Palexia Depot (tapentadol, prolonged-release tablets)
Palexia Depot is a strong analgesic with µ-agonist opioid properties, and at the same time inhibits reuptake of noradrenaline. Palexia Depot has shown a better effect than placebo in treatment of chronic pain. It has not been investigated what effect Palexia Depot would have, if it is added to a maximal treatment with i.e. acetaminophen and NSAID.
Fewer patients experience gastrointestinal side effects when treated with Palexia Depot compared to oxycodone treatment. However, prophylactic treatment with laxatives was not used during the clinical trials, as opposed to the standard recommendations for opioid treatment.
Palexia Depot 200 mg given twice daily costs 1,517 Dkr. for a month’s treatment. This is more than 4-5 times as much as the cost of treatment with depot morphine tablets 60 mg given twice daily together with two kinds of laxatives (302-362 Dkr. per month).
Based on the lacking comparison between Palexia Depot and morphine with concomitant treatment with laxatives, and also the significantly higher price, IRF finds that Palexia Depot should not be the first line treatment for opioid-demanding pain. However, it can be tried in patients with opioid-induced side effects, i.e. obstipation which cannot be treated sufficiently with laxatives.
Palexia Depot was marketed on December 27th, 2010. There is general reimbursement for Palexia Depot, as of February 1st, 2011.