Nucynta and opiates differ in one way

Dear Dr. Roach: I have a question about prescription pain relievers. In the past, after getting stitches, I was given Percocet, which made me nauseated. A friend recently had foot surgery and was prescribed Nucynta. I am not familiar with this medicine. Is it similar to Vicodin and Percocet? How are the side effects compared with other prescription pain relievers?

L.B.

Answer: Tapentadol (Nucynta) is an opiate, related to natural medicines like opium and morphine, as well as semi-synthetic and synthetic opiates like oxycodone or fentanyl.

However, it has an additional pharmacologic effect called noradrenergic reuptake inhibition. Like all opiates, it carries the risk of overdose, addiction, abuse and misuse.

Nucynta is reported to have less intestinal side effects than other opiates, such as the opiates in Percocet and Vicodin, at similarly effective doses. Experts feel Nucynta’s overall risks and effectiveness are like other opiates. For a person who has had nausea with other opiates, it might be reasonable to try for post-surgical pain.

Dear Dr. Roach: I will have a repeat cholesterol test in a couple of weeks, as my bad cholesterol was slightly high on a recent test. If it’s still high, my nurse practitioner will want me to go on a statin.

Many, many years ago, I took Welchol, and it did bring my numbers down. I know that works in the intestine rather than in the liver, like statins. Is Welchol still an acceptable treatment for a mildly elevated result?

R.W.

Answer: The treatment goal for cholesterol is not to make numbers look better, it’s to reduce risk of heart attack and stroke. There is abundant evidence that treatment with statins in people at higher risk is effective at reducing risk of heart attack and stroke.

Colesevelam (Welchol) works by binding bile acids, which reduces total serum and LDL cholesterol. However, the evidence that this translates into better outcomes is not as strong as it is with statins. Few people are treated with this type of medication now. I have not prescribed colesevelam for treatment of cholesterol in years.