Yury Bayarski asked: Tramadol has been used as an analgesic since the late 1970s, and became one of the most popular analgesics of its class in Germany. International interest for the drug has been renewed when it was discovered that tramadol not only acts like opioids, but also inhibits serotonin and noradrenaline reuptake.
Mechanism of action
Tramadol is a unique medication. Its mode of action and safety profile distinguishes it from other opioids. It is classified as an atypical centrally acting analgesic, and has opioid and non-opioid properties. Tramadol is a synthetic analogue of codeine that has weak opioid agonist properties. It also inhibits the neuronal reuptake of norepinephrine and serotonin as do the antidepressant drugs
Tramadol has strong structural similarities to the antidepressant venlafaxine. Because of its similarities to venlafaxine, tramadol may possibly exert a degree of antidepressant effect in certain patients, particularly those with chronic pain.
Side effects
Tramadol is generally well tolerated, the most common side effects being nausea and vomiting. In contrast to agents such as morphine and pethidine, respiratory depression rarely occurs during tramadol treatment at equipotent doses. But large doses of tramadol may increase the respiratory effects of other drugs. It is also associated with a low incidence of cardiac depression and significantly less dizziness and drowsiness than morphine.
Finally, dependence and abuse potential is relatively low because it has only a weak opioid effect. The low abuse potential of tramadol has been demonstrated by postmarketing surveillance data.
Tramadol appears to carry the same risk of urinary disorders (difficulty in micturition, urinary retention) as other opiates.
The medication should be avoided in persons with epilepsy and used cautiously in those taking medications which lower the threshold for seizures.
Tramadol uses
It is effective in different types of moderate-to-severe pain, including neuropathic pain. This medication has a dose-dependent efficacy that lies between that of codeine and morphine, with a parenteral potency comparable to that of pethidine.
Comparative studies have demonstrated that tramadol is more effective than NSAIDs for controlling post operative pain. Moreover, as the mode of action of tramadol does not overlap with that of NSAIDs, it is a useful agent to be combined with these drugs. Use of a combination of tramadol and NSAIDs allows the tramadol dose to be reduced and results in a lower incidence of side effects.
Tramadol may be particularly useful for elderly population suffering from osteoarthritis because, unlike NSAIDs, it does not aggravate high blood pressure and cardiovascular complications, nor does it have the potential to cause peptic ulcer disease.
Tramadol has been used with good results for the management of labour pain without respiratory depression of the neonate. It is effective for the treatment of pain from myocardial ischaemia, renal colic and acute trauma.
Recommendations
Migraine
