Download Tramadol - Wayne Anderson

Disclaimer: This is for informational purposes only. This does not replace the instructions you received from Dr. Anderson or any other practitioner,
constitute medical treatment, establishment of a patient-physician relationship, constitute any form of recommendation, prescription or medical
advice, or imply that the medication is appropriate or FDA approved for any condition. This information may be outdated and is not a complete
listing of instructions, doses, uses, or side effects. If this was prescribed to you, you must review this information with your pharmacist and
prescriber before starting the medication. Any medication may interfere with the ability to drive, concentrate, or operate machinery; patients must
be responsible for their own behavior and should not engage in any dangerous activity if there is any question of impairment. All medications have
side effects and drug interactions, some serious, some fatal. Let all of your practitioners and pharmacist know about every substance used. Alcohol,
herbals, or illegal drugs are not considered safe with these medications. Assume no medication is safe during pregnancy or while breast feeding. The
medication may interfere with birth control. Almost any medication can cause sleepiness, insomnia, dizziness, confusion, hallucinations, anxiety,
panic, constipation or diarrhea, headache, chest pain and nausea or vomiting, among others. These could cause physical injury, such as dizziness
causing one to fall down stairs. Many reduce blood pressure, which could cause fainting, dizziness, stroke, or other problems. Most medications
should NOT be stopped suddenly because of the risk of withdrawal. This is a supplement to the standardized drug information sheets.
Drug: TRAMADOL
Wayne E. Anderson, D.O.
A Medical Corporation
FDA-approved uses: Moderate to severe pain
Common off-label uses: Moderate to severe pain, long term
Chronic Intractable Pain Disorders
Headache & Facial Pain Disorders
Neurotoxin Therapy
Alternatives: Non-medication modalities, pain interventions and
other medications that may work in a similar manner.
How it works: Tramadol is a centrally acting opioid that has typical
opioid properties, but is not considered a controlled substance in the
United States. Tramadol has both pain killing properties and antidepressant-type qualities.
Board Certified Neurology
American Board of Psychiatry & Neurology
Board Certified Pain Medicine
American Board of Psychiatry & Neurology
in association with the
American Board of Anesthesiology
Subspecialty Certified Headache Medicine
United Council for Neurological
Subspecialties
Qualified Medical Evaluator
Member of the
California Pacific Neuroscience Institute
Side effects: Please see the standardized drug information sheet for
detailed information about risks, side effects, interactions, and other
important information. Tramadol has side effects of both pain killers
and anti-depressants. The most common side effects of tramadol are
stomach upset and constipation. Seizures can occur in patients who
abuse tramadol, use antidepressants or who have a history of
seizures. Dependence/addiction is always possible with any
medication, but the risk of tramadol addiction appears to be very
low. All opioids are dangerous in persons with asthma or other lung
disease, prostate problems, low blood pressure, head injury or
increased intracranial pressure. Side effects that are common are:
headache, nausea, constipation, dental disease from dry mouth,
dizziness, sweating, dry mouth, abdominal pain, and low blood
pressure causing lightheadedness.
Common doses: In the United States, tramadol is available as one of
three preparations
1. Tramadol: a 50mg tramadol tablet, with a typical use up to 4
doses per day but with an absolute limit of 8 doses per day
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2. Tramadol/APAP, a combination of tramadol and
acetaminophen, with a similar limit
3. Tramadol ER, a long-acting preparation of tramadol, taken
once per day. The long-acting form usually is taken as 100mg
per day for 1 week, then, if needed and well tolerated, 200mg
per day for 1 week, and then, if needed and well tolerated,
300mg per day. Studies suggest that if a patient uses more
than 300mg per day of the long-acting form, there is no
additional benefit but there are additional side effects.
Time to effect: Regular tramadol typically has an effect in approximately one hour. The long-acting
form should have an ongoing effect after approximately 72 hours.
Financial: Dr. Anderson has never received payment in exchange for prescribing a medication. Dr.
Anderson has no financial relationship with the manufacturers of tramadol products.
Insurance coverage: Because these are generic medications, insurance typically covers these agents.
Clinical and Scientific evidence: Some scientific evidence supportive of the use of the medication is
listed in this section. Of course, scientific information changes rapidly and the information listed may
become outdated or incorrect overnight. Tramadol has evidence-based efficacy in chronic pain states
and acute pain states. Tramadol is proven to help improve pain control when added to an opioid such
as morphine or fentanyl. Tramadol with acetaminophen has been shown effective for diabetic
neuropathy pain. Tramadol is a first-line pain medication for some conditions and a second-line pain
medication for others, and may be used in combination with other pain medications.
References:
1.
Nossaman VE, Ramadhyani U, Kadowitz PJ, Nossaman BD. Anesthesiol Clin. 2010 Dec;28(4):647-66. Advances in perioperative
pain management: use of medications with dual analgesic mechanisms, tramadol & tapentadol.
2.
Romero A, Miranda HF, Puig MM. Pharmacol Biochem Behav. 2010 Dec;97(2):363-9. Antinociceptive effects of morphine,
fentanyl, tramadol and their combination, in morphine-tolerant mice.
3.
Ko SH, Kwon HS, Yu JM, Baik SH, Park IB, Lee JH, Ko KS, Noh JH, Kim DS, Kim CH, Mok JO, Park TS, Son HS, Cha BY. Diabet
Med. 2010 Sep;27(9):1033-40. Comparison of the efficacy and safety of tramadol/acetaminophen combination therapy and gabapentin in
the treatment of painful diabetic neuropathy.
4.
Park HJ, Moon DE. Korean J Pain. 2010 Jun;23(2):99-108. Pharmacologic management of chronic pain.
5.
Haanpää ML, Gourlay GK, Kent JL, Miaskowski C, Raja SN, Schmader KE, Wells CD. Mayo Clin Proc. 2010 Mar;85(3 Suppl):S1525. Treatment considerations for patients with neuropathic pain and other medical comorbidities.