Does switching to tapentadol reduce the risk of falls for older patients?

Health · Published 3 October 2026 Swipe more like this →

In short: Opioid medications are often linked to an increased risk of falls, a significant concern for older patients. Recent research comparing tapentadol to oxycodone suggests that tapentadol may offer a safer profile in clinical practice, potentially reducing fall-related emergency visits and hospitalizations among those initiating treatment for pain management.

Tapentadol is a synthetic opioid analgesic that functions through a dual mechanism: as a selective agonist of the mu-opioid receptor and as a norepinephrine reuptake inhibitor. Developed by Grünenthal in the late 1980s, the drug was designed to improve upon tramadol by minimizing serotonin activity and eliminating the need for metabolic activation. Because it is highly addictive, it is strictly regulated as a Schedule II controlled substance in the United States and a Schedule 8 drug in Australia.

A retrospective cohort study conducted in New South Wales between 2014 and 2020 analyzed over 200,000 initiators of sustained-release tapentadol and controlled-release oxycodone. The findings indicated that tapentadol was associated with a lower risk of falls within 28 days of initiation compared to oxycodone. While the absolute risk reduction was small—roughly one to two fewer falls per 1,000 patients—the benefit was more pronounced in older populations. Specifically, for opioid-naïve patients aged 80 and older, the study observed six to ten fewer falls per 1,000 patients.

Despite these potential safety advantages, clinical access to such medications remains complex. In Australia, podiatrists operate under a fixed prescribing formulary known as the National Podiatry Scheduled Medicines List. Clinicians have criticized this static model, arguing that it is misaligned with contemporary pharmacological evidence. They suggest that restrictive lists can lead to fragmented care pathways, delayed pain relief, and increased healthcare utilization, particularly for patients in rural settings who may struggle to access appropriate pain management.

It is important to note that tapentadol is not without risks. It is contraindicated for individuals with epilepsy or those prone to seizures, as it can lower the seizure threshold. Furthermore, concurrent use with other central nervous system depressants, such as alcohol or benzodiazepines, can lead to profound sedation and respiratory depression. While tapentadol may offer a lower incidence of certain side effects compared to oxycodone, its use requires careful clinical judgment, especially in vulnerable or elderly patient groups.

General information, not professional advice. Spotted an error? Flag the card or see corrections and complaints.

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