Tramadol

Tramadol – Full Introduction

Tramadol is a centrally acting analgesic used for the management of moderate to moderately severe pain. It has a dual mechanism, acting as a weak opioid receptor agonist and inhibiting the reuptake of norepinephrine and serotonin in the central nervous system.

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Drug Class

• Centrally acting analgesic

• Weak opioid agonist

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Mechanism of Action

Tramadol relieves pain through:

1. Opioid pathway: Weak agonist at μ-opioid receptors → modulates pain perception

2. Monoaminergic pathway: Inhibits norepinephrine and serotonin reuptake → enhances descending inhibitory pain pathways

This dual mechanism provides effective analgesia with lower risk of respiratory depression compared to strong opioids.

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Therapeutic Uses

• Moderate to moderately severe pain (acute or chronic)

• Postoperative pain

• Musculoskeletal pain

• Neuropathic pain (off-label use)

• Osteoarthritis pain

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Benefits

• Effective analgesic for moderate pain

• Available in oral, injectable, and sustained-release formulations

• Lower risk of severe respiratory depression than morphine

• Can be used in combination with paracetamol or NSAIDs

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Common Side Effects

• Nausea and vomiting

• Dizziness

• Drowsiness

• Constipation

• Sweating

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Serious but Rare Side Effects

• Seizures (higher risk in overdose or with certain medications)

• Respiratory depression (rare at therapeutic doses)

• Serotonin syndrome (if combined with other serotonergic drugs)

• Dependence and withdrawal with prolonged use

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Contraindications & Precautions

• Hypersensitivity to tramadol or opioids

• Severe respiratory depression

• Acute intoxication with alcohol, hypnotics, or CNS depressants

• History of seizures (caution)

• Avoid abrupt discontinuation after prolonged use

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Dosage & Administration

• Adults: 50–100 mg every 4–6 hours as needed

  • Maximum: 400 mg/day (immediate-release)

• Extended-release tablets: 100 mg once daily initially, titrate as needed

• Children: Dose based on body weight (specialist-prescribed)

• Administer with or without food

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Conclusion

Tramadol is a moderate-strength analgesic suitable for managing pain when NSAIDs or paracetamol are insufficient. Its dual mechanism makes it effective, but careful monitoring is needed for side effects, drug interactions, and risk of dependence.