Many people think that tramadol is a non-addictive medication for relief of severe pain. But many reports suggest otherwise. In 2014, abuse of opioids, among them tramadol, led to 28,000 deaths. But most doctors are not aware of these facts. For this reason, they continue to prescribe tramadol to millions of patients. This exposes users to dangers of tramadol such as serious side effects, addiction and abuse.

But what is tramadol and how does it work?

What is Tramadol?

Tramadol is a synthetic analgesic or pain medication used in the management of moderate and moderately severe pain. Tramadol is a type of narcotic known as an opioid (1). Tramadol was first synthesized in 1962 by a German pharmaceutical company called Grunethal. It was patented in 1972 and got onto the European market in 1977. It was later introduced in the United States. In 1995, the US Food and Drug Administration approved the use of tramadol, without classifying it as a controlled substance (2).

Through the years, tramadol has been manufactured under brand names like Ultram, Zamadol, Invodol, Marol, Mabron, Zydol, Tramulief, Tradorec, Larapam, Maneo and Zeridame.

For much of its existence, tramadol was viewed as a safer alternative to other opioids like hydrocodone and morphine. However, recent research suggests that tramadol may have high potential for abuse.

How Is Tramadol Taken?

Tramadol is a prescription drug available for oral intake in forms of tablets, capsules or drops. It may also be administered by injection.

Dosage depends on the level of pain and stage of use. In most cases, tramadol is prescribed in doses of 25 milligrams taken once and up to four times in 24 hours. The maximum tramadol dosage is 400 milligrams in 24 hours. This translates to eight doses of 50 milligrams each.

How Does Tramadol Work?

Tramadol works by acting on the central nervous system which includes the brain and the spinal cord. It works in a similar way to other opioids like morphine by attaching to mu-opioid receptors in the brain and other areas of the body. However, tramadol has 10 percent the potency of morphine (3). Tramadol also inhibits the reuptake of the neurotransmitters serotonin and norepinephrine.

Benefits of Tramadol

Tramadol helps to relieve moderate to severe pain which cannot be managed using ordinary painkillers. It works in cases of acute and chronic pain especially resulting from surgery and conditions like cancer, back pain and fibromyalgia.

People who should not take tramadol

While many doctors prescribe tramadol as a drug of choice for severe, acute and chronic pain, the analgesic should not be prescribed for young children. In fact, it should only be prescribed to those over 16 years. Additionally, as per warnings issued in 2010 by the FDA and Janssen, tramadol should not be prescribed for people with suicidal tendencies. It should also not be given to people who are prone to addiction to other drugs or alcohol.

Other groups of people who should not take tramadol include those who have the following conditions:

Asthma

Intestinal blockage

Mental problems

Stroke

Kidney disease

Liver disease

Those who have recently used monoamine oxidase inhibitors (MAO) like linezolid, phenelzine and selegiline

Pregnant or nursing mothers

Interactions with Other Drugs
Taking tramadol while taking other medications may lead to negative interactions. For this reason, you should always inform your doctor about any other medications you are using. This includes any OTC medications, supplements, herbal preparations or recreational drugs. (4).

Tramadol is known to have negative interactions with the following:

• Antibiotics like erythromycin
• Antifungal drugs like Nizoral
• Blood thinners like warfarin
• Heart medications like digoxin
• Antidepressants like amitriptyline, SRRIs and Prozac
• St. John’s Wort herb
• Seizure medicines like Tegretol

Side Effects Of Tramadol

Many tramadol users have reported experiencing some side effects. It is important that users are aware of the potential adverse effects of every medication that they may use. This will help you decide if you still want to take a drug like tramadol for the prevailing condition.

The most common side effects of tramadol include:

• Nausea
• Diarrhea
• Vomiting
• Tremors
• Pruritus
• Agitation
• Anxiety
• Hallucination

Other less common side effects:

• Bloating
• Blurred vision
• Dark urine
• Chest pain
• Skin blisters and itchiness
• Dizziness
• Increased or irregular heartbeat
• Numbness in the face, fingers and toes
• Cramping
• Hand and feet tremors
• Tinnitus
• Headaches
• Constipation
• Itchiness
• Anxiety
• Seizures
• Serotonin syndrome
• Disruption of the menstrual cycle
• Reduced libido

But besides these side effects, tramadol has other dangerous effects on the user.

Tramadol Withdrawal

While normal dosage is thought to work with minimal adverse effects, tramadol is addictive or habit forming if it is used for a long time. This means that when a user finally decides to discontinue using it, he may find it difficult to quit.

Tramadol withdrawal symptoms include:

• Insomnia
• Nausea
• Sweating
• Muscle aches
• Tremors
• Anxiety

Abuse Of Tramadol

A report by Public Health England indicates that tramadol may have accounted for 12 percent of all drug abuse deaths reported in England and Wales in 2013. This shows that tramadol was the third most common cause of drug abuse deaths after heroin/ morphine at 41 % and methadone at 19 %.

The same report shows that the deaths occurred in older people, with the average age being 46 years in 2013 and 49 years in 2014. The general average age for deaths due to drug misuse is 41 years. (5)

But these facts took a long time to appreciate. This is because the initial clinical trials conducted on the use of tramadol were not based on real-life oral intake. Instead, the trials involved administration of the drug through injections. Results suggested that tramadol was effective at relieving severe pain in a manner similar to other more addictive analgesics without the danger of addiction.

These findings meant that tramadol remained an unscheduled drug for close to 20 years. As a result, many doctors prescribed it as an alternative to other opioids.

It is worth to note that, while tramadol and other similar substances are called opioids to differentiate them from narcotics, they act in similar ways.

Tramadol is also addictive. And being easily available, the numbers of people using and abusing tramadol grew. This worsened after 2009 when tramadol went off patent protection. This meant that more tramadol could be manufactured under many generic names.

There was an exponential increase in prescriptions in the years that followed; doubling within five years to reach 45 million in 2013 in the United States (6). In the State of Ohio, tramadol prescriptions increased by 93 % between 2007 and 2014. Within the same period, use of products containing hydrocodone increased by a mere 0.7 % and 29.9 % for oxycodone.

These statistics were a result of many abusers switching to tramadol from other substances especially hydrocodone. (7)

Besides the United States and Europe, abuse of tramadol has been growing in many regions of the world, including Africa. Abuse of tramadol is especially serious in countries like Egypt, Cameroon and Nigeria. (8).

Why Is Tramadol Abused?

In addition to being addictive, tramadol has antidepressant effects in some people. This makes them feel a burst of energy and euphoria when they use it. The effect is different from the drowsiness brought about by other opioids and is the main reason tramadol is used as a recreational drug.

Conclusion

While tramadol helps to relieve pain, many reports have shown that similar to other opioids, it has many side effects. Tramadol is also addictive and habit forming. In addition to the available statistics, many tramadol users have expressed their regret in using it, with most of them citing its addictive nature.

Based on this information, tramadol was reclassified in 2014, into Schedule IV in the U.S. and Schedule 3 of the Misuse of Drugs Act in Britain. This has led to a slight reduction in tramadol prescriptions.

Source: Healthiest