A Tramadol

In a double-blind, randomized, controlled study, the addition of a tramadol infusion to morphine for PCA in 69 patients undergoing elective abdominal surgery resulted in improved analgesic efficacy and reduced morphine requirements, with a relative lack of adverse effects (32). 

Webb AR, Leong S, Myles PS, Burn SJ. The addition of a tramadol infusion to morphine patient-controlled analgesia after abdominal surgery a double-blinded, pla-cebo-controUed randomized trial. Anesth Analg 2002 95(6) 1713-18. 

Ketorolaco frente a tramadol estudio comparative de la eficacia analgesica en el dolor postoperatorio de histerecto-mias abdominal. [Ketorolac versus tramadol comparative study of analgesic efficacy in the postoperative pain in abdominal hysterectomy.] Rev Esp Anestesiol Reanim 2000 47(4) 162-7. 

Mellor K, Ahmed A, Thomson A. Tramadol hydrochloride use and acute deterioration in Parkinson s disease tremor. Mov Disord 2009 24(4) 622-3. 

Lota AS, Dubrey SW, Wills P. Profound hyponatraemia following a tramadol overdose. QJM April 2012 105(4) 397-8. 

Timolol maleate a-Bromoacetophenone Nomifensine maleate Bromoacetyl bromide Bromazepam Cephapirin sodium Clonazepam Flunitrazepam 5-Bromoacetyl salicylamide Labetalol HCI m-Bromoanisole Tramadol HCI p-Bromoanisole Cyclofenil Bromobenzene... 

Cavoy E., Deltent M. E, Lehoucq S., Miggiano D. (1997) Laboratory-Developed Simulated Moving Bed for Chiral Drug Separations. Design of the System and Separation of Tramadol Enantiomers, J. Chrotnatogr. A 769 49-57. 

Tramadol is a pain reliever (analgesic). Its action is similar to opioid narcotics such as codeine and morphine, but it does not depress breathing the way the others can, and less often leads to abuse and addiction. 

Tramadol is an alkaloid, with an amine group (where the nitrogen atom is), which puts it in a group of bitter plant chemicals that often have potent biological activity. 

Cj]HyBrMgO 38046-82-1) see Naproxen (5)-2-(5-bromo-6-methoxy-2-naphthyl)propanoic acid (Ci4Hi BrO 84236-26-0) see Naproxen bromo(3-methoxyphenyl)magnesium (C7H7BrMgO 36282-40-3) see Tramadol (/f)-2-bromo-A -[2-(4-methoxyphenyl)-l-methylethyl]-acetamide... 

Tramadol a weak opioid that also blocks the reuptake of NA and 5-HT—these combined actions synergise to give a good analgesia that lacks some of the typical opioid side-effects. 

Tramadol is a reasonable option for patients with contraindications to NSAIDs or failure to respond to other oral therapies. For the treatment of hip or knee OA, tramadol is as effective as NSAIDs. The addition of tramadol to NSAIDs or acetaminophen may augment the analgesic effects of a failing regimen, thereby securing sufficient pain relief in some patients. Moreover, concomitant tramadol may permit the use of lower NSAID doses. 

Tramadol should be initiated at a lower dose (100 mg/day in divided doses) and may be titrated as needed for pain control to a dose of 200 mg/ day. It is available in a combination tablet with acetaminophen and as a sustained-release tablet. 

Tramadol, a centrally acting analgesic for moderate to moderately severe pain, binds to jl opiate receptors and weakly inhibits norepinephrine and serotonin reuptake. 

Tramadol has a side-effect profile similar to that of other opioid analgesics. It may also enhance the risk of seizures. It may be useful for treating chronic pain, especially neuropathic pain, but it has little advantage over other opioid analgesics for acute pain. 

FIGURE 4 Chiral CE ESI/MS analysis of five amphetamine derivatives and two pharmaceutical compounds. Total ion current (TIC) and extracted ion currents (XIC) of amphetamine (A), methamphetamine (MA), methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA), and methylenedioxyethylamphetamine (MDEA), and tramadol (TMD) and methadone (MTD) in plasma after LLE with electrokinetic injection. 

Rudaz, S., Veuthey, J. L., Desiderio, C., and Fanali, S. (1999). Simultaneous stereoselective analysis by capillary electrophoresis of tramadol enantiomers and their main phase I metabolites in urine.. Chromatogr. A 846, 227—237. 

Two artificial compound libraries were chosen as compound mixtures, of which library 1 was composed only of dummy ligands (acetanilide, amitryptiline, benzoic acid, (+)-bicuculline, 4-chloraniline, 2,3-dichloraniline, methylbenzoate, phenol, tramadol see Fig. 7.11), whereas library 2 contained, in addition to these compounds, naloxone, a known //-opioid receptor ligand. 

The opioid analgesics, such os codeine, tramadol and fentanyl may cause drowsiness. Sumatriptan, which is a serotonin agonist, also tends to cause drowsiness. Modern non-steroidal anti-inflammatory drugs, such as diclofenac, do not cause drowsiness. 

One of the main side-effects of opioid analgesics, such as codeine and tramadol, is constipation. Amitriptyline (tricyclic antidepressant) and orphenadrine tend to have antimuscarinic properties, resulting in side-effects such as constipation. Senna is a stimulant laxative indicated in constipation. 

Tramadol is an opioid analgesic and when given to patients who are also receiving imipramine (a tricyclic antidepressant), there is an increased risk of central nervous system toxicity. The risk of occurrence of sedation is increased. 

Seizures Seizures may be aggravated or may occur in individuals with or without a history of convulsive disorders if dosage is substantially increased above recommended levels because of tolerance. Observe patients with known seizure disorders closely for hydromorphone-, meperidine-, morphine-, or tramadol-induced seizure activity. 

S Rudaz, S Cherkaoui, P Dayer, S Fanali, J-L Veuthey. Simultaneous stereoselective analysis of tramadol and its main metabolites by on-line capillary zone electrophoresis-electrospray ionization mass spectrometry. J Chromatogr A 868 295-303, 2000. 

FIGURE 17.7 Chromatograms of tramadol and its three metabolites on a Chiralcel OD-H CSP. The chromatograms were obtained in the SRM mode. Mobile phase isohexane EtOH DEA (97 3 0.1, v/v/v). (Reprinted from Ceccato, A. et ah, J. Chromatogr. B, 748, 65, 2000. Copyright Elsevier, 2000. With permission.)... 

Musshoff et al. [35] developed a method for the enantiomeric separation of the synthetic opioid agonist tramadol and its desmethyl metabolite using a Chiralpak AD column containing amylose tris-(3,5-dimethylphenylcarbamate) as chiral selector and a n-hexane/ethanol, 97 3 v/v (5mM TEA) mobile phase nnder isocratic conditions (1 mL/min). After atmospheric pressure chemical ionization (APCI), detection was carried out in positive-ion MS-MS SRM mode. The method allowed the confirmation of diagnosis of overdose or intoxication as well as monitoring of patients compliance. 

Tramadol is a central-acting analgesic, effective for mild to moderate acute and chronic pain. It impairs nociception by a unique mechanism that is not completely understood. In animal models, it binds to the /u. opioid receptor and is a weak inhibitor of serotonin and norepinephrine reuptake, actions similar to those ascribed to the SSRIs and TCAs. Seizures have been reported in patients taking tramadol. Abuse potential is low, but does exist. 

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