Tapentadol is an opioid agonist, increasingly being used for the management of chronic pain. A nasal spray formulation developed in the year 2020 has further made it more accessible to over-the-counter use. Although considered a safer alternative to Tramadol owing to its pharmacodynamic and pharmacokinetic properties, case reports are emerging highlighting the potential of misuse and dependence. Our case highlights dependence on tapentadol nasal spray formulation (up to 450 mg/day) in a young girl, leading to serious physical complications in the form of nasal necrosis, which required reconstructive surgery. The patient was started on buprenorphine tablets as a part of opioid substitution therapy, which helped her achieve abstinence from Tapentadol, and improved her overall physical health. Our case further highlights the risks associated with opioid analgesic use by various subspecialties (e.g., pain medicine) and the importance of liaison with psychiatry during the course of such treatments.
Adarkar et al. (Wed,) studied this question.