Nausea 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, dopaminagonists and many antibacterial can cause nausea and vomiting. 

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). 

The reported adverse effects of tramadol are nausea, vomiting, sweating, dry mouth, dizziness, sedation, headache, and hypertension (SEDA-17, 84) (SEDA-20, 81). The atypical analgesic effects of tramadol and its associated adverse effects profile have been reviewed (1). 

When tramadol was compared with codeine in 65 patients undergoing elective intracranial surgery, there was a significantly higher incidence of postoperative nausea, vomiting, and sedation with tramadol 75 mg (7). The patients given codeine had significantly lower pain scores over the first 48 hours postoperatively. 

Intravenous tramadol 1.5 mg/kg has been compared with a single dose of intravenous ketorolac 10 ng in 60 patients scheduled to undergo day-case laparoscopic sterilization in a prospective, randomized, double-blind comparison (11). Tramadol was associated with significantly less postoperative pain. There was no difference in the incidence or severity of nausea and vomiting between the two groups. Dry mouth was significantly more common with tramadol (60 versus 27%). 

In a comparison of the analgesic effects of intermittent boluses of tramadol or morphine after abdominal surgery in 523 patients, tramadol caused more adverse effects (43 versus 34%), although the difference was not statistically significant. The commonest adverse effects were nausea (32 and 22%), vomiting (4.9 and 3.8%), urinary retention (3.0 and 2.7%), and sweating (3.8 and 0.4%) (SEDA-20, 81). 

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). 

In a randomized, placebo-controlled study, the addition of an intravenous bolus of dexamethasone 150 micro-grams/kg with a PCA system programmed to deliver tramadol 20 mg in a 1 ml solution on demand in 50 patients after major abdominal surgery significantly reduced the incidence of nausea, vomiting, and subsequent administration of rescue antiemetic therapy (27). 

In 44 patients the addition of magnesinm sulfate 30 mg/ml to PCA tramadol both significantly reduced the consumption of tramadol at 6, 12, and 24 hours postoperatively, with no differences in the incidence of nausea and sedation (31). 

The role of tramadol in the treatment of rheumatologi-cal pain has been reviewed (33). Tramadol causes fewer opioid adverse effects for a given level of analgesia compared with traditional opioids. Common adverse effects, such as nausea and dizziness, usually occur only at the beginning of therapy, abate with time, and are further minimized by up-titrating the dosage over several days (34). 

When tramadol 1 mg/kg was given intravenously to 110 adults for postoperative shivering, few adverse effects were reported two had transient hypotension and two complained of nausea without vomiting. Similarly, mild adverse effects were reported in 20% of patients in a trial of tramadol in cancer pain (SEDA-16, 86), and when it was used to relieve severe pain in sports injuries (SEDA-16, 86). 

In one study the incidence of nausea was high (30-35%) when tramadol was used for postoperative pain (SEDA-20, 81). 

In mild to moderate postoperative pain, rectal tramadol has been compared with standard treatment with co-codamol (paracetamol plus codeine) suppositories in 40 patients who were given either tramadol 100 mg suppositories 6-hourly or 1000/20 mg of co-codamol 6-hourly (43). Nausea and vomiting were significantly more frequent with tramadol (84%) than with co-codamol (31%). 

The effect of tramadol on postoperative nausea and vomiting after ENT surgery has been studied in a prospective, randomized, double-blind comparison with... 

Petrone D, Kamin M, Olson W. Slowing the titration rate of tramadol HCl reduces the incidence of discontinuation due to nausea and/or vomiting a double-blind randomized trial. J Clin Pharm Ther 1999 24(2) 115-23. 

The effects of a single preoperative dose of gabapentin 600 mg 2 hours preoperat-ively on postoperative pain and tramadol consumption after minilap open cholecystectomy have been assessed in a doubleblind study in 120 adults [163 ]. Sedation was common, and the incidence of postoperative nausea and vomiting was significantly reduced by gabapentin. 

Comparative studies Intramuscular pethidine 50 mg and tramadol 100 mg have been compared in full-term parturients with moderate pain. Those who received pethidine ( = 80) had a higher incidence of nausea and vomiting (35% versus 15%) and drowsiness (80% versus 29%) [163 ]. 

In 20 healthy volunteers subjected to menthol-evoked cold pain tramadol 100 mg significantly reduced hyperalgesia and was associated with minor adverse reactions, mainly nausea and fatigue, with an NNTh of 1.6 (95% Cl = 1.16, 2.79) [187. ... 

The postoperative analgesic effect of intravenous tramadol 1 mg/kg 6-hourly for up to 24 hours has been compared with that of intravenous lornoxicam 8 mg immediately postoperatively -I- 8 mg 12 hours later. The two regimens provided similar analgesia after inguinal hernia repair, but one of those who received tramadol (n = 8) had nausea [188 ]. 

Tramadol 100 mg/day has been compared with ibuprofen and pregabalin in 20 healthy volunteers [173 ]. Tramadol was associated with mild adverse effects, mainly fatigue/drowsiness (eight episodes), nausea/ vomiting (seven), dizziness/headache/dijfi-culty in concentrating (seven). The NNTh for tramadol was 1.6. 

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