Tramadol is an opioid agonist medication used to treat moderate to severe pain. It is available in tablet or capsule form and works by changing how the brain perceives pain. While it is a controlled substance, it was initially marketed as a safer noncontrolled analgesic with less potential for abuse than opioids. However, reports of abuse, overdose, and misuse have since surfaced, and it is now a Schedule IV controlled substance.
Tramadol has serious side effects and warnings, including slowed or stopped breathing, accidental ingestion, and life-threatening effects for children. It can also cause physical dependence and withdrawal symptoms when stopping the drug. Due to these risks, it should be prescribed with caution, especially in the elderly, who are more susceptible to adverse effects.
So, is tramadol safe for stroke patients? The answer is not straightforward, as there are potential benefits and risks to consider. On the one hand, tramadol has been found effective in reducing pain in patients with central post-stroke pain, a difficult type of neuropathic pain to control with medical treatment. On the other hand, tramadol may cause or worsen seizures, and stroke patients are already at an increased risk of seizures. Therefore, it is crucial for healthcare providers to carefully assess the benefits and risks of administering tramadol to stroke patients on a case-by-case basis.
Characteristics | Values |
---|---|
Type of drug | Opioid agonist medication |
Forms | Tablets, capsules |
Use | Treat moderate to severe pain |
Side effects | Drowsiness, nausea, vomiting, constipation, dry mouth, perspiration, dizziness, tremor, confusion, hallucination, blood pressure instability, seizures |
Risk | Addiction, abuse, misuse, overdose, serotonin syndrome, drug interactions, hypoglycemia, physical dependence, withdrawal, accidental ingestion, neonatal opioid withdrawal syndrome |
FDA warnings | Addiction, abuse, misuse, slowed or stopped breathing, accidental ingestion, life-threatening effects for children, neonatal opioid withdrawal syndrome, interactions with certain drugs, interactions with benzodiazepines or other central nervous system (CNS) depressants |
What You'll Learn
Tramadol's efficacy in treating central post-stroke pain
Tramadol is an opioid analgesic that has been approved for the treatment of non-cancer pain in Japan since 2011. It is often used in combination with acetaminophen. Central post-stroke pain (CPSP) is the most difficult type of central neuropathic pain to control with medical treatment. While opioids are commonly used for chronic neuropathic pain, their efficacy in treating central neuropathic pain, particularly CPSP, is unclear.
A 2013 study evaluated the efficacy of oral tramadol/acetaminophen medication for CPSP. Nine cases of CPSP were reviewed retrospectively, and all cases received tramadol/acetaminophen medication after first taking pregabalin and then antidepressant medication. Pain levels were assessed before and after a maintenance dose was reached, using a visual analogue scale (VAS) and the McGill pain questionnaire (MPQ). The mean dose of tramadol was 121±61.6 mg/day. Tramadol/acetaminophen medication was found to be effective in reducing pain in seven out of nine cases (77.8%). The VAS improved by 32.9±13.8% from pre-to post-medication, and the MPQ improved from 15.4±9.1 pre-medication to 8.1±4.7 post-medication (p<0.05). These effects continued for an average of 9.3±4.5 months during the follow-up periods. Side effects were observed in six cases (one severe, one moderate, two mild, two transient), but medication was continued in eight cases.
In conclusion, oral tramadol/acetaminophen medication was effective at reducing pain levels in patients with CPSP and is a viable medication option for the treatment of CPSP.
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Tramadol's side effects
Tramadol is a controlled substance used to treat moderate to severe pain. It is available in tablet or capsule form and works by changing how the brain perceives pain. It is typically used for short-term or long-term treatment.
Tramadol has been associated with a range of side effects, some of which can be serious or even fatal. Here is a detailed breakdown of the side effects:
Common Side Effects
Common side effects of tramadol can include:
- Dizziness
- Drowsiness
- Headache
- Blurred vision
- Constipation
- Diarrhoea
- Nausea and vomiting
- Dry mouth
- Sweating
- Loss of appetite
- Stomach pain
- Gas
- Heartburn
These side effects are typically mild and may go away within a few days or a couple of weeks.
Serious Side Effects
Tramadol may also cause serious side effects that require immediate medical attention. These can include:
- Slowed or stopped breathing
- Serotonin syndrome (symptoms include a higher body temperature, stronger reflexes, hallucinations, and lack of coordination)
- Physical dependence and withdrawal symptoms (such as irritability, anxiety, increased blood pressure, nausea, and vomiting)
- Adrenal insufficiency (symptoms include long-lasting tiredness and abdominal pain)
- Addiction or misuse
- Seizures
- Hypoglycaemia
- Serotonin syndrome
- Allergic reactions, including anaphylaxis
- Increased risk of falls and fractures
- Interactions with certain drugs, such as benzodiazepines or other central nervous system (CNS) depressants
It is important to note that older adults are more susceptible to adverse effects of medications, including tramadol. Therefore, increased awareness of this risk is crucial for developing appropriate medication regimens with improved monitoring parameters.
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Tramadol's potential for abuse
Tramadol is a widely used opioid analgesic indicated for moderate to moderately severe pain. It is often prescribed to treat neuropathic pain resulting from diabetes, injuries, or stroke. While it is considered to be less prone to abuse and addiction than other opioids, tramadol use can still result in a substance use disorder.
