Prescribing trend of tapentadol in a Sydney local health district

Abstract

Aims Tapentadol, an opioid with mu‐opioid receptor agonism and noradrenaline reuptake inhibition, has been increasingly used in Australia since 2011. However, data on hospital prescribing trends and indications are scarce. This study aimed to investigate hospital prescribing trends of tapentadol, oxycodone and tramadol in a Sydney local health district (LHD) and the indications for tapentadol hospital prescriptions in an Australian tertiary hospital. Methods We analysed 5‐year patient dispensing for tapentadol, oxycodone and tramadol from four hospitals in a Sydney LHD with data expressed as oral morphine equivalents (OME). We also conducted a retrospective review of 140 and 54 patients prescribed tapentadol at a tertiary hospital's surgical and spinal units in 2020. Results Over 5 years in the Sydney LHD, there was a 19.5% reduction in total dispensing of these opioids from 1 225 210 to 986 477.5 OME milligrams. Decreases were specifically for oxycodone (−37.8% immediate‐release, −65.2% sustained‐release) and tramadol (−74.6% immediate‐release, −70.1% sustained‐release). Contrastingly, hospital prescriptions of tapentadol immediate‐release increased by 223.2% between 2018–19 and 2020–21 while sustained‐release increased by 17.9% from 2016–17 to 2020–21. By 2020–21, tapentadol overtook oxycodone to become the most prescribed opioid in the Sydney LHD (51.4%). At the hospital's surgical units, 137 (97.9%) patients were prescribed tapentadol for acute post‐operative pain with the majority (54.0%) prescribed both immediate‐release and sustained‐release tapentadol, while 71.1% were prescribed for neuropathic pain in the spinal units. Conclusion In a Sydney LHD, tapentadol prescriptions increased significantly to become the preferred opioid analgesic. At the hospital's surgical units, off‐label prescriptions of tapentadol sustained‐release for acute post‐operative pain were observed.

Effect of discharge opioid on persistent postoperative opioid use: a retrospective cohort study comparing tapentadol with oxycodone

“…Compared with full opioid agonists such as oxycodone, the lower mu-opioid receptor activation of tapentadol required to provide comparable analgesia may be associated with fewer opioid-related side effects such as constipation [17]. In Australia, there have been recent rapid increases in tapentadol prescriptions [12,18], with tapentadol having the largest opioid market share by oral morphine equivalent (17.1%) in 2019 [19]; it is used more frequently than oxycodone in some hospital settings [20].…”

“…Compared with full opioid agonists such as oxycodone, the lower mu‐opioid receptor activation of tapentadol required to provide comparable analgesia may be associated with fewer opioid‐related side effects such as constipation [17]. In Australia, there have been recent rapid increases in tapentadol prescriptions [12, 18], with tapentadol having the largest opioid market share by oral morphine equivalent (17.1%) in 2019 [19]; it is used more frequently than oxycodone in some hospital settings [20]. Despite its contemporary uptake in Australia, there are fewer studies which capture its use on longer‐term side effects, as tapentadol use commenced less than a decade ago and, to our knowledge, there have been no studies separately analysing surgical patients discharged with tapentadol for the outcome of persistent postoperative opioid use.…”

Restriction of oxycodone in the emergency department (ROXY-ED): A randomised controlled trial

“…26,27 It has been recently reported that tapentadol has replaced oxycodone and tramadol to become the most frequently prescribed oral opioid prescribed in an Australian local health district. 28 Similarly, equivalence of oral oxycodone and tramadol has also been concluded. 29 Previous studies had demonstrated wide variations in the practice of opioid prescription on discharge.…”

Opioid poisoning in Newcastle over the last three decades: From heroin to prescription opioids

“…Tramadol overdose had the highest incidence of seizures and is also associated with serotonin toxicity 21 . Tapentadol is another important opioid, and recent data suggests it may soon become one of the most common opioids ingested in overdose 22,23 …”