Side effects
Painkillers from the group of opioids have fewer side effects in therapeutic dosage than the painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs), which cause lasting damage to the organism. Nevertheless, they have numerous undesirable effects, some of which can be very stressful for those affected. Nausea, dizziness and vomiting (>10%) are among the most common side effects of treatment with Tramal ®.
They are caused by the stimulation of dopamine receptors in the so-called vomiting center in the postrema area of the central nervous system and can therefore be reduced by the administration of dopamine antagonists such as metoclopramide or similar drugs.Other common (1-10%) side effects of Tramal ® therapy are sweating, dizziness, headaches, dry mouth and constipation. Constipation is one of the few side effects of opioids that is not subject to habituation during long-term therapy, so it can become a permanent problem during treatment with Tramal ®. Accordingly, it is possible to decide individually whether prophylactic treatment, i.e. right at the beginning of the therapy, or in the course of the treatment a comedication with a drug that stimulates the intestinal activity (Laxans) is necessary.
Movicol® (contains macrogol, potassium chloride, sodium chloride, sodium hydrogen carbonate) and Bifiteral® (contains lactulose) are frequently used here. Occasional side effects during therapy with Tramal ® are skin symptoms such as flushing, exanthema and pruritus, diarrhea and bloating, and an increased heartbeat (tachycardia) with palpitations. Furthermore, there are numerous side effects that rarely occur.
These include a reduction in muscle strength, changes in appetite, tingling sensations (paresthesia) and tremors (tremor). The dreaded respiratory depression feared in the therapy with opioids occurs very rarely under a therapy with Tramal ® in therapeutic dosage. However, it can occur in the case of an overdose or in combination with substances which also inhibit the respiratory center, such as sleeping pills, some psychotropic drugs and alcohol.
The occurrence of seizures is also extremely rare under a dose-adapted therapy with Tramal ®, but can occur in case of overdose or in combination with other substances that lower the seizure threshold. These include some antidepressants (including amitriptyline) and antipsychotics (e.g. haloperidol). Symptoms such as insomnia and nightmares, hallucinations and confusion, as well as mood changes in the sense of euphoria or dysphoria (irritability) also occur rarely during treatment with Tramal ®.
Changes in activity in the sense of an increase or decrease in activity, blurred vision, slowing of the heartbeat (bradycardia), increase in blood pressure (hypertension), difficulty urinating (micturition difficulties) and allergic reactions are other rare side effects that can occur during treatment with Tramal ®. The dreaded development of dependency during the therapy with opioids rarely occurs with Tramal ® because Tramal ® has a rather low dependency potential in the group of opioids. Nevertheless, after a longer period of therapy a dependency can develop which becomes apparent after discontinuation of Tramal ® through withdrawal symptoms.
These include trembling, sweating, restlessness, muscle cramps, cold feeling, palpitations, nausea, vomiting, diarrhoea, perception and sleep disorders, mood swings and anxiety attacks. Overdosage (intoxication) of Tramal ® can lead to vomiting, circulatory collapse, loss of consciousness up to coma, respiratory depression up to respiratory paralysis, seizures and a narrowing of the pupils (miosis) characteristic of opioid intoxication. Naloxone can be given as an antidote for respiratory depression, while diazepam is given intravenously for cramps.
During treatment with Tramal ® it should be noted that the ability to react can be impaired, so that active participation in traffic and the operation of machines should be avoided in this case. If side effects occur during treatment with Tramal ®, the doctor should be informed. The pain therapeutic effect of Tramal ® long 100 mg can be reduced if carbamacepin-containing drugs (drugs for epileptic seizures) are taken at the same time.
Tramal ® long 100 mg can increase the effect on the central nervous system if taken at the same time as a sedative or alcohol. The simultaneous use with other opioids (e.g. Valoron ®) should be avoided. The resulting effect cannot be estimated. There are interactions with certain antidepressants (drugs used to treat depression) and, in general, drugs that lower the cramp threshold. If Marcumar ® (phenprocoumon) is taken at the same time, small areas of bleeding may occur.
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