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Drug vs. Drug

Nucynta vs. oxycodone: Differences, similarities, and which is better for you

Karen Berger medical writer and reviewer headshot By | Updated on April 1, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Nucynta and oxycodone are two FDA-approved opioid prescription drugs indicated for the treatment of severe, acute pain. They are generally used for pain that cannot be relieved by non-opioid medications, or when a patient cannot tolerate other alternatives. Both pain medications are classified as narcotics (Schedule II), meaning they have a high potential for abuse or dependence.

The way Nucynta works is not completely understood. Some studies have shown that Nucynta is a mu receptor (pain receptor) agonist and a norepinephrine reuptake inhibitor, which leads to pain relief. Oxycodone works by binding to mu receptors in the brain, which weakens or blocks pain signals, resulting in pain relief.

Because both drugs are very powerful, they are generally used in pain management situations where a milder (non-narcotic) pain reliever would not be effective or cannot be tolerated. Although both drugs are used for severe pain, they have many differences, which we will outline below.

What are the main differences between ‌Nucynta and oxycodone?

Nucynta (tapentadol) is an opioid, or narcotic, analgesic (painkiller). It is available in brand-name as both an immediate-release and extended-release tablet. The extended-release tablet is called Nucynta ER. The initial dose is 50 mg to 100 mg every four to six hours as needed for pain. The dose may be adjusted by your doctor, and the maximum dose is 600 mg per day.

Oxycodone is also a generic opioid analgesic (and oxycodone IR, for immediate-release) and available in brand-name form as Oxycontin—an extended-release tablet. The dosage varies, but a typical dose for immediate-release oxycodone tablets is 5 to 15 mg every four to six hours as needed for pain.

Main differences between ‌Nucynta and oxycodone
Nucynta Oxycodone
Drug class Opioid (narcotic) analgesic Opioid (narcotic) analgesic
Brand/generic status Brand Brand and generic
What is the generic/brand name? Generic: Tapentadol Brand: OxyIR (immediate-release), Oxycontin (long-acting)
What form(s) does the drug come in? Immediate-release tablet
Extended-release tablet
Immediate-release tablet
Immediate-release capsule
Extended-release tablet
Oral solution
What is the standard dosage? Initial:
50 mg to 100 mg every 4 to 6 hours as needed. Dose may be adjusted by doctor as needed. Maximum of 700 mg per day on the first day of treatment, then the maximum dose is 600 mg per day after the first day
Immediate-release tablet:
5 to 15 mg every 4 to 6 hours as needed
Extended-release tablet:
20 mg every 12 hours
How long is the typical treatment? Short-term, may be used longer based on condition treated (such as chronic pain) and response Short-term, may be used longer based on condition treated (such as chronic pain) and response
Who typically uses the medication? Adults Adults

Conditions treated by ‌Nucynta and oxycodone

Both Nucynta and oxycodone have one indication for treatment, which is to manage acute pain in adults that is severe enough to require an opioid analgesic, and when alternative treatments are inadequate or not tolerated.

Condition Nucynta Oxycodone
Management of acute pain in adults which is severe enough to require an opioid analgesic, and when alternative treatments are inadequate Yes Yes

Is ‌Nucynta or oxycodone more effective?

In a study comparing immediate-release Nucynta to immediate-release oxycodone in patients with moderate to severe acute back pain, both drugs were found to be similarly safe and effective in treating back pain, as well as associated leg pain. Nucynta patients had less adverse effects related to the stomach.

In a study comparing the abuse potential of patients taking Nucynta or oxycodone, Nucynta was found to have less potential for abuse.

The most effective medication for you should only be determined by your doctor who will look at your medical condition(s), history, and other medications you take.

Coverage and cost comparison of ‌Nucynta vs. oxycodone

Due to state laws, if you are receiving an opioid painkiller for the first time, it is likely that you will receive a small quantity.

Insurance coverage varies with Nucynta. Since it is more expensive and only available in brand name, your copay may be higher, or the drug may require a prior authorization from your insurance company. Nucynta is generally not covered by Medicare Part D. The out-of-pocket price for Nucynta 50 mg, 30 tablets is usually around $250 but you can get it for as low as $211 with a SingleCare discount.

Oxycodone is usually covered by insurance as well as Medicare Part D. The out-of-pocket price for 30, 5 mg tablets can cost about $100 but you can use a Single coupon at participating pharmacies and get it starting at $36.

  Nucynta Oxycodone
Typically covered by insurance? Varies Yes
Typically covered by Medicare Part D? No Yes
Standard dosage 50 mg, #30 tablets 5 mg, #30 tablets
Typical Medicare Part D copay $95-$482 $2-$56
SingleCare cost $211+ $36-$62

Common side effects of ‌Nucynta vs. oxycodone

The most common side effects of Nucynta are nausea, vomiting, drowsiness, dizziness, constipation, dry mouth, and itching. Serious respiratory depression (slowed breathing, not getting enough oxygen), which could be life-threatening or fatal, may occur.

