Tramadol
Tramadol Side Effects: Tramadol is perhaps better known by the brand name Ultram. Tramadol is available as 50 and 100 mg dose tablets. There are also sustained release formulations, and formulations that also contain acetaminophen. Tramadol is a synthetic opioid-like drug that has its effects primarily as an agonist (stimulator) of the mu opioid receptor site. Tramadol is used primarily for moderate to severe pain control. It has many properties in common with other opioid medications, but is different in that it acts more specifically on the opioid mu receptor than most other opioids. (there are other opioid receptors) Like other opioids tramadol is potentially habit forming, although some experts feel this is a less severe and common problem with tramadol than with other opioids. Tramadol is also used for treatment of restless legs syndrome and fibromyalgia, and has additional properties that affect neurotransmitter release and reuptake.
Common Tramadol Side Effects: Tramadol side effects include many of the gastrointestinal side effects associated with other opioid agonists including constipation, nausea, vomiting, dyspepsia and occasionally diarrhea. These are due to the opioid mu receptors in the GI tract that lead to increased stimulation of the circular muscles and decreased stimulation of the longitudinal muscles of the colon wall. This leads to poor propulsive effect of the bowel content and increased churning of the bowel content, as well as causing dryer and firmer stool, and slower transit time. It can also lead to decreased feeling of fullness in the distal colon and reduced urge to defecate. Non GI tramadol side effects that are common include somnolence, itching, dizziness, sweating and flushing.
Life Threatening Tramadol Side Effects: Seizures are the most important tramadol side effect to consider. They are more common in people with a history of seizures, and if you have a history of seizures you should be sure your physician knows about this history, and if used tramadol dosing should be minimized. The other serious side effects can be primarily grouped into the allergic side effects including angioedema, anaphylaxis, severe rashes including the Stevens-Johnson Syndrome and toxic epidermal necrolysis, and those side effects shared with most opioids including withdrawal syndrome if discontinued suddenly, dependency and abuse, respiratory depression, and depression/suicide. Another serious tramadol side effect can be the serotonin syndrome, and orthostatic hypotension (drop in blood pressure on sitting or standing).
Unusual Tramadol Side Effects: Seizures are the most unusual tramadol side effect that is occasionally seen.
Contraindications, cautions and drug interactions: Like all medications tramadol is contraindicated when for patients with a known hypersensitivity to tramadol or other drugs in its class. Caution needs to be used with hypersensitivity to opioids. Patients with addiction history should be prescribed tramadol with extreme caution. Caution needs to be taken in patients with history of seizures or who are at risk for seizure as well as in cases of acute head injury. In patients with psychiatric disorder caution needs to be used also. Caution is advised in elderly patients, in patients with suicidal ideation or who are felt be a risk of suicide, and in patients known to have a major organ impairment including renal and hepatic impairment especially with immediate release forms of tramadol. Tramadol is contraindicated for use with all of the monoamine oxidase inhibitors as well as with alcohol and with the HIV combination drug lopinavir/ritonavir. The list of medications where use in conjunction with tramadol is best avoided and an alternative used if possible is extensive and only some of the more commonly used medications are listed here. For complete information see the manufacturers prescribing guidelines or for specific drug interaction concerns consult your pharmacist or personal physician. Several anticonvulsant medications including carbamazepine and the phenytoins are best avoided with tramadol. Any rifampin containing medication is best avoided. Ginkgo biloba, a commonly used herbal supplement, should be avoided with tramadol. Careful monitoring or modification of treatment may be needed with a large list of medications, the most prominent of which is warfarin but also includes digoxin, bupropion and ketamine. Because of the potential for serotonin syndrome use with serotonergic medications require special caution. This would include any of the selective serotonin reuptake inhibitor type medications as well as several other classes drugs. Cumulative central nervous system and respiratory depression can be noted with any the other opioids and so facing combination needs to be monitored carefully. The same is true for use with any other central nervous system depressant including the benzodiazepines, barbiturates, antihistamines, and cannabinoids. Again keep in mind this list is purposefully brief and checking for drug interactions with any medications you’re using is appropriate with tramadol.
Pregnancy and Lactation Class: Tramadol is pregnancy Category C and is considered possibly unsafe for use during lactation.
Special Considerations: Tramadol is generally considered to be less addictive than many other opioid analgesics, but it is still an opioid mu receptor and has the potential for abuse. Do not share this medication with others, and certainly do not crush the pills for inhalation or injection. Seizures are the unique tramadol side effect and is especially a concern if used taken in higher than the recommended dosage or if you have a history of seizures.
Tramadol abuse is more widespread as a drug obtained via internet sites that cater to individuals who would be unlikely to be given tramadol prescriptions by their physician in person. The catch with many of the online sites is that they charge exhorbitant prices to obtain the “free prescription” promised. Sites may offer tramadol at prices of $100./thirty 50mg doses, whereas a pharmacy like Costco offers the same #30 doses for under $10. with a prescription from your physician. In essence the online providers are selling inflated price tramadol as a way to skirt the legality of dispensing a potentially addictive drug without direct physician supervision and prescriptions.
