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Submitted on April 2nd, 2007
When it comes to the mechanics of the dependence on Tramadol, it has yet to be understood fully. Tramadol is actually believed to work through modulation of the serotonergic, GABAergic and noradrenergic systems. The contribution of the non-opioid activity is demonstrated by the Tramadol analgesic effects not fully antagonized by the opioid receptor antagonist naloxone. Tramadol is normally marketed as a racemic mixture with a weak affinity for the opioid receptor (with a 1/16 of morphine). It’s a known theory that Tramadol could actually be effective for alleviating symptoms of depression and anxiety due to its action on GABAergic, noradrenergic and serotonergic systems. However, the reality is health professionals normally don’t suggest use of the treatment drug of such disorders. Moreover, Tramadol may also be used in the treatment of hypertension when other treatments fail.
Tramadol undergoes a particular hepatic metabolism through the cytochrome isozyme. Reduced doses may be used in hepatic and renal impairment. The most common adverse drug reactions are sweating, vomiting and nausea. Drowsiness is reported, but is less of an issue in comparison to other opioids. A common side-effect of most opioids, respiratory depression, is not clinically important in normal doses. By itself, Tramadol can diminish seizure threshold. When combined with inhibitors, tricyclic antidepressants—or in patients with epilepsy—the seizure threshold is further reduced. Seizures have been reported in humans receiving excessive single oral doses (normally 700 mg) or large intravenous doses (300 mg). Dosages of warfarin (coumadin) may need to be decreased for anticoagulated patients to refrain from bleeding complications.
Certain brands of Tramadol, such as Ultram, may induce physical and psychic dependence of the morphine-type (opioid). Dependence and abuse, which includes drug-seeking behavior to illicit actions to take the drug, aren’t limited to patients with prior history of opioid dependence. The risk in patients with substance abuse has been observed to be prevalent. Ultram is associated with tolerance development and craving. It’s believed that if Ultram is abruptly discontinued, withdrawal symptoms may occur. Tramadol is well absorbed orally, as it can be administered in 50 to 100 mg tablets needed for pain relief every 4 to 6 hours (not to exceed 400 mg/ day). Seizures normally occur in patients taking the recommended doses, but are even more likely at high doses combined with abuse of the Tramadol.
Dependence, along with tolerance and addiction to Tramadol, has been validated. The abrupt cessation from Tramadol has been likened with two types of withdrawal syndromes. One is customary of opioid drugs with flu-like symptoms, drug craving and restlessness. This type is encountered in approximately 90% cases of Tramadol withdrawal. The other withdrawal syndrome is encountered in approximately 10% cases of withdrawal from Tramadol. This is atypical of opioids and associated with extreme anxiety, confusion, panic attacks, paranoia, hallucinations, as well as tingling and numbness in the extremities. Unfortunately, Tramadol is abused for its opiate adverse effects. Recently, there were an estimated 2,984 emergency room visits for Tramadol. Statistics show that approximately 1.3 million people have used Tramadol non-medically. It’s important to know that Tramadol is currently not controlled under the CSA (Controlled Substances Act).
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