Tramadol
Introduction
Tramal® is a drug containing the active ingredient tramadol. It belongs to the group of opioids, which are among the most powerful painkillers and are largely covered by the German narcotics law. Tramadol, however, is not subject to this law.
The potency of opioids is measured by the potency of morphine, the potency of morphine being set as 1. Tramadol has about 0.1 times the potency of morphine, so it belongs to the low-potency opioids. According to the World Health Organization (WHO), low-potency opioids such as tramadol should be used from level 2 in the 3-stage pain management regimen.
These can also be combined with painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or drugs such as paracetamol and metamizole (Novalgin ®). A combination of low and high-potency opioids such as fentanyl should be avoided as they inhibit each other in their efficacy. From WHO level 3 on, high-potency opioids should be used for pain relief.
Side effects
Opioids are – in comparison to the weaker painkillers such as NSAIDs – relatively gentle in terms of their effects on the organism. Even when taken continuously, opioids cause less permanent organ damage than ibuprofen and others. One problem with opioids, however, is the risk of developing dependency during long-term therapy.
As a result, withdrawal symptoms may occur after discontinuation of the medication. An example of this is the drug heroin, which also belongs to the group of opioids. However, due to its pharmacological behaviour, its dependence potential is significantly higher than that of opioids used in everyday clinical practice.
Furthermore, opioids can lead to numerous side effects, some of which are very unpleasant for the person concerned. For example, the use of tramadol often leads to nausea and vomiting, dizziness, dry mouth, headaches and drowsiness. Another frequent side effect of opioids is constipation.
Patients who are treated with opioids over a longer period of time are therefore usually prescribed an additional laxative medication to ensure that bowel activity does not come to a standstill. Sweating and skin symptoms such as redness or a rash (exanthema) can also occur under opioid therapy. Less frequently, difficulties in urination (micturition problems) occur.
Other rare side effects are muscle weakness, respiratory depression, seizures, hallucinations and confusion, mood changes both in the sense of euphoria and dysphoria (irritable mood), slowing of the heartbeat (bradycardia), increase in blood pressure (hypertension) and allergic reactions. Tramal® can lead to an impairment of the ability to react. The patient should therefore take responsibility for assessing whether he/she feels able to actively participate in traffic or operate machines and avoid doing so if symptoms such as drowsiness or attenuation occur.
