What Is Tramadol?
Tramadol is an opioid (narcotic) pain reliever used to treat moderate to severe pain. Most brands of tramadol are only intended for adult use, and the medication comes in regular and extended-release tablets and capsules. It is also available in a liquid form, and patients recovering from surgery may receive it as an injection. Tramadol can be taken with or without food. When prescribed for chronic pain, doctors may gradually increase the patient's dose. Patients taking the regular tablet form can use the medication every four to six hours as needed for pain. The extended-release tablets and capsules should only be taken once a day, and these should be taken at the same time each day.
Tramadol is a controlled substance, and it may be habit-forming for some individuals, especially if it is taken for a long time. Patients who have been given a prescription for tramadol should discuss the risks and benefits of this medication with their doctor before starting treatment. Patients should also check with their doctor about how to taper their tramadol dose to reduce the risk of withdrawal symptoms while stopping the medication.
Class Of Medication
Tramadol belongs to a class of medication known as opioids. These medications are pain relievers that work by activating the opioid receptors in the nervous system, which reduces the transmission of pain signals. Some opioids are designed to treat mild pain, and others are appropriate for the treatment of moderate to severe pain. Opioids can be used to manage acute pain, including post-surgical pain, and they are also used to manage chronic pain from cancer and injuries. Opioids are controlled substances that are only available by prescription. Some are given as a patch, and others can be taken orally or by injection.
Some of the most commonly reported side effects associated with opioid use include constipation, nausea, dry mouth, reduced urinary output, headaches, and dizziness. Patients tend to feel very drowsy while taking opioids, and respiratory depression is frequently observed. Opioids can lead to dependence, and patients are advised to only use these medicines for a short period. Individuals with endocrine disorders, hypothyroidism, myasthenia gravis, or central nervous system depression may need to have their opioid dose adjusted. Adjustments are also necessary for patients who frequently consume alcohol.
How It Works
Like other opioids, tramadol attaches to receptors in the brain and changes the way the body perceives pain. Several theories have been proposed regarding the specific action of this medication, and research into these theories is ongoing. Currently, theories proposed by Driessen and Raffa center around tramadol's impact on several key receptors in the brain. For example, studies suggest tramadol allows serotonin and norepinephrine to be used by the brain for longer periods than hydrocodone and some other opioids, and doctors believe this mechanism makes tramadol especially effective in blocking pain signals located in the spinal cord.
Additional research has shown tramadol acts on the mu-opioid receptors, and this decreases the transmission rate of the nerve signals that produce pain. Generally, tramadol does not act on the mu-opioid receptors to the same degree as other opioids, and this means it has a lower risk of dependence than other narcotic pain relievers. Scientists have concluded tramadol is approximately one-tenth as strong as morphine.
Uses For Tramadol
Tramadol is used to treat both acute and chronic pain. For instance, it is often prescribed for patients experiencing acute pain while recovering from surgery. The medication is also prescribed to patients coping with chronic pain caused by accidents and injuries and by illnesses such as cancer. Some doctors may prescribe tramadol for moderate to severe lower back pain and pain from arthritis. The medicine is sometimes considered as a treatment option for pain from autoimmune conditions, including lupus.
In certain instances, it might be recommended as one of several medications to control pain from migraines. Patients who have been prescribed tramadol for any reason should always let their doctors know if they feel the medication is not relieving their pain or if they experience any changes in their symptoms.
Side Effects Of Tramadol
Tramadol can affect sleep, and patients could experience sleepiness or difficulty falling asleep or staying asleep. Headaches, dry mouth, heartburn, and muscle tightness have been reported, and some patients have noticed mood changes, nervousness, and uncontrolled shaking of a limb. Tramadol could also lead to flushing, congestion, sore throat, and itching.
Serious side effects may develop as a result of using tramadol, and patients are most at risk of these during the first seventy-two hours of using the medicine and at any time their tramadol dose is increased. Seizures, breathing and swallowing difficulties, hives, confusion, agitation, and hallucinations are among the most serious side effects that could occur. Some patients lose consciousness after taking tramadol. Patients should mention all side effects to their doctor, and any serious side effects should be treated in an emergency room.
Precautions To Remember
Before prescribing tramadol, doctors will need to know if the patient has ever had breathing difficulties, kidney issues, liver issues, or seizures. The doctor must know whether the patient has ever struggled with an alcohol or substance use issue and whether they have ever had suicidal thoughts. This information helps the physician determine if tramadol is a safe medication for the patient's overall health. Tramadol can cause dizziness and fainting when getting up from a lying position. To reduce the risk of fainting, patients using this medication should get out of bed slowly; it often helps to rest the feet on the floor for a few minutes before standing up.
Tramadol should not be used by women who are breastfeeding, and alcohol mustn't be consumed during treatment with tramadol. Mixing alcohol and tramadol could lead to life-threatening side effects. Tramadol may reduce fertility in both men and women, and patients might want to discuss this with their doctor before deciding to use this opioid. As with other opioids, tramadol can impair coordination. For this reason, patients should not drive or operate heavy machines until they understand how the medication affects them.
Potential Medication Interactions
Tramadol is known to interact with a variety of other medications, including anticoagulants such as warfarin and anti-fungal medicines like ketoconazole. This opioid interferes with antibiotics, including erythromycin and linezolid, and it also interacts with medication for epilepsy and migraines. In particular, tramadol has strong interactions with antidepressants, including monoamine oxidase inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors, and patients who take lithium or anti-anxiety medications such as sertraline or paroxetine have experienced interactions as well.
Due to potential interactions, patients who take tramadol should not take any other medication containing this opioid, and they should be aware tramadol could interact with muscle relaxants and with other types of pain relievers such as oxycodone. Doctors should go over the patient's complete medication list before prescribing tramadol, and pharmacists should check for interactions before dispensing the medicine.
Commonly Prescribed Alternatives
For patients who cannot take tramadol, doctors may prescribe other opioids. Commonly prescribed alternatives to tramadol include hydrocodone, hydrocodone-acetaminophen, meperidine, and codeine. Tramadol is a relatively weak opioid, and doctors may need to prescribe something stronger for patients in moderate to severe pain. Medicines such as morphine, oxycodone, and oxymorphone may be considered.
For patients in very severe pain, hydromorphone or fentanyl could be prescribed. All of these drugs are controlled substances that may cause dependence. Patients are often very sedated on these medicines, and they could experience confusion. Due to the side effects of opioids, some doctors often recommend that patients try other methods of pain relief before starting opioids.
Dosage Factors
Healthcare providers consider a patient's age, general health, and pain level when deciding on an appropriate dose of tramadol. For acute pain, the recommended dose for adults is fifty to one hundred milligrams every four to six hours as needed to control pain. Adults who take tramadol for chronic pain may use an extended-release tablet of one hundred milligrams. This is usually taken once per day. Patients who are seventy-five years old and older should not take more than three hundred milligrams of the immediate-release tablet in one day.
This drug is not intended for use in patients under seventeen years old, and individuals who have certain pre-existing health conditions may need to have their dose adjusted. For example, patients who have liver cirrhosis are advised to take fifty milligrams of the immediate-release tablet every twelve hours, and individuals with severe liver impairment should not use tramadol at all. Patients with kidney issues and CrCl values of less than thirty milliliters per minute should take no more than two hundred milligrams of tramadol per day. The extended-release tablet is not recommended for patients with renal issues.
Who Shouldn't Take Tramadol
Individuals with severe breathing issues should not use this medication, and it is not recommended for patients who have seizure disorders. Patients with blockages in the stomach or intestines should not use tramadol, and it is not safe for use by those who are pregnant or breastfeeding. Patients who have had suicidal thoughts cannot safely use this medicine, and it should not be taken by those who are prone to dependence. Patients who take other opioids need to ask their doctor before taking tramadol, and individuals who use antidepressants should also inform their doctor of this. If the patient has recently used sedatives, narcotics, tranquilizers, methylene blue injections, selegiline, or phenelzine, tramadol is contraindicated.
Contraindications are in place for patients who have recently taken isocarboxazid, linezolid, or tranylcypromine as well. Before tramadol is prescribed, patients should let their doctor know if they have ever had urination problems, liver disease, kidney disease, sleep apnea, or stomach disorders. They should also inform their healthcare provider if they have ever had any gallbladder, stomach, pancreas, or thyroid issues, and it is particularly important for the doctor to know about any history of mental health conditions or suicide attempts. Tramadol may not be safe for patients with a history of these conditions.
Tips For Taking It
Tramadol should be stored at room temperature, and it needs to be kept away from moisture and heat. Patients can take tramadol with or without food, and it should be taken the same way each time. Tramadol can slow down an individual's breathing, and this is most likely to happen when the patient first starts using the medicine or when the dose is changed. Patients should let their doctor know if they notice any breathing changes while taking this drug. When tramadol is started, patients need to stop taking all other narcotic pain relievers used around-the-clock.
This medicine should be used at the exact dose prescribed, as taking larger doses could result in life-threatening or fatal complications. Tramadol tablets should never be crushed, broken, or inhaled, as this could be fatal. The extended-release tablet shell may be visible in the patient's stools, and this is considered normal. Patients who want to stop taking tramadol need to talk to their doctor first, since stopping the medication suddenly could cause withdrawal symptoms.