With oxycodone, exact percentages are not reported, except that side effects occurred in greater than or equal to 3% of patients. The most common side effects are nausea, constipation, vomiting, headache, pruritus (itching), insomnia, dizziness, weakness, and drowsiness. Serious adverse reactions may include respiratory depression, respiratory arrest (breathing stops), cardiac arrest (sudden loss of heart function, breathing, and consciousness), low blood pressure, and/or shock.

Because of the serious risks, it is very important that if you take Nucynta or oxycodone, that you take the drug exactly as prescribed and do not take additional doses. You should also be monitored for respiratory depression, especially when starting one of these drugs or during a change in dose.

Other adverse events may occur. Consult your healthcare provider for a full list of side effects.

  Nucynta Oxycodone
Side Effect Applicable? Frequency Applicable? Frequency
Nausea Yes 30% Yes ≥3%
Vomiting Yes 18% Yes ≥3%
Constipation Yes 8% Yes ≥3%
Dry mouth Yes 4% Yes % not reported
Drowsiness Yes 15% Yes ≥3%
Dizziness Yes 24% Yes ≥3%
Itching Yes 5% Yes ≥3%

Source: DailyMed (Nucynta), DailyMed (oxycodone)

Drug interactions of ‌Nucynta vs. oxycodone

Using benzodiazepines or other CNS depressants, including other opioid medications, in combination with Nucynta or oxycodone can lead to low blood pressure, respiratory depression, profound sedation, coma, and/or death. The combination should be avoided. However, if no other option is available, the lowest doses of each medication for the shortest time period should be used, and the patient should be closely monitored, especially at the beginning of treatment and during any changes in dose.

Taking Nucynta or oxycodone with drugs that increase serotonin can also increase the risk of serotonin syndrome, a life-threatening condition caused by a buildup of too much serotonin. These drugs include antidepressants such as serotonin reuptake inhibitors, muscle relaxants, MAO inhibitors (MAO inhibitors should not be used within 14 days of Nucynta or oxycodone), and triptans for migraine.

Taking oxycodone with certain medications that are metabolized by an enzyme called CYP3A4 or CYP2D6 may result in a drug interaction. These drugs are known as enzyme inhibitors and include macrolide antibiotics, azole antifungals, and protease inhibitors. Using them together with oxycodone can result in higher levels of the opioid, which can be very dangerous. These drugs interact with oxycodone, but not Nucynta.

Other drugs, known as enzyme inducers, have the opposite effect as inhibitors, lowering the level of opioid so that it is not as effective or can even cause withdrawal symptoms. Inducers can affect Nucynta or oxycodone.

Consult your healthcare provider for a full list of drug interactions.

Drug Drug Class Nucynta Oxycodone
Alprazolam
Clonazepam
Diazepam
Lorazepam
Benzodiazepines Yes Yes
Alcohol Alcohol Yes Yes
Codeine
Fentanyl
Hydrocodone
Hydromorphone
Methadone
Morphine
Tramadol
Opioids Yes Yes
Baclofen
Carisoprodol
Cyclobenzaprine
Metaxalone
Tizanidine
Muscle relaxants Yes Yes
Amitriptyline
Citalopram
Desipramine
Desvenlafaxine
Duloxetine
Escitalopram
Fluoxetine
Antidepressants Yes Yes
Phenelzine
Rasagiline
Selegiline
Tranylcypromine
MAO inhibitors Yes Yes
Furosemide
Hydrochlorothiazide
Diuretics Yes Yes
Benztropine
Diphenhydramine
Oxybutynin
Tolterodine
Anticholinergic drugs Yes Yes
Almotriptan
Eletriptan
Rizatriptan
Sumatriptan
Zolmitriptan
Triptans for migraine Yes Yes
Clarithromycin
Erythromycin
Fluconazole
Ketoconazole
Ritonavir
CYP3A4 or CYP2D6 inhibitors No Yes
Carbamazepine
Phenytoin
CYP3A4 inducers Yes Yes

Warnings of ‌Nucynta and oxycodone

There is a boxed warning on both Nucynta and oxycodone, which is the strongest warning required by the FDA (United States Food and Drug Administration).

  • Opioid drugs have a risk of addiction, abuse, and misuse. This can lead to overdose and death. Patients should be assessed for risk before taking an opioid and should be monitored carefully.
  • Opioids can cause serious, life-threatening, or fatal respiratory depression. Patients should be carefully monitored, especially when treatment begins, and after a change in dose.
  • Accidental ingestion, especially by children, can result in fatal overdose. Patients should secure opioids out of the reach of children, and under lock and key if possible.
  • Prolonged opioid use during pregnancy can cause neonatal opioid withdrawal syndrome, which can be life-threatening if not recognized and treated.
  • Using benzodiazepines such as Xanax, or other CNS depressants, such as other opioids (or alcohol), can result in profound sedation, respiratory depression, coma, and death. The combination of opioids and benzodiazepines should be avoided if possible. Patients who must take this combination due to other alternatives not working should be prescribed the lowest effective dose for the shortest amount of time and must be closely monitored.

Other warnings:

  • Patients with significant respiratory depression, acute/severe bronchial asthma in an unmonitored setting, gastrointestinal obstruction, or hypersensitivity to any of the ingredients should not use Nucynta or oxycodone.
  • Nucynta or oxycodone should not be used in patients with chronic pulmonary disease or elderly or debilitated patients.
  • Serotonin syndrome may occur, especially with the use of drugs that increase serotonin levels, such as antidepressants. Patients should be monitored for mental status changes (agitation, hallucinations), changes in blood pressure, incoordination, and/or stomach symptoms such as nausea, vomiting, or diarrhea. The patient should seek immediate medical attention if any of these symptoms occur because serotonin syndrome is very dangerous and can be fatal.
  • Adrenal insufficiency may occur, usually after one month. Patients should seek treatment if they experience nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, and/or low blood pressure.
  • Nucynta or oxycodone may cause low blood pressure.
  • Nucynta or oxycodone should not be used in patients with impaired consciousness or in a coma.
  • Nucynta or oxycodone can increase the risk of seizures in patients with seizure disorders.
  • Nucynta or oxycodone should not be withdrawn abruptly, but should instead be tapered slowly.
  • Nucynta should not be used in patients with severe liver or kidney problems.
  • Do not drive or operate machinery until you know how the medication affects you.
  • Unsecured opioids can be a deadly risk to anyone else in the home, including visitors. Store securely, out of sight and reach of children, and in a location not accessible by others. Ask your healthcare professional how to dispose of unused opioids in your area.
  • When taking any opioid, talk to your doctor about a prescription for naloxone, a drug that can treat an opioid overdose in an emergency situation.

Because there are no well-controlled studies in women, Nucynta or oxycodone should not be used in pregnancy. Using opioids during pregnancy, whether for medical or nonmedical use, can cause physical dependence in the baby, and can lead to neonatal opioid withdrawal syndrome shortly after birth.

Frequently asked questions about ‌Nucynta vs. oxycodone

What is Nucynta?

Nucynta is a narcotic, or opioid, painkiller used in the treatment of severe pain. It is available in brand-name as an immediate-release (Nucynta) or extended-release tablet (Nucynta ER).

What is oxycodone?

Oxycodone is a narcotic painkiller used to treat severe pain. It is available in generic as an immediate-release tablet or capsule and in brand-name as long-acting Oxycontin.

Are ‌Nucynta and oxycodone the same?

No, but they are similar. Nucynta contains tapentadol. Oxycodone and tapentadol are both opioid analgesics (painkillers) but they do have some differences, such as in dose, price, and side effects, outlined above.

Is ‌Nucynta or oxycodone better?

In a study comparing the two drugs, Nucynta and oxycodone were similarly safe and effective in treating lower back pain. Nucynta may have lower abuse potential. Talk to your doctor if Nucynta or oxycodone is appropriate for you, if other pain relievers have not helped or if you cannot tolerate them.

Can I use ‌Nucynta or oxycodone while pregnant?

No. Nucynta or oxycodone (or any opioid, such as Percocet) can cause neonatal abstinence withdrawal syndrome, which can be dangerous or life-threatening to the baby.

Can I use ‌Nucynta or oxycodone with alcohol?

No. Taking Nucynta or oxycodone with alcohol can increase the risk of serious side effects such as respiratory depression (not getting enough oxygen, and your breathing slows down) and can even lead to a coma or death.

What is stronger than Nucynta?

Higher doses of opioids are associated with a higher risk of overdose and death, according to the CDC. It is important to look at the total daily dose of opioids and convert to MME (morphine milligram equivalents) to calculate the risk of overdose and the need for closer monitoring. If your dose of Nucynta is not working for you, talk to your doctor about changing the dose or changing the medication. Do not increase the dose on your own, without talking to your doctor. Never take an opioid for a use other than for which it was prescribed.

Is Nucynta the same as tramadol?

Nucynta is stronger and has more addictive potential than tramadol—Nucynta is a Schedule II drug, while tramadol is a Schedule IV drug. Nucynta is also more expensive than tramadol, which is available in both generic and brand (Ultram). Many patients find that tramadol is sufficient to control their pain.

Does Nucynta cause weight loss?

Less than 1% of patients in Nucynta ER Phase 2 and 3 clinical trials had a weight decrease but the amount of weight loss was not reported.