Definiton
Tramal® is the trade name for an analgesic containing the active ingredient tramadol. Tramadol belongs to the group of opioids and is used to treat moderately severe to severe pain. Tramadol is available only on prescription, but is not subject to the German Narcotics Law (BtMVV).
The substance tramadol was synthetically developed by Grünethal GmbH, patented in 1965 and the first preparation was launched on the market in 1977. Today, many generic drugs are available in different dosage forms and dosages (tablets, drops, suppositories, infusions). (R,R/S,S)-2-(dimethylaminomethyl)-1-(3-methoxyphenyl)cyclohexanol
Application
According to the World Health Organization (WHO) step-by-step scheme for pain therapy, tramadol is used for moderate to severe pain in combination with, for example, ibuprofen, ASA, paracetamol, diclofenac (non-opioid analgesics).
Effect
Tramal works in nerve tissue, i.e. also in the brain. It acts at the three different opioid receptors like morphine, but its potency is only about 10% of morphine. Tramal acts at the receptors in a very non-specific way and the binding power (affinity) is not very high, therefore the effect of pain relief is not very strong.
Tramal also inhibits the reuptake of norepinephrine and increases the release of serotonin at the nerves. These effects have an anxiety-relieving (anxiolytic) and slightly antidepressant effect. However, the increased release of serotonin results in increased nausea as an undesirable side effect.
Dosage
Interval between receipts: at least 8 hours. Do not exceed daily dose of 400mg. Individual dose adjustment may be necessary (in acute pain, long-term treatment, elderly patients, liver and kidney damage)
- Moderate pain: single dose (ED) 50mg, if there is no improvement of pain take another 50mg
- Severe pain: ED 100mg
- Tumor pain or severe pain after surgery: highest dose possible with sustained release tablets morning and evening 100mg, if necessary increase to 2x daily 150mg or 200mg
Side effects
Tramal generally has few side effects in the area of organ damage. However, side effects may occur such as sweating, drowsiness (sedation), confusion, drowsiness and blurred vision. Furthermore, severe nausea is often reported.
Seizures have also been observed at doses above the therapeutic dose. Unfortunately, Tramal has a rather high rate of non-responders (non-responders) of 30%. In this case it is necessary to switch to another drug.
In the case of poisoning with Tramal (if one takes significantly more than the therapeutic dose), as with other opioids (morphine), circulatory collapse, loss of consciousness and even coma can occur. Vomiting, constriction of the pupils, cramps, respiratory disorders up to respiratory arrest can also occur. Therapy: If it is not more than 2 hours ago, you can take activated carbon or perform a gastric lavage in case of tablet poisoning.
Otherwise you can give Naloxon as an antidote and Diazepam for cramps. Tramal contains the active ingredient tramadol, which belongs to the large group of opioids and, like all opioids, can cause side effects in addition to the desired pain-reducing effects. However, side effects do not always occur, as each person reacts differently to the intake of drugs or the specific intake of tramal.
In addition, side effects can also vary depending on the form of application. Graduated according to the frequency of occurrence, the following possible side effects should be mentioned: In very many patients (more than 1 in 10 patients treated) nausea and dizziness occur. Side effects such as dry mouth, constipation, headache, increased sweating, vomiting and dizziness are common (more than 1 in 100 but less than 1 in 10 patients).
Occasionally (more than 1 in 1000 but less than 1 in 100 people treated) the occurrence of weakness, circulation fluctuations, circulatory collapse, allergic reactions (redness, itching, rash), heartbeat acceleration and palpitations, and gastrointestinal complaints such as nausea, diarrhea and stomach pain are reported. In rare cases (more than 1 in 10,000 but less than 1 in 1000 people treated) side effects such as muscle weakness, decreased performance, changes in appetite, tremors, blood pressure increase, slowed heartbeat, blurred vision, shock, and respiratory or mental disturbances (hallucinations, confusion, depression, nightmares, sleep disturbances) occur.Furthermore, in rare cases, the occurrence of allergic reactions such as shortness of breath or skin swelling is reported. Very rarely there is an increase in liver enzymes.
Long-term use of Tramal may lead to dependence, although the probability of developing dependence is low compared to other drugs. Withdrawal symptoms after stopping the tramal is rare but possible. These withdrawal symptoms are likely to occur before sudden discontinuation after a longer period of use.
In older patients (> 75 years), as well as in patients with kidney or liver dysfunction, the occurrence of side effects is increased due to the slower elimination and excretion. Therefore, these patients require close control while taking Tramal and possible dose adjustment. Furthermore, the doctor should know the medication schedule of the patients in order to exclude possible interactions of tramal with other drugs and thus avoid possible side effects. If side effects occur, depending on their severity, a doctor should be contacted to decide on further action (dose reduction/continuation).