Tramadol, safety

Cossmann, M., Kohnen, C., Langford, R., McCartney, C. [Tolerance and safety of tramadol use. Results of international studies and data from drug surveillance), Drugs 1997, 53, Suppl 2, 50-62. 

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. 

Wiebalck A, Tryba M, Hoell T, Strumpf M, Kulka P, Zenz M. Efficacy and safety of tramadol and morphine in patients with extremely severe postoperative pain. Acute Pain 2000 3 112-18. 

Grond, S. Meuser, T. Zech, D. Hennig, U. Lehmann, K.A. Analgesic efficacy and safety of tramadol enantiomers in comparison with the racemate a randomised, double-blind study with gynaecological patients using intravenous patient-controlled analgesia. Pain 1995, 62, 313-320. 

Committee on Safety of Medicines/Medicines Conttol Agency. In focus— tramadol. Current Problems 996)22, 11. 

Saidi H, Ghadiri M, Abbasi S, Ahmadi S-F. Efficacy and safety of naloxone in the management of postseizure complaints of tramadol intoxicated patients a self-controlled study. Emerg Med J 2010 27 928-30. 

Because of its dual analgesic effects, tramadol may be more effective than standard opioids for neuropathic pain. The efficacy of tramadol was evaluated in patients suffering painful polyneuropathy. Forty-five patients were treated with either tramadol 200 mg/day to 400 mg/day or placebo over a period of 4 weeks. Upon study completion, ratings for pain (median 4 vs. 6), paresthesia (4 vs. 6), allodynia (0 vs. 4). and touch-evoked pain (3 vs. 5) were significantly lower with tramadol treatment than with placebo [ 12 ]. In an evaluation of safety and efficacy in painful diabetic neuropathy, patients were treated with tramadol ( = 65)... 

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... 

Barking RL. Extended-release tramadol (ULTRAM ER) a pharmacotherapeutic, pharmacokinetic, and pharmacodynamic focus on effectiveness and safety in patients with chronic/persistent pain. Am J Ther 2008 15 157-166. 

Bar-Or D, Salottolo KM, Orlando A, Winkler JV. A randomized double-blind, placebo-controlled multicenter study to evaluate the efficacy and safety of two doses of the tramadol orally disintegrating tablet for the treatment of premature ejaculation within less than 2 minutes. Euro Urol April 2012 61(4) 736-43. 

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