Talk:Tramadol

Who said tramadol is not addictive?

I've been addicted to tramadol for at least a year, maybe two or more (difficult to estimate). During this summer I've tried to get rid of them by phasing them out. I've had severe problems with abstinence.

I'm writing this because I think this matter is of importance, and it's in my interest to help people avoid what I experienced.

- Repabil 22:20, 5 Aug 2003 (UTC)

I replaced but is not addictive with therefore it's also addictive. - Repabil 13:16, 9 Aug 2003 (UTC)

- I added a reference to the Ortho-McNeil prescribing information which does discuss the potential for dependence and abuse. 66.166.22.146 18:04, 15 February 2006 (UTC)

That is original research... Is there evidence in the literature?

Tramadol is less addictive than Morphine

First  : it'is impossible to take large amount of tramadol otherwise you get convusion due to the action on serotonine recapture Second : by acting on serotonine receptors it have two way of acting

This is not true. It is definitely possible to take a large amount of Tramadol. The more you take, the more you have to take for it to work. nut-meg 05:23, 23 January 2007 (UTC)

=> then you could'nt have a large morphinomimetics effect with tramadol

tramadol is not a very potent morphinomimetics, not like methadone, or very more potent : fentanyl and there analogues

Tramadol have a semi long timelife in your body : it'is good for pain medication, it make the comming on tollerence slower

But of corse if you use tramadol a long time ( and especially without pain ) you can get dependend .

You have right it is codeine structure related, but it'is 100% syntetic

Tramadol belong on the class IIb of the analgesics, it'is not the most lightest of the opiates.

I think that the opiates that have acte on morphinomimetics receptors + the nmda receptors are better than thous that acte only on morphinomimetic receptors. Methadone do it, dextropropoxyphen, there is now a combinaison that is called Morphidex.

Hope that a day we got good medication against pain, that are not acting on morphinomimetics repectors

I realise you probably aren't well-versed in medical terminology, but I thought I might try to clarify a few things for you. Tramadol may be "morphinomimetic" in the sense that it mimics the action of morphine; however there is no such thing as a "morphinomimetic" receptor - you're probably referring to the μ-opioid receptor. And while it is a synthetic structure unrelated to the opiates, it is still an opioid with all the same problems associated with opioids (largely mediated by the aforementioned μ-opioid receptor). Tolerance does not depend on the rate-of-onset or the half-life of the drug, tolerance will occur to an agent regardless. You're probably confusing tolerance with psychological drug dependence where drugs with a rapid euphoric effect (e.g. intravenous heroin) are associated with a higher occurence of dependence. I was not aware that any of the opioids had any action at glutamatergic NMDA-receptors, but even so this would not have any significant effect of making them "better" in terms of the known pharmacology of glutamate and opioid receptor systems. Techelf 06:20, 10 Nov 2004 (UTC)

It's also good to note, except for opioid like withdrawal symptoms, a chronic user of tramadol, will also have to go through the depression similarly caused by the cessation of anti-depressants. Double whammy. Good news, its milder.--78.86.117.164 20:20, 28 September 2007 (UTC)

However, Tramadol doesn't increase tolerance much at all. The typical abuser gets to 400 to 800 mgs per day and stays in that area. It's one of the most widely abused drugs in the former Soviet Union, so that information should be easy to verify, although it may require some knowledge of one of the languages of CIS states. —Preceding unsigned comment added by 128.195.186.70 (talk) 12:53, 20 February 2008 (UTC)

Antidepressant effects (?) of Tramadol

Due to its purported inhibition of reuptate for norepinephrine and its potentiation of serotonin effects, I have heard it mentioned that Tramadol can exert an antidepressant effect. I have noticed no drowsiness, for example, as I might even get with codeine---no muddledness. Also, the notion that an upper limit exists for ingestion per day is an indication of its limited drowsiness potential. As for withdrawal, I did notice mild withdrawal for 2-3 days, but I think it would indeed be minor---consistent with anecdotal reports of its limited addictive potential. Apart from issues of seizure activity in susceptible individuals, it appears to be a safe and effective painkiller for lower back pain (in my experience).

Also - quite anecdotally, as well - I imagine antidepressant action. Mu receptor involvement might be the "third rail" of comtemporary psychiatric practice, with practitioners considering mu receptor involvent (bona fine neurotrammiters receptors like the other noncontroversial ones such as serotonin and norepinephrine) are off-limits in moderating depression. Tramadol offered this to me in my experience (concommitant to back pain relief), and I hope it might be given consideration in that capacity.