Tramadol abuse and addiction are serious issues, even though the drug was designed to be a safer alternative to more potent prescription analgesics. The effects of tramadol can induce substance-seeking behaviours similar to those of other opioid drugs. As an individual's tolerance to tramadol increases, they may need to increase their dosage to achieve the same effects. This can lead to a cycle of substance abuse and addiction.
Signs of tramadol abuse include using the drug without a prescription, taking higher doses or more frequent doses than prescribed, and combining tramadol with other substances to increase its effects. Abuse of tramadol can lead to severe adverse reactions, such as seizures, especially when taken in large doses or in combination with antidepressants.
Those with a history of substance abuse are more likely to develop an addiction to tramadol, but even those without such a history are at risk. A person addicted to tramadol may exhibit behaviours such as doctor shopping, compulsive use of the drug, neglecting responsibilities, and social or interpersonal problems related to tramadol use. They may also experience physical and psychological withdrawal symptoms when they try to reduce their dosage or stop taking the drug.
To reduce the risk of tramadol abuse and addiction, it is important to recognise the signs of abuse early on and provide appropriate treatment and support. Inpatient and outpatient rehab programs, as well as medically-supervised detox, can help individuals battling tramadol addiction achieve recovery.
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Tramadol's effects on children
Tramadol is a synthetic opioid designed to treat moderate to severe nociceptive pain in children. It is a prodrug, meaning it is metabolised by the body into its active form. This process is carried out by the liver enzyme system, cytochrome P450 2D6 (CYP2D6). CYP2D6 is polymorphic, meaning it has many variants, and this results in large interindividual differences in responses to the same dose of tramadol.
The safety of tramadol in children has been questioned since the mid-2010s, as respiratory depression induced by the drug has been associated with overdosing and CYP2D6 ultra-rapid metaboliser (UM) phenotypes. In 2015, the FDA issued a drug safety communication to alert healthcare providers of the risk of respiratory depression in children receiving tramadol. In 2017, the FDA issued a new drug safety communication with restrictions for the use of tramadol in children:
- A contraindication for treating pain in children younger than 12 years old and in children younger than 18 years old after surgery to remove the tonsils and/or adenoids.
- A warning recommending against use in obese adolescents between 12 and 18 years and children who have conditions such as obstructive sleep apnea or severe lung disease.
Tramadol is not the only opioid with these restrictions; codeine is also contraindicated for these patient groups.
In light of the current data, it appears that by supporting personalised medicine, good education of parents and caregivers, as well as child-friendly formulation, its use may be pursued in the majority of the paediatric population for the treatment of moderate to severe pain.
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Tramadol's effects on pregnant people
Tramadol is not recommended for use during pregnancy. It is a narcotic prescribed to treat pain and is in a group of medications called opioids. It has been shown to cross the placental barrier and animal studies have shown that at very high doses, it can affect organ development, bone growth, and the mortality rate.
There is insufficient data to determine a drug-associated risk for major birth defects and miscarriage. However, one study found that the use of tramadol in early pregnancy was associated with a moderately increased risk of congenital malformations, particularly cardiovascular defects and pes equinovarus. Another study did not find a risk for miscarriage among people who filled a tramadol prescription during the first 22 weeks of pregnancy.
Prolonged maternal use of opioid analgesics during pregnancy may result in respiratory depression and physical dependence in the neonate, as well as neonatal opioid withdrawal syndrome shortly after birth. There have been reports of neonatal seizures, neonatal withdrawal syndrome, fetal death, and stillbirths. Chronic use of opioids may also cause reduced fertility, although it is unknown whether these effects are reversible.
Tramadol passes into breast milk in small amounts and the United States Food and Drug Administration (FDA) and the manufacturer recommend that it not be used during breastfeeding due to concerns that it could build up in the baby's system and cause serious adverse reactions such as trouble breathing or not waking to feed.
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Frequently asked questions
The most common side effects of tramadol, affecting 10% of people who take it, include: nausea, constipation, dizziness, headache, drowsiness, and vomiting.
Serious side effects and warnings include: slowed or stopped breathing, accidental ingestion (especially in children), seizures, serotonin syndrome, and physical dependence and withdrawal.
Tramadol has several boxed warnings from the FDA, which are the most serious warnings from the Food and Drug Administration. These include: addiction, abuse, and misuse; slowed or stopped breathing; accidental ingestion; life-threatening effects for children; neonatal opioid withdrawal syndrome; interactions with certain drugs; and interactions with benzodiazepines or other central nervous system (CNS) depressants.
Tramadol can cause or worsen seizures. It can also cause a severe allergic reaction and worsen certain health conditions, including seizures, mental health problems, addiction, head injuries, and stomach problems. It may also be dangerous for pregnant or breastfeeding people.
Tramadol is not recommended for people with severe breathing problems, a head injury, or increased pressure inside the skull. It is also not advised for those who have recently used alcohol, sedatives, tranquilizers, or narcotic medication. Therefore, it is important to consult a doctor or medical professional to determine if tramadol is safe for stroke patients on a case-by-case basis, as they may be at higher risk for certain side effects.