Constipation tramadol

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. 

Tramadol is an opioid analgesic, which acts by exerting an opioid effect and through the stimulation of adrenergic and serotonin pathways. Compared with the other opioids, tramadol is less likely to cause the typical opioid side-effects, such as respiratory depression, and constipation. It is also less likely to cause addiction. 

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. 

Side-effects Typical side-effects of tramadol are nausea, sweating and dizziness. In rare cases seizures after high i.v. doses are reported, mostly in combination with other proconvulsant componds or in patients with reduced seizure theshold (Gardner et al., 2000). Tramadol shows a reduced level of opioid side-effects, especially respiratory depression and constipation are less frequent and severe than with standard opioids such as morphine. Tramadol has a very limited abuse potential and is not subject to narcotic control (Cossmann et al., 1997). 

Tramadol, however, is thousands of times less potent than morphine as an analgesic agent [18]. It is marketed in the racemic form, and each enantiomer has distinct pharmacological actions. The (+)-isomer is a weak MOP agonist, while the (-)-isomer inhibits neurotransmitter reuptake (norepinephrine and serotonin). The O-demethylated metabolite has improved opioid receptor affinity but is still much less potent (35-fold) than morphine. The ability for this metabolite to ameliorate the analgesic effects of tramadol has not been well studied and remains questionable. The drug has been used for decades in Europe, but was only recently introduced in the United States. It has a greater safety profile than morphine, and produces no respiratory depression or constipation. It is also claimed to be nonaddictive, but remains unscheduled. 

All opioids reduce gastrointestinal motility and cause constipation. There is some evidence to suggest that the incidence of constipation is lower with tramadol than with comparable agents for equivalent pain... 

Tramadol is claimed to be less likely to constipate, depress respiration and addict. Confusion, convulsions, hallucinations and anaplhylaxis have been reported with its use. 

In two randomized, double-blind studies tramadol provided effective and safe long-term relief of pain in diabetic neuropathy (20) and fibromyalgia (21). The adverse effects (constipation, nausea, and headache) were well tolerated. 

In 129 patients with severe joint pain associated with osteoarthritis, tramadol was significantly more effective than placebo, but 26 patients taking tramadol and 43 taking placebo withdrew because of ineffectiveness or adverse effects the main adverse effects of tramadol were nausea and constipation (9). 

Although associated with less respiratory depression than morphine at recommended doses, tramadol has a side-effect profile that in some ways is similar to that of the previously mentioned opioid analgesics (e.g., dizziness, euphoria, hallucinations, cognitive dysfunction, and constipation). Tramadol alone may enhance the risk of seizures. In addition, concomitant use with serotonin reuptake... 

Tramadol has been used in Europe since the 1980s and was introduced to the U.S. market in 1995. The drug is nonaddioting and, thus, is not a scheduled agent. In addition, tramadol does not cause respiratory depression or constipation. 

Because of its dual site of action pharmacology, tramadol is less likely to be associated with mu receptor-mediated respiratory depression, constipation, and abuse when compared to pure mu agonists. These qualities may make this drug choice more advantageous for elderly and high-risk patients with moderate pain. 

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