I can understand, theoretically, how the adrenergic and serotonergic effects might lead to the conclusion that tramadol has antidepressant effects. And while I have seen several studies published, based on in vivo studies in rats, which show some efficacy; this is insufficient evidence to justify its use in humans for this indication. To the first poster in this thread, I find it quite surprising that you did not notice any drowsiness, given that sedation is a common effect of μ-opioid receptor activation and 5-HT reuptake inhibition. It may be that your body had already developed tolerance to the sedative effects of opioids from previous codeine use. To the second poster, μ-opioid receptors are indeed bona fide - and one of the known effects of μ-opioid receptor activation is to produce euphoria. This, however, is not the same as alleviating major depression. Using μ-opioid receptor agonists as a therapy for major depression is hardly rational - if they are effective in depression you would expect that more potent and selective opioid receptor agonists (e.g. morphine or fentanyl) would also be effective; however they are clearly NOT. This suggests that, if tramadol really is effective in depression, it may be an idiopathic effect - particularly since the mechanism of action of current antidepressants is also poorly understood. In the coming years the role of the endogenous opioids (dynorphins, endorphins, enkephalins) should be more substantially characterised and we shall see whether this hypothesis is correct. And even if tramadol or other opioids are shown to be clinically efficacious in humans, the risk of using opioids as antidepressants would be unjustified in light of their propensity to produce dependence/tolerance and risk of abuse compared with SSRIs. Techelf 06:20, 10 Nov 2004 (UTC)

Egad! Fentanyl is a serious CNS depressant, and would be as bad a candidate for an antidepressant as a bottle of vodka. Quite right that one would never treat major depression with opioids per se. However, tramadol has much more than mu activity. . . Look at its panoply of neurotransmmiter effects. A soupcon of mu activity (the lack of it) is of course a component in depression; if we had no natural opioids, we would terminate our lives in short order. Drowsiness or muddledness is, in fact, much reduced in tramadol, probably because of the comcomitant GABA, norepinephrine and serotonin effects. I am here to tell you---and since you are likely a medical professional you are aware of this---that SSRI's and others outside that class like Wellbutrin are only truly efficacious to 50-60%, so one should keep an open mind. My point is that simply because an opioid effect is present, many will rule it out as a possible treatment for depression. One last point: more exists in patient issues than major depression. Minor depression is widely dealt with by myriad Rx's; my implication was tramadol's possible consideration in minor depression.

What you are presenting here is original research. If you feel Tramadol should be used as an antidepressant you will need to back it up with literature references. While we need to keep an open mind, Wikipedia is not a forum for original research unless you can back this up (and a web page is insufficient, I'm talking peer-reviewed stuff here). There is a lot of amateur psychopharmacology on the web anyway. JFW | T@lk 12:35, 18 Nov 2004 (UTC)

Tramadol definitely has theoretical antidepressant potential as an SNRI (similar to venlafaxine). See http://opioids.com/tramadol/ultramantidep.html and http://opioids.com/tramadol/tramadol.html They both come from reputable publications, but mostly involve studies on mice, not humans.

The comment from a longtime contributor-editor of many Wikipedia pharmacology/drug articles opined [in the comment above from 18 Nov 2004] some 2-1/2 years ago that my musings on tramadol's consideration as an antidepressant drug candidate should be relegated out of even this discussion section . . . that I was proposing original research. Proposing original research is, I believe, entirely fitting as a Wiki discussion section comment. Now [in April of 2007] I find the article has been continually updated to currently include apparently substantiated information that the drug has SSRI qualities (I had heard before that it possessed reuptate inhibition for a different neurotransmitter). Does not SSRI activity fall under the aegis of antidepressant potential? If this is so, and if it is also so that tramadol potentiates dopamine presence, then this drug is looking more interesting as one to alleviate depression and fatigue. I am also hearing that the Mu receptor effect/involvement of tramadol is now thought to be relatively miniscule by comparison with traditional opioids: that much of its pain mitigating activity actually derives from the other potentiated neurotransmitters: GABAergic, noradrenergic, dopaminergic and serotonergic. Furthermore, the action of tramadol in achieving the sensation of fatigue lift (part and parcel of the lifting of depression)—along with its curious aspect of causing virtually no drowsiness at moderate dosages—is rather immediately achieved; any drug that can do this instead of entailing a wait-and-see of two to six weeks before onset of action seems worth a further look. --PLK

Not meant for extended use

Tramadol has warning about quantity per day and "not for long term administration". Its unknown mechanism of action could produce changes in the synaptic gap similar to antidepressant effects but of no or of harmful value. Long term or overuse could produce personality change, anxiety symptoms and other disorders.

In practice many people are on long-term tramadol, most with no long-term repercussions. JFW | T@lk 05:09, 5 February 2006 (UTC)

Me included. I was prescribed it for long term usage, and that's with my stipulation to my doctor that I not be prescribed any medication with mood/personality affecting effects. ⇒ SWATJester ^Ready Aim _Fire! 05:30, 14 April 2006 (UTC)

I started using Tramadol about two weeks ago for severe burning and spiking sensation in my feet, hip pain, lower back pain and fatique. Tests have ruled out diabetes, hepatitus etc. While the tramadol is not really helping the pain it has dulled the burning sensations in my feet when I am at rest but not while working and it also has greatly alleviated my fatigue and depression. I was not expecting this as the precautions said it would cause drowsiness. I do not feel hyper, doped up or anything unusual suprisingly i feel normal like I am not even taking medicine. I do not feel addicted or have cravings for more of the pills. I take it as prescribed 2 every 4-6 hrs. While I would not keep taking tramadol for its non pain relieving effects I will keep taking it for its non narcotic uplifting effects.

Length of use

I have been taking Tramadol for a year for pain associated with fibromyalgia. My doctor decided to change medications. I was on 100 to 300 mg per day.

I am most definitely experiencing physical symtoms as I am limiting the use of the drug. Within the last week I have gone from 300 mg to 50 per day. I am experiencing pretty severe anxiety and chills along with insomnia, and some physical discomfort. How long can I expect this to continue? When should I just stop the meds completely? I would have to agree that I have experienced physical dependence with the use of Tramadol. Is a year to long to have been on this medication? —This unsigned comment is by Jodygaff (talk • contribs) .

Hi Jodygaff,

Wikipedia cannot give medical advice (nor can wikipedians), so I need to advise you to speak with your physician. Opioid withdrawl syndrome is quite variable and duration seems to depend on the individual as well as the substance. While typical heroin withdrawl is over within 48-72 hours, acute methadone withdrawl has been said (anecdotally) to last much longer, perhaps even weeks. Some experience little or no withdrawl symptoms at all. I don't know of any studies offhand regarding the duration (or even existance of) tramadol withdrawl. It's important that you speak with your physician about the symptoms you are experiencing regardless. --Bk0 (Talk) 00:16, 15 March 2006 (UTC)

--Rick53 09:56, 20 June 2006 (UTC) I too want to agree with Jodygaff,withdrawing gives me anxiety and chills,sneezing, runny nose,also bouts of crying and physical discomfort internally,i use 100mg Tramal per day. My main reason for going off Tramel is it makes my mouth stimulate so much saliva ,also the end of my tongue has a metalic taste,& lastly an irritation of air bubbles under the tongue & also on the top to the roof of my mouth,which is driving me to a point of despair

Tramadol VS Dihydrocodeine

I read in the DHC artical that the potency was 30% that of morphine

Tramadol is 10%

Is Dihydrocodine really 3 times more potent than Tramadol????

Somethings wrong; right?

Yes, the article on dihydrocodeine was incorrect. With respect to IM administration, approximately 130 mg codeine/dihydrocodeine or 100–120 mg tramadol is considered of similar analgesic potency to 10 mg morphine – not taking inter-individual variability of course. -Techelf 10:38, 26 May 2006 (UTC)

Codeine and dihydrocodeine are not of the same potency; the analgesic potency of DHC is some 170 - 200% that of codeine; while 130 mg codeine i.m. are equianalgesic to 10 mg MS i.m., 70 mg dihydrocodeine i.m. are equianalgesic to 10 mg MS i.m.--84.163.77.244 21:50, 4 September 2007 (UTC)

Opioid?

Tramadol is an opioid? News to me. A couple of years ago I was able to order 100 tablets of it from a Swiss mail-order pharmacy, without a prescription. AFAIK, no other opioids can be shipped internationally, at least on the consumer market. Does anyone have URLs for any whitepapers on the subject, which determine that it is, in fact, an opioid and not merely a strong non-opioid analgesic? Clearly, I need to be enlightened on this subject. Avalyn 14:48, 30 June 2006 (UTC)

Yes an opioid, and yes in UK most definitely is a Prescription only Medicine (meaning anyone supplying the drug without a prescription, in the UK, would be breaking the law). Likewise Ciailis & Viagra are POMs, yet as much spam email attests to often available without prescription from suppliers operating out of other countries. David Ruben ^Talk 21:09, 30 June 2006 (UTC)

Recreational Drug

Like yall said, it can be a recreational drug. Ive given it to many of my friends and taken high doeses