What is tramadol ?
Tramadol is a morphine-like painkiller that is counted among the opioids. Tramadol does not fall under the Opium Act as opposed to the slightly heavier opiates / opioids and include morphine and methadone.
Tramadol is used as a painkiller (analgesic) with moderate to severe pain and as a cough-suppressant (antitussive). It is only available on prescription.
Introduction
Tramadol belongs to the synthetic opioids, and is a weak agonist for all opioid receptors with a preference for μ-receptors. In addition, tramadol inhibits the reuptake of norepinephrine and serotonin, making this agent particularly suitable for the treatment of neuropathic pain, for which it is, moreover, not been registered. For the treatment of acute pain, first earn paracetamol followed by optionally NSAIDs are preferred. An advantage of tramadol compared to other opioids is that it is hardly in low doses has an inhibitory effect on the respiration.
It is sold as effervescent tablet, (retard) tablet, suppositories (suppository), capsules, drops, injection / infusion fluid, and as ready-to-use injection 100 mg. Tramadol is a relatively cheap drug.
Tramadol tolerance and addiction
After prolonged use of any opioid tolerance occurs; after a period of time is a higher dose in order to achieve the desired effect (usually analgesia) than in the beginning. Upon discontinuation of the use of any opioid withdrawal symptoms act up. Once a person has been 'kicked the habit' tolerance has disappeared again, so in a next time can be resumed with the normal starting dose. Tramadol is slower and less potent than morphine so it is not so interesting for drug users. Psychological addiction to opioid pain patients coming in first place only very rarely. Nevertheless, ex-drug addicts are advised to use this drug.
Tramadol is not suitable for heavier opiates, such as heroin, to replace and / or reduce, such as with methadone.
Place of tramadol in the clinic
Often working in pain management, according to the WHO pain ladder.
- The first step is paracetamol or an NSAID, such as ibuprofen.
- The next step is to combine the product of step 1 with a weak opioid as codeine or tramadol. A well-known product is ParaCod (paracetamol and codeine in one tablet).
- The third step is the use of strong opioids such as morphine and fentanyl ("morphine-patches").
- In desperate situations in people with very much pain (terminal cancer patients) is the last step continuous, intravenous administration of strong opioids, morphine usually, with the aid of a pump morphine.
Tramadol is often used in general practice in chronic neuropathic pain with NSAIDs has not been fighting very well.
Loss of Contador in the Tour de France in 2014 came tramadol into play as a painkiller which also robs the mind of a healthy view of the physical condition.
Tramadol dosage and side effects
These opioids such as tramadol have many side effects. Most adverse events with opioid use are strongest in the first week and gradually disappear over time. Nausea, constipation, dizziness (vertigo), excessive sweating and drowsiness (sedation) are common. Sometimes delusions or hallucinations occur. The trick is to dispense so that a proper balance is achieved between pain relief and side effects, bearing in mind the expected buildup of tolerance. As an indication, the starting dosage is dependent on the severity of the pain, and the body weight, typically between 50 and 100 milligrams.
The registration text warns explicitly relating to the influence of the drive and ability to operate machinery.
Less common side effects include:. Mood change (usually cheerful (euphoria), sometimes depressed (dysphoria), fatigue, hypotension, urinary problems, anorexia (lack of appetite), convulsions, respiratory depression, allergies and insomnia also sometimes a combination of insomnia and fatigue, it is very tired but restless and can not sleep. Sometimes other sedatives play a role.
People with epilepsy are likely to experience an increase in the number of attacks.
Metabolism, interactions and contraindications
Tramadol is metabolized in the liver; the breakdown products leave the body with the urine (ie via the kidneys). The half-life is about 6 hours; this may be extended to 40% in the elderly and liver patients - the dose should be reduced accordingly. Hepatic metabolism by CYP2D6 results include the active metabolite O-desmethyl.
Tramadol has an average force of 12 to 24 hours at or capsules, modified-release tablets (time-released / retard). The effervescent tablets and capsules without work-release 4 to 7 hours. Concomitant use of MAO inhibitors is dangerous. In combination with other agents acting on the central nervous system (such as diazepam or ethanol) to the sedating effect of tramadol and the other agent are mutually reinforcing. It is certainly in the beginning is better to drive a car or operate dangerous machinery while taking opioids.
Tramadol is not recommended for patients with severe hepatic or renal impairment. Caution is advised in COPD, asthma, shock, brain injury, and in combination with agents that reduce respiratory reserve (eg sedatives).
Pregnancy and lactation
The effects of use in pregnancy is insufficiently known. Tramadol crosses the placenta, and will also count in the blood of the fetus. There is no evidence of harmful effects seen in animal studies. Still, caution is advised, especially towards the end of pregnancy, because of the risk of respiratory depression in the newborn. A small amount of tramadol ends up in the milk.
Brand names
Tramadol since 1977 internationally marketed under numerous names. In Europe, trade names used his Adolonta, Anodol, Boldol, Contramal, Crispin, Dolol, Dolzam, Dromadol, Ixprim, Lumidol, Mandolgin, Nobligan, Siverol, Tiparol, Topalgic, Tradolan, Zamadol, Tradnol, Trad Oil Tralgit, Tramacet, Tramadin, Tramake , Tramagetic, Tramal, Tramalgic, Tramundal, Trodon, Ultracet, Ultram, TRAMACET, Zamadol, Zydol, Zytram and Zytrim. In other parts of the world are often used other names. This proliferation is in trade because it is produced by Grünenthal as Tramal patented agent licensed by many different manufacturers who want to distinguish themselves from each other. Note that the active substance and effectiveness is always exactly the same. In the Netherlands the price of generic tramadol only a fraction of that of the original.
Tramadol overdose
Respiratory depression tramadol overdose can be controlled with an injection of naloxone. Diazepam is used for seizures after an overdose.