Risk indicators in tapentadol use: opportunities to improve outcomes with a personal pharmaceutical care approach in community pharmacies

Abstract

Opioids have historically been the pharmacological choice in the treatment of moderate to severe pain of oncological and chronic origin but they have also become a growing and controversial tool in the treatment of non-oncological pain that requires a risk/ benefit evaluation. The present study focuses on the opioid tapentadol, the newest opioid considered highly effective in treating cancer and non-cancer pain. According to the WHO Collaborating Center for Drugs Statistics Methodology, the stated Tapendatol Defined Daily Dose (DDD) for oral administration is 400 mg but the prescribed doses range from 100 mg/day in patients without previous opioid treatments up to a maximum of 600 mg/ day. However, the DDD is a unit of measurement that does not have to reflect the prescribed daily dose (PDD) because therapeutic doses usually differ from DDDs by taking into account individual patient considerations and pharmacokinetic conditions. This retrospective observational study in a community pharmacy on the island of Tenerife (Canary Islands, Spain) is based on the 471 dispensations of opioids for the year 2020, of which 213 correspond to tapentadol (45.2%). In 2020, among the 62 patients using opioids, 58% (36) were treated with tapentadol. For both genders, the predominant age range among tapentadol users is over 61 years, accounting for 70% of the sample (50% women and 20% men). Regarding the origin of the prescription of tapentadol, 68% of the prescriptions were originated in Primary Care services and only 14% were prescribed at a Hospital. Recorded tapentadol PDDs range from 25 mg/day to 500 mg/day but the most prescribed PDD in both women (22%) and men (11%) was 100 mg/day. When studying the polymedication of tapentadol users we observed that 36% of them are also treated with benzodiazepines (34% women and 2% men), 34% also use SSRI antidepressants (32% women and 2% men), 15 % take antiepileptic drugs (13% women and 2% men) and 8% receive TCA antidepressants. The tapentadol dispensing was also recorded in synergy with other major opioids. Thus, 3.2% of patients (women over 61 years of age) receive a combination of oral tapentadol (150 mg and 200 mg) and oral sublingual fentanyl (0.13 mg - 0.4 mg/day). Therefore, the authors believe that in any pharmaceutical care intervention on opioids treatment users, especially dispensing and follow up, is an ideal time to promote a safer user of Tapentadol and to detect and to avoid potential drug related problems (DRP) and negative medicine outcomes (NMO).