or immediately before labour or delivery. Due to the opioid activity of tapentadol, newborn infants whose mothers have been taking tapentadol should be monitored for respiratory depression.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Tapentadol is contraindicated in breastfeeding.

    At the time of writing there is limited published information regarding use during breastfeeding.

    There is no information on the excretion of tapentadol in human milk. Studies in animals have shown that tapentadol is excreted in breast milk therefore a risk to the child can not be excluded. Schaefer (2015) states that a single dose does not require any breastfeeding limitation, but repeated use is not recommended.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Effects on Ability to Drive and Operate Machinery

    This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.

    Side Effects

    Abdominal discomfort
    Abnormal thinking
    Allergic reaction
    Altered temperature sensation
    Attention disturbances
    Decrease in blood pressure
    Decrease in heart rate
    Decreased appetite
    Depressed mood
    Dream abnormalities
    Dry mouth
    Feeling abnormal
    Feeling drunk
    Gastric disorders
    Hypersensitivity reactions
    Impaired co-ordination
    Impaired consciousness
    Impaired memory
    Increased heart rate
    Involuntary muscle contractions
    Muscle spasm
    Oxygen saturation decreased
    Respiratory depression
    Sensation of heaviness
    Serotonin syndrome
    Sleep disturbances
    Urinary hesitancy
    Visual disturbances
    Withdrawal symptoms


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2018

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Summary of Product Characteristics: Palexia film coated tablets. Grunenthal Ltd. Revised November 2018.

    Summary of Product Characteristics: Palexia 20 mg/ml oral solution. Grunenthal Ltd. Revised June 2019. Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: Last accessed: 6 January 2015
    New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: Last accessed: 6 January 2015

    MHRA Drug Safety Update January 2019
    Available at:
    Last accessed: 07 March 2019

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