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).