How to take Tramadol. The importance of the prescription.

Millions of patients live with a feeling of physical suffering that needs constant therapy. Of course, their life is not easy, but nowadays there are several medications to improve their quality of life. Paincare is an important worry of many foundations, societies and professionals. For this, several pharmaceutical companies have developed different drug substances to defeat pain. Although opiophobia and ignorance are sometimes real problems to use the proper medication for each medical condition, now there is a deeper knowledge on the alternatives to cure and help patients who suffer severe pain.

About twenty years ago, Tramadol tablets were launched more than twenty years ago, and this centrally acting synthetic opioid painkiller is still commercialized under different names in many countries: Adolan, Crispin Adolonta, Boldol, Calmador, Contramal, Dolol, Dromadol, Anadol, Lumidol, Ralivia, Tiparol Toplagic Ultram and Ultram ER, among others.

Tramadol may not be for all cases. Doctors should assess patients’ medical histories in order to know if this medication is the right for them. Patients who suffer from kidney or liver disease, gastric disorder, mental illness, depression, or suicidal ideation may not use Tramadol. In addition, those who have experienced drug or alcohol addition should be monitored carefully by their family doctors. All this information will be evaluated by General Practitioners to come out to a better prescription.

Patients always ask how to take Tramadol and doctors often ask themselves how to prescribe this medication. Although this active principle is thought to be less addictive than many other substances used to treat and control chronic pain, they should consider many things before prescribing it.

If you have been prescribed this drug, you can be also asking yourself how to take Tramadol. You do not have to get anxious because your physician is going to give you many details about this issue but if you read the data explained below, you will know something more about the medicine will help you to deal with pain.

How to take Tramadol: If you need to use Tramadol tablets, take these pills by mouth as directed. In general, it should be taken every 4 to 6 hours when you consider necessary to improve your condition (not to exceed 400 mg per day). Doctors often use titration schedules to find the best dose for their patients because the amount of drug should be adjusted to the kind of pain and the patient’s response to the palliative action of Tramadol. In addition, to reduce the risk of adverse reactions, your physician may ask you to gradually increase your dose after starting Tramadol therapy. You should not change the dose without having talked to your doctor before. In case of chronic pain, your doctor should give you special recommendations for use. Apart from that, do not stop the treatment without your physician’s approval. In such cases, withdrawal signs and symptoms may occur. When taking extended-release tablets that contain Tramadol, they should be swallowed whole.

Tramadol also comes in other pharmaceutical forms (it will depend on the brand name and on the country where it is marketed): extended-release tablets, oral drops, solution for injection and suppositories. Each patient should receive the adequate presentation for their particular cases by taking into account their medical background.

Regarding how to take the other Tramadol pharmaceutical forms, health care providers should give patients the best dosage and administration guide for each of them.

All these recommendations about how to take Tramadol are necessary because of different facts. Some of them are: the risk of Tramadol dependence or abuse (addiction is possible with this pharmaceutical product), the possibility of not getting the effect needed to get pain relief and the possible adverse reactions that may occur. Your GP can also prescribe the correct medicine to take with Tramadol to assist you when having adverse reactions.

How to take Tramadol is not a difficult or risky task if your follow your doctor’s directions. Remember that this drug will help you to have a normal life again. By starting the right therapy you will be able to cope with your daily responsibilities and to share the most pleasant moments with your loved ones.

Veterinary medicine

Tramadol may be used to treat post-operative, injury-related, and chronic (e.g., cancer-related) pain in dogs and cats as well as rabbits, coatis, many small mammals including ratsand flying squirrels, guinea pigs, ferrets, and raccoons. Tramadol comes in ampules in addition to the tablets, capsules, powder for reconstitution, and oral syrups and liquids; the fact that its characteristic taste is distasteful to dogs, but can be masked in food, makes for a means of administration. No data that would lead to a definitive determination of the efficacy and safety of tramadol in reptiles or amphibians is available at this time, and, following the pattern of all other drugs, it appears that tramadol can be used to relieve pain in marsupialssuch as North American opossums, Short-Tailed Opossums, sugar gliders, wallabies, and kangaroos among others.

Tramadol for animals is one of the most reliable and useful active principles available to veterinarians for treating animals in pain. It has a dual mode of action: mu agonism and mono-amine reuptake inhibition, which produces mild anti-anxiety results. Tramadol may be utilized for relieving pain in cats and dogs. This is an advantage because the use of some non-steroidal anti-inflammatory substances in these animals may be dangerous.

When animals are administered tramadol, adverse reactions can occur. The most common are constipation, upset stomach, decreased heart rate. In case of overdose, mental alteration, pinpoint pupils and seizures may appear. In such case, veterinarians should evaluate the correct treatment for these events. Some contraindications have been noted in treated animals taking certain other drugs. Tramadol should not be co-administered with selegiline or any other psychoactive class of medication such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, or monoamine oxidase inhibitors. In animals, tramadol is removed from the body via liver and kidney excretion. Animals suffering from diseases in these systems should be monitored by a veterinarian, as it may be necessary to adjust the dose.

Side effects of tramadol

tramadol

Tramadol hydrochloride (Ultram, Tramal) is a centrally acting synthetic opioid analgesic used in treating severe pain. The drug has a wide range of applications, including treatment for restless legs syndrome and fibromyalgia. It was developed by the pharmaceutical company Grünenthal GmbH in the late 1970s.^]

Tramadol possesses weak agonist actions at the μ-opioid receptor, releases serotonin, and inhibits the reuptake of norepinephrine.

While its action is not like that of other opioids, Tramadol is a synthetic analog of the phenanthrene alkaloid codeine. Tramadol is converted to O-desmethyltramadol, a significantly more potent μ-opioid agonist. Opioids are chemical compounds which act upon one or more of the human opiate receptors. The euphoria and respiratory depression of opioids are mainly caused by the μ₁ and μ₂ receptors; the addictive nature of tramadol, as well as other opioids, is due to these effects, but tramadol's serotonergic and noradrenergic effects may contribute to possible dependence as well.The opioid agonistic effect of tramadol and its major metabolite(s) are almost exclusively mediated by the substance's action at the μ-opioid receptor. This characteristic distinguishes tramadol from many other substances (including morphine) of the opioid drug class, which generally do not possess tramadol's degree of subtype selectivity.

Medical uses

Tramadol is used similarly to codeine, to treat moderate to moderately severe pain. Tramadol is somewhat pharmacologically similar tolevorphanol (albeit with much lower μ-agonism), as both opioids are also NMDA-antagonists which also have SNRI activity (other such opioids to do the same are dextropropoxyphene (Darvon) & M1-like molecule tapentadol (Nucynta, a new synthetic atypical opioid made to mimic the agonistic properties of tramadol's metabolite, M1(O-Desmethyltramadol). Tramadol is also molecularly similar to venlafaxine(Effexor) and has similar SNRI effects, with antinociceptive effects also observed. It has been suggested that tramadol could be effective for alleviating symptoms of depression, anxiety, and phobias because of its action on the noradrenergic and serotonergic systems, such as its "atypical" opioid activity However, health professionals have not endorsed its use for these disorders, claiming it may be used as a unique treatment (only when other treatments failed), and must be used under the control of a psychiatrist.

In May 2009, the United States Food and Drug Administration issued a Warning Letter to Johnson & Johnson, alleging that a promotional website commissioned by the manufacturer had "overstated the efficacy" of the drug, and "minimized the serious risks" The company which produced it, the German pharmaceutical company Grünenthal GmbH, were alleged to be guilty of "minimizing" the addictive nature and proposed efficacy of the drug, although it showed little abuse liability in preliminary tests. The 2010 Physicians Desk Reference contains several warnings from the manufacturer, which were not present in prior years. The warnings include more compelling language regarding the addictive potential of tramadol, the possibility of difficulty breathing while on the medication, a new list of more serious side effects, and a notice that tramadol is not to be used in place of opiate medications for addicts. Tramadol is also not to be used in efforts to wean addict patients from opiate drugs, nor to be used to manage long-term opiate addiction.

Availability and usage

Tramadol is classified as a central nervous system drug usually marketed as the hydrochloride salt (tramadol hydrochloride); the tartrate is seen on rare occasions, and rarely (in the US at least) tramadol is available for both injection (intravenous and/or intramuscular) and oral administration. The most well known dosing unit is the 50 mg generic tablet made by several manufacturers. It is also commonly available in conjunction with APAP (paracetamol, acetaminophen) as Ultracet, in the form of a smaller dose of 37.5 mg tramadol and 325 mg of APAP. The solutions suitable for injection are used in patient-controlled analgesia pumps under some circumstances, either as the sole agent or along with another agent such as morphine.

Tramadol comes in many forms, including:

• capsules (regular and extended release)
• tablets (regular, extended release, chewable, low-residue and/or uncoated tablets that can be taken by the sublingual and buccal routes)
• suppositories
• effervescent tablets and powders
• ampules of sterile solution for SC, IM, and IV injection
• preservative-free solutions for injection by the various spinal routes (epidural, intrathecal, caudal, and others)
• powders for compounding
• liquids both with and without alcohol for oral and sub-lingual administration, available in regular phials and bottles, dropper bottles, bottles with a pump similar to those used with liquid soap and phials with droppers built into the cap
• tablets and capsules containing (acetaminophen/APAP), aspirin and other agents.

Tramadol has been regularly used in the form of an ingredient in multi-agent topical gels, creams, and solutions for nerve pain, rectal foam, concentrated retention enema, and a skin plaster (transdermal patch) quite similar to those used with lidocaine.

Tramadol has a characteristic and unpleasant taste which is mildly bitter but much less so than morphine and codeine. Oral and sublingual drops and liquid preparations come with and without added flavoring. Its relative effectiveness via transmucosal routes (i.e. sublingual, buccal, rectal) is similar to that of codeine, and, like codeine, it is also metabolized in the liver to stronger metabolites (see below).

The maximum dosage per day is 400 mg for oral use and 600 mg for parenteral use. Certain manufacturers or formulations have lower maximum doses. For example, Ultracet (37.5 mg/325 mg tramadol/APAP tablets) is capped at 8 tablets per day (300 mg/day) due to its acetaminophen content. Ultram ER is available in 100, 200, and 300 mg/day doses and is explicitly capped at 300 mg/day as well.

Patients taking SSRIs (Prozac, Zoloft, etc.), SNRIs (Effexor, etc.), TCAs, MAOIs, or other strong opioids (oxycodone, methadone, fentanyl, morphine), as well as the elderly (> 75 years old), pediatric (< 18 years old), and those with severely reduced renal (kidney) or hepatic (liver) function should consult their doctor regarding adjusted dosing or whether to use Tramadol at all.