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Its principal metabolite, tapentadol-O-gluroronide has tapentadol no activity on opioid receptors, reuptake systems in synapses or other junctures .
Tramadol is tapentadol metabolized almost entirely by the enzyme of the P450, CYP26 cytochrome .
CYP2D6 gene mutations occur in approximately 1 to 7% of the Caucasian tapentadol bijsluiter nucynta for knee pain nucynta liver damage tapentadol euphoria tapentadol population and can increase or decrease enzymatic activity and produce alterations of opioid analgesia .
Aside of the potential differences in individual responses to opioids metabolized by the P450 cytochrome there is a high-risk of pharmacological interactions as some of the substrates of tapentadol CYP2D6 are antiarrhythmic medications, antidepressants, antipsychotics anti-parasite medications and tamoxifen .

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