This week was a nice short week for me, and I was very grateful to have time off for Thanksgiving. Being on an office rotation is especially great for that reason. I didn’t get asked very many questions this week, and no topic stuck out for me to post on. So, I decided to post on a commonly encountered medication: Tramadol. I think a review of this medication is warranted since I am seeing it used more and more, and there are some important things to remember about it such as the uses, side effects, and drug interactions.
Tramadol (Ultram) is a very commonly used pain killer with some very interesting characteristics. It is also available in an extended release (ER) form for patients who need constant or near constant pain relief. Some other interesting uses (off-label) of tramadol are for restless leg syndrome and premature ejaculation.
Tramadol is classified by the FDA as a “nontraditional centrally acting analgesic.” It received this description because it binds to opioid receptors like morphine and codeine, but it also inhibits serotonin and norepinephrine reuptake like some antidepressants. This mechanism of action has made the drug popular because it is not a controlled substance, and it has fewer side effects than the other opioids such as respiratory depression, constipation, and addictiveness. Because of this, patients taking tramadol do not have to be watched as closely. It also does not lower the immune system and cannot be abused as easily as the other opioids.
Tramadol is metabolized in the liver and excreted in the urine. It is very useful for acute pain, chronic pain, post-surgical pain, cancer patients, obese patients, pediatric patients, immunocompromised patients, patients in labor, older patients, and smokers. It should not be used with other opioids, alcohol, carbamazepine (a seizure medication), antidepressants (SSRIs, SNRIs, TCAs, and MAOIs), digoxin, and warfarin, among others. The most common side effect is nausea. Other common side effects are constipation (but lower than for other opioids), dizziness, headache, fatigue, vomiting, and GI upset. Tramadol is pregnancy category C and should not be used in breastfeeding mothers.
In conclusion, tramadol is an important pain killer due to its two mechanisms of action. It is available in a pill, liquid, and suppository, in addition to IM, IV, and SQ injections. This allows it to be administered to a wide variety of patients and in many different conditions.
Sources:
Grond, Stefan, and Armin Sablotzki. "Clinical Pharmacology of Tramadol." Clinical Pharmacokinetics 43.13 (2004): 879+. Expanded Academic ASAP. Web. 25 Nov. 2011. < http://adisonline.com/pharmacokinetics/pages/articleviewer.aspx?year=2004&issue=43130&article=00004&type=abstract>
Wolters Kluwer Health. "Complete Tramadol Hydrochloride Information from Drugs.com." Drugs.com | Prescription Drug Information, Interactions & Side Effects. Drugs.com, 2009. Web. 25 Nov. 2011. <http://www.drugs.com/ppa/tramadol-hydrochloride.html>.
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