| chronic pain (diagnosis)
Butrans vs Nucynta ER
Side-by-side clinical, coverage, and cost comparison for chronic pain (diagnosis).Deep comparison between: Butrans vs Nucynta with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsNucynta has a higher rate of injection site reactions vs Butrans based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Nucynta but not Butrans, including UnitedHealthcare
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Category
Butrans
Nucynta
At A Glance
Transdermal patch
Every 7 days
Partial mu-opioid agonist
Oral
Twice daily
Opioid agonist / NRI
Indications
- chronic pain (diagnosis)
- chronic pain (diagnosis)
- Diabetic peripheral neuropathy
Dosing
chronic pain (diagnosis) For opioid-naive patients, initiate with BUTRANS 5 mcg/hour transdermal patch worn for 7 days; for patients on 30-80 mg/day oral morphine equivalents, taper current opioid to <=30 mg/day then initiate at 10 mcg/hour; maximum dose is 20 mcg/hour (one system); titrate no more frequently than every 72 hours in increments of 5, 7.5, or 10 mcg/hour.
chronic pain (diagnosis), Diabetic peripheral neuropathy Initiate at 50 mg orally every 12 hours in opioid-naive patients; titrate by 50 mg increments no more than twice daily every three days; maximum total daily dose 500 mg.
Moderate hepatic impairment Initiate at 50 mg no more than once every 24 hours; maximum 100 mg per day; regularly evaluate for respiratory and CNS depression.
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity (e.g., anaphylaxis) to buprenorphine or any excipient
- Significant respiratory depression
- Acute or severe bronchial asthma or hypercarbia in an unmonitored setting or in the absence of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity to tapentadol or any other ingredient of the product
- Concurrent use of MAOIs or use within the last 14 days
Adverse Reactions
Most common (>=5%) Nausea, headache, application site pruritus, dizziness, constipation, somnolence, vomiting, application site erythema, dry mouth, application site rash
Serious Life-threatening respiratory depression, addiction/abuse/misuse, interactions with CNS depressants, neonatal opioid withdrawal syndrome, QTc prolongation, anaphylaxis/allergic reactions, hepatotoxicity, seizures, adrenal insufficiency, severe hypotension
Postmarketing Serotonin syndrome, adrenal insufficiency, anaphylaxis, androgen deficiency, hyperalgesia and allodynia, hypoglycemia, opioid-induced esophageal dysfunction
Most common (>=10%) Nausea, constipation, dizziness, headache, somnolence, vomiting
Serious Respiratory depression, serotonin syndrome, adrenal insufficiency, severe hypotension, seizures, neonatal opioid withdrawal syndrome
Postmarketing Hallucination, suicidal ideation, panic attack, anaphylaxis, androgen deficiency, hyperalgesia, allodynia, hypoglycemia, opioid-induced esophageal dysfunction
Pharmacology
Buprenorphine is a partial agonist at the mu-opioid receptor, an antagonist at kappa-opioid receptors, an agonist at delta-opioid receptors, and a partial agonist at ORL-1 (nociceptin) receptors; it produces analgesia and respiratory depression via central opioid receptor modulation, with pharmacodynamic effects including CNS depression, reduced GI motility, and peripheral vasodilation.
Tapentadol is a centrally-acting synthetic analgesic that acts as a mu-opioid receptor (MOR) agonist and norepinephrine reuptake inhibitor (NRI); analgesia in animal models is derived from both properties, though the exact mechanism in humans is unknown.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Butrans
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (0/12) · Qty limit (10/12)
Nucynta
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (9/12)
UnitedHealthcare
Butrans
- Covered on 4 commercial plans
- PA (4/8) · Step Therapy (0/8) · Qty limit (6/8)
Nucynta
- Covered on 4 commercial plans
- PA (7/8) · Step Therapy (6/8) · Qty limit (7/8)
Humana
Butrans
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (3/3)
Nucynta
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Butrans.
No savings programs available for Nucynta.
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ButransView full Butrans profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.