ABOUT TRAMADOL

Since Tramadol was introduced in Australia in late 1998 its use has increased significantly. While there is a huge amount of information supporting Tramadol uses for pain, there is gradually more large body of confirmation from post-marketing observation showing there are troubles. In 1999 there were 19 reports of unfavorable events, while in 2003 there were 286 reports. As of March 2004 the Australian unfavorable Drug Reactions Advisory Committee (ADRAC) has received 726 reports of unfavorable events related with Tramadol, detailing 1922 reactions. In 453 of the reports, Tramadol was the sole assumed drug. These reactions recommend that the choice to recommend Tramadol should be cautiously considered.Tramadol is a centrally acting painkiller. Structurally it is not an opiate, but it exhibits some opioid distinctiveness. Like codeine, Tramadol is metabolized via the CYP2D6 is enzyme of cytochrome P450 to an active metabolite which binds to µ receptors. Patients who metabolize drugs poorly via CYP2D6 (about 7% of Caucasians) may get less benefit from Tramadol (and codeine) due to reduced formation of the active metabolite. Tramadol is also metabolized by CYP3A4 so its activity is reduced by drugs which induce CYP3A4.3The analgesic effect of Tramadol is not completely reversed by the opioid opponent naloxone and some patients who do not react to codeine do react to Tramadol. This suggests that Tramadol has extra mechanism of action. Tramadol inhibits reuptake of serotonin and noradrenalin and this probably contributes to its analgesic effects.There is no doubt that Tramadol is an useful analgesic for moderate, and in some cases, severe pain.4 In proportional studies in postoperative and post-trauma pain, Tramadol 100 mg intramuscularly or intravenously was alike to 5–10 mg of morphine. However, in cruel agonizing related with either surgical treatment or cancer, morphine was more effective than Tramadol and remains the drug of choice. In acute and chronic non-malignant pain, oral Tramadol 100 mg is equivalent to a mixture of paracetamol and codeine (1000 mg/60 mg).

ADVERSE EFFECTS OF TRAMADOL

The unfavorable effects of Tramadol are related to other opioids and consist of nausea, sickness, constipation, pain, giddiness, dry mouth, sedation, asthenia, tiredness and sweating1. Ordinary effects comprise skin reactions. Titrate the dosage bit by bit may improve acceptability, and intra-operative loading may decrease post-operative sickness and queasiness. With the exemption of sweating, constipation and dry mouth, most adverse sound effects appear to reduce with delayed use. Tramadol is improbable to produce clinically related respiratory hopelessness at suggested dose but respiratory despair may occur if suggested doses are exceeded. Bronchus tremor has been noted with Tramadol, but always with other mixed up contributing factors.

Tramadol bring the same risk of urinary disorder (urinary detention) as other opiates. Seizures reported in patients enchanting Tramadol at and above the prescribed dose, mainly in the charisma of other pro-consultant drugs5. According to the Database from (1994-96) it is identified 17 cases of idiopathic seizure (11 exact, 6 likely) among the 10,916 patients treated with Tramadol. The final decision was that there was no increased threat of idiopathic incident seizures associated with experience to Tramadol alone. However, Tramadol should avoid in epileptics and should be used with concern in patients on related medication which lower seizure entrance, such as tricyclic antidepressants, choosy serotonin reuptake inhibitors, fantasy and specially pethidine.  

The cruelty or reliance possible for Tramadol is low, provided it is dosed within suggested range. On the other hand, reports of drug reliance and removal have occurred. Tramadol has very little resemblance for opioid receptors (10 times less than codeine, 60 times less than propoxyphene and 6005 times less than that of morphine. Low cruelty probable has been established in a randomized, double-blind, placebo-controlled, intersect trial comparing Tramadol 75mg, 150mg and 300 mg with morphine 15mg and 30 mg and placebo in 12 volunteers who were before register drug addicts, but were at this time non-opioid needy. Effects were assessed on measures of subjective, behavioral and physiological response.

The special effects of Tramadol 75mg and 150mg over 12 hours were not dissimilar from placebo. Although Tramadol 300mg was identified as an opiate, it shaped no other morphine like effects. The opioid agonist and competitor characteristics of Tramadol were assessed in 6 male opioid needy volunteers enrolled in a methadone maintenance program. Intramuscular Tramadol 100mg and 300mg were compared with placebo in a double-blind fashion. Tramadol neither produced morphine-like effects, nor were precipitated withdrawal signs and its effects indistinguishable from placebo.However, a number of case reports have been published which highlight the potential for reliance, ill-treatment and removal syndrome after long-term cure. Up until 2000, the FDA had received reports of 115 cases of patients developing abuse, dependence or pulling out in association with Tramadol use. The marketing of the Australian Drug Reaction Advisory Committee (ADRAC) has received 3 reports of drug withdrawal syndrome in association with Tramadol. In all cases Tramadol has been the sole suspected drug.