Generic Medication Name: Tramadol
Brand Medication Name: Ultram ER, Ultram
Ultram / Tramadol is an opioid which acts as a centrally acting analgesic, which is imprinted with an 627 and it is used for treating moderate to severe pain. It is a synthetic agent, as a 4-phenyl-piperidine analogue of codeine. It appears to have actions on the GABAergic, noradrenergic and serotonergic systems.
Tramadol was created by German pharmaceutical company Grünenthal GmbH in the late 1970s and sold under the trade name Tramal. Grünenthal has also cross licensed the medication to many other pharmaceutical firms that market it under various names.
Tramadol is most commonly marketed as the hydrochloride salt (tramadol hydrochloride) and it is available in both oral and injectable forms. It is also available in conjunction with paracetamol (acetaminophen).
Tramadol doses range from 50–400 mg daily, exceeding up to 600 mg daily when given IV/IM. The formulation containing APAP contains 37.5 mg of Tramadol and 325 mg of paracetamol, intended for oral ingestion with a typical dosing recommendation of one or two pills every four to six hours.
Unlike most opioids, Tramadol is not considered a controlled substance in most countries (the US and Australia, among others), and is available with a normal prescription. Tramadol is available over the counter without prescription in some countries. As of 2008 Sweden has chosen to classify Tramadol as a controlled substance in the same way as dextropropoxyphene and codeine. This means that this medication is a scheduled drug but that the chemical makeup is not.
How it Works
The method of action of tramadol has yet to be fully understood, but it’s believed to work through modulation of noradrenergic and serotonergic systems in addition to its mild agonism of μ-opioid receptor. The contribution of non-opioid activity is demonstrated by the analgesic effects of tramadol not being fully antagonised by the μ-opioid receptor antagonist naloxone.
Tramadol is marketed as a racemic mixture with weak affinity for the μ-opioid receptor (approximately 1/6th that of morphine). The (+)- enantiomer is approx 4 times more potent than the (-)- enantiomer in terms of μ-opioid receptor affinity and 5-HT reuptake, whereas the (-)-enantiomer is responsible for noradrenaline reuptake effects (Shipton, 2000). Thee mentioned actions appear to produce a synergistic analgesic effect, with (+)-tramadol exhibiting ten-fold higher analgesic activity than (-)-tramadol.
The serotonergic modulating properties of tramadol means that it has the potential to interact with many serotonergic agents. There is increased risk of serotonin syndrome when it is taken with serotonin reuptake inhibitors (e.g. SSRIs) or with use of a light box, since the agents not only potentiate the effect of 5-HT but also inhibit tramadol metabolism. Tramadol is thought to have some NMDA-type antagonist effects which has given it a potential application in neuropathic pain states.
How to use: Take Tramadol by mouth as prescribed. The drug is usually taken every 4 to 6 hours as needed. Use it exactly as prescribed. Do not increase your dose, use it more frequently or use it for a longer period of time than prescribed because this drug can be habit-forming. Also, if used for an extended period of time, do not suddenly stop using it without your doctor’s approval. When used for extended periods, Tramadol may not work as well and may require different dosing. Consult your doctor if the medication stops working well.
How To Take
Tramadol comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet is taken with or without food every 4-6 hours as needed. The extended-release tablet should be taken once daily. Take extended-release tablets at about the same time of day every day, and either always take it with food or always take it without food. Take this medication exactly as directed. Do not take more medication as a single dose or take more doses per day than prescribed by your doctor. Taking more tramadol than prescribed by your physician may cause severe side effects or death.
Your doctor may start you on a low dose and gradually increase the amount of Tramadol you take, not more often than every 3 days if you are taking the regular medication or every 5 days if you are taking the extended-release medication.
Swallow the extended-release tablets whole; do not split, chew, or crush them. Do not snort (inhale powder from crushed tablet) or inject the dissolved extended-release Tramadol tablets. Taking it in a way that is not recommended may cause serious side effects or death.
This medication can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Call your doctor if you find that you want to take extra Tramadol or if you notice any other unusual changes in your behavior or mood.
Do not stop taking this medication without talking to your doctor. Your doctor will probably decrease your Tramadol dose gradually. If you suddenly stop taking this medication you may experience withdrawal symptoms such as nervousness; panic; sweating; difficulty falling asleep or staying asleep; runny nose, sneezing, or cough; numbness, pain, burning, or tingling in your hands or feet; hair standing on end; chills; nausea; uncontrollable shaking of a part of your body; diarrhea; or rarely, hallucinations (seeing things or hearing voices that do not exist).
Precautions: Tell your doctor your medical history, especially of: kidney disease, liver disease, seizure disorder, lung disease, history of drug or alcohol dependency, any allergies you may have (especially to other opiate narcotics such as codeine or morphine). Limit alcohol as it may add to the dizziness or drowsiness effects caused by Tramadol. Because the drug may make you dizzy/drowsy, use caution performing tasks requiring alertness such as driving. Caution is advised when using it in the elderly because they may be more sensitive to the effects of Tramadol. Tramadol should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It’s excreted into breast milk. Because the effects on a nursing infant are not known, consult your doctor before breast- feeding.
Tramadol side effects cannot be anticipated. If side effects develop or change in intensity, contact your physician as soon as you can. Only your physician can determine if it is safe for you to continue taking Tramadol.
The medication is usually tolerated well, side effects are usually transient. Some reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received it have reported seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.
This list of side effects is not a complete and different ones may occur. Tell your physician about any different or unusual side effects you may incur while taking Tramadol.
If you incur a more serious Tramadol side effect, you or your physician may send a report to the FDA MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch/ or by phone at 1-800-332-1088.