Tramadol/acetaminophen

Silverfield, J.C., Kamin, M., Wu, S.C., Rosenthal, N. Tramadol/acetaminophen comination tablets for the reatment of osteoarthritis flare pain a multicenter, outpatient, randomized, double-blind, placebo-controlled, parallel-group, ad-on study, Clin. Ther. 2002, 24, 282-297. 

Mullican WS, Lacy JR TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain a comparative trial. Clin Ther 2001 23(9) 1429-45. 

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 with or without acetaminophen has modest analgesic effects in patients with OA. It may also be effective as add-on therapy in patients taking concomitant NSAIDs or COX-2 selective inhibitors. As with opioids, tramadol may be helpful for patients who cannot take NSAIDs or COX-2 selective inhibitors. 

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. 

An alternative strategy uses the combination of known drugs such as tramadol and acetaminophen, thereby targeting multiple components of the pain pathway (Silverfield et al., 2002). This combination of opioids with NSAIDs is a well-established strategy that is part of the WHO scale for treatment of chronic pain. 

NONE All over-the-counter pain relievers (i.e., aspirin, acetaminophen, ibuprofen, naproxen, etc.), prescription antidepressants, anticonvulsants, muscle relaxants (except benzodiazepines), migraine medications, steroids, celecoxib, BoTox, herbal remedies, tramadol, local caine family (except cocaine)... 

Contraindications fc>r nonsalicylate NSAID therapy are the same as those for aspirin (see Box 7-I).The formation of a gastric ulcer or erosion that may bleed profusely is a serious potential problem with NSAIDs. Consequently, the nonsalicylate NSAIDs should be avoided or used with great caution in patients with active peptic ulcer disease. NSAIDs may increase the risk of GI complications even when used in conjunction with low-dose aspirin for cardioprotection. In addition, because of potential crosssensitivity to other NSAIDs, the nonsalicylate NSAIDs should not be given to patients in whom aspirin or other NSAIDs have caused symptoms of asthma, rhinitis, urticaria, angioedema, hypotension, bronchospasm, or of symptoms of hypersensitivity reactions. Opioids, tramadol, or acetaminophen may be suitable alternatives for patients with known or suspected susceptibility. 

Tramadol Ultram tablets Ultracet Tramadol (50) Tramadol (37.5) Acetaminophen (325) 1-2 tabs q4-6 hr Not to exceed 400 mg/day 2 q4-6 hr... 

Lopinavir/ritonavir (LPV/r) Kaletra 33.3 mg and 133.3 mg capsules 20 mg/ml and 80 mg/ml solutions Acetaminophen/propoxyphene or tramadol, codeines, aspirin/caffeine/propoxyphene, erythromycins, itraconazole, ketoconazole, fluconazole, voriconazole... 

Nalbuphine has similar efficacy and incidence of adverse effects to tramadol and paracetamol (acetaminophen) (3). Dysrhythmias and coughing occurred more often with nalbuphine than fentanyl (4). 

Turturro MA, Paris PM, Larkin GL. Tramadol versus hydrocodone-acetaminophen in acute musculoskeletal pain a randomized, double-blind clinical trial. Ann Emerg Med 1998 32(2) 139-43. 

Pluim MA, Wegener JT, Rupreht J, Vulto AG. Tramadol suppositories are less suitable for post-operative pain relief than rectal acetaminophen/codeine. Eur J Anaesthesiol 1999 16(7) 473-8. 

Rodriguez RF, Castillo JM, Castillo MP, et al. Hydrocodone/acetaminophen and tramadol chlorhydrate combination tablets for the management of chronic cancer pain a double-blind comparative trial. Clin J Pain 2008 24 1-4. 

HYDROCHLORIDE/ACETAMINOPHEN (Ultracet tablets 325 mg acetaminophen/37.5 mg tramadol hydrochloride)... 

Tramadol hydrochloride/acetaminophen is a nonnarcotic analgesic combination. Tramadol the exact mechanism is... 

The term opioids refers to these and other derivatives of naturally occurring opium (eg, morphine, heroin, codeine, and hydrocodone) as well as new, totally synthetic opiate anaiogs (eg, fentanyl, butorphanol, meperidine, and methadone Table 11-43). A wide variety of prescription medications contain opioids, often in combination with aspirin or acetaminophen. Dextromethorphan (see p 183) is an opioid derivative with potent antitussive but no analgesic or addictive properties. Tramadol (Ultram )... 

Generic Names tramadol, tramadol plus acetaminophen... 

Tramadol has been shown to provide effective analgesia after both oral and intravenous administration for the treatment of post-operative pain [10]. Comparative studies have generally shown that tramadol is more effective than NSAIDs for controlling postoperative pain however, wide individual variations exist, possibly related to low P450-2D6 metabolism in certain patients. A single 100 mg oral dose of tramadol is equivalent to 1000 mg of acetaminophen. At... 

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