Management overview for tapentadol poisoning

Tapentadol is an opioid analgesic with centrally acting mu-opioid receptor agonism; it is also an inhibitor of noradrenaline reuptake, which contributes to its analgesic effect. Tapentadol has minimal effect on serotonin reuptake. It has no active metabolites, so its opioid effects are more predictable.

Tapentadol is available as both immediate-release and modified-release preparations. In Australia, only the modified-release preparation is available on the Pharmaceutical Benefits Scheme (PBS), so it is commonly implicated in poisoningsChan, 2022.

Opioid-mediated sedation and respiratory depression are the primary concerns following tapentadol poisoning. Significant toxicity is more likely in children, the elderly and opioid-naive patients. Seizures rarely occur and, if present, tend to be brief and respond to benzodiazepines. Serotonergic toxidrome is highly unlikely unless tapentadol is co-ingested with a serotonergic drug, in particular a monoamine oxidase inhibitorGressler, 2017.

Management of tapentadol poisoning is primarily supportive care of the airway and ventilation, and aims to urgently identify and address serotonergic toxidrome and seizures, if present. The opioid antagonist, naloxone, is used to reverse hypoventilation in tapentadol poisoning. Support of airway and breathing to prevent hypoxia is the clinical priority while waiting for naloxone to take effect.