Tramadol adverse events

Dizziness, vertigo, nausea, vomiting, constipation, and lethargy are all relatively common adverse events. These effects are more pronounced for several days after initiation and following upward dose titration. Seizures have been reported rarely the risk is dose-related and appears to increase with concomitant use of antidepressants, such as tricyclic antidepressants or selective serotonin reuptake inhibitors. Tramadol should be avoided in patients receiving monoamine oxidase (MAO) inhibitors because tramadol inhibits the uptake of norepinephrine and serotonin. 

Nervous system Serotonin syndrome is being increasingly recognized as a serious adverse effect linked to opioids, and the effects of tramadol on inhibition of serotonin reuptake and the potential of serious adverse events such as serotonin syndrome after interactions with antidepressants have been reviewed [2 ]. 

Comparative studies ControUed-release oxycodone 20 mg ( =26) has been compared with controUed-release tramadol 200 mg ( = 27) in the management of postoperative pain after breast surgery there were no significant differences in adverse events [149 j. 

Placebo-controlled studies The use of tramadol in neuropathic pain after spinal cord injury has been assessed in a double-blind, randomized, placebo-controlled study in 35 patients [186 ]. There were moderate to severe adverse events in 91% of patients on tramadol and 58% of those on placebo 48% of those taking tramadol were withdrawn from the study because of adverse events. The most common adverse events were tiredness, dry mouth, and dizziness. 

Kim E, Choi C-B, Kang C, Bae S-C. Adverse events in analgesic treatment with tramadol assodated with CYP2D6 extensive-metaboliser and OPRMl high-expression variants. Aim Rheum Dis 2010 69(10) 1889-90. 

Ease of use, tolerability tramadol ER was well tolerated in controlled clinical trials, with a safety profile similar to short-acting tramadol, which has been used for over 10 years in the USA and 30 years worldwide. Tramadol ER appears to be better tolerated than narcotic preparations with fewer adverse events for the level of analgesia achieved. Tramadol ER does not contain acetaminophen or NSAIDs. Tramadol has low potential... 

Tramadol ER was administered to a total of 3108 patients during studies conducted in the USA. These included four double-blind studies in patients with osteoarthritis and/or chronic low back pain and one open-label study in patients with chronic non-malig-nant pain. A total of 901 patients were 65 years or older. Adverse events increased with dose from 100 mg to 400 mg in the two pooled, 12-week, randomized, double-blind, placebo-controlled studies in patients with chronic non-malignant pain [4) (see Table 30.1)... 

The use of modified-release tramadol in chronic malignant pain has been examined in an open, prospective study in 146 patients with moderate to severe cancer pain 90 patients completed the 6-week trial (53). Dropouts were due to opioid adverse effects (20%), inadequate pain relief (9%), or both (2.5%). There was at least one adverse effect in 86%. Overall, 433 adverse effect events were reported but some reduced in frequency over the 6 weeks. Modified-release tramadol (400 mg/day) provided fast and efficient pain relief in almost 60% of patients both during initial dosing and long-term treatment. 

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