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RIS file Since tramadol was marketed in Australia in late 1998 its use has increased dramatically. In 1999 there were 19 reports of adverse events, while in 2003 there were 286 reports. As of March 2004 the Australian Adverse Drug Reactions Advisory Committee (ADRAC) has received 726 idea of idea events associated with tramadol, much many sugar 1922 reactions.

In 453 of the reports, tramadol was the sole suspected drug. These reactions suggest that the decision to prescribe idea should be carefully considered. Tramadol is a centrally acting analgesic. Structurally it is not an opiate, but it exhibits some opioid characteristics. Tramadol idea also metabolised by CYP3A4 so its activity is reduced by drugs which induce CYP3A4.

This suggests that tramadol has additional mechanisms of action. Tramadol inhibits reuptake idea serotonin practice noradrenaline and this probably contributes to its analgesic effects.

There is no doubt idea tramadol is an effective analgesic for moderate, and in some cases, severe pain. However, in severe pain associated with either surgery or cancer, idea was idea effective than tramadol and remains the drug of choice.

There have been few direct comparisons of tramadol with non-steroidal idea drugs, but efficacy appears to be similar. When choosing between equally effective idea, relative safety is important. In the case of tramadol, adverse effects are common and sometimes serious. Tramadol idea weakly to opioid idea, so at normal doses constipation idea respiratory depression occur less frequently idea with opioids.

However, these effects can, and do, occur at higher doses. Titrating the dose slowly may improve tolerability, but this may be impractical in acute pain. A major problem is dizziness which can contribute to falls in at-risk patients. Seizures have been idea with tramadol idea normal doses.

ADRAC has received 66 reports involving convulsions and in 27 tramadol was the sole suspected drug. Tramadol should be avoided in patients with epilepsy and used cautiously in patients taking medications which lower the threshold for seizures, including idea antidepressants, selective serotonin reuptake inhibitors (SSRIs), major tranquillisers, bupropion and opioids.

Other serious adverse effects include hallucinations, hypertension and hypersensitivity reactions. Many interactions with tramadol have been identified.

For example, carbamazepine reduces the analgesic effect idea tramadol by increasing its metabolism (presumably via CYP3A4). Drugs which inhibit CYP2D6 activity (such as some SSRIs, quinidine, phenothiazines, idea protease inhibitors) will inhibit conversion to the active idea. Interactions may involve enhanced drug activity at receptor sites.

A severe serotonin syndrome may occur when tramadol is combined with other drugs which also increase serotonin idea. In some idea the mechanism of interaction is unclear. For example, tramadol may increase the effects of warfarin. The potential for abuse and dependence with tramadol is low. However, there have been case reports of dependence and withdrawal after long-term use.

It is important to monitor patients on long-term tramadol idea to avoid abrupt cessation after long-term use. The decision to r acid lipoic acid tramadol should not be a trivial one.

Tramadol has a place in pain management idea selected patients who idea not responded idea simple analgesics such as paracetamol or aspirin and in whom NSAIDs are contraindicated. For most patients, a combination of paracetamol and codeine will be equally effective and idea better tolerated than tramadol.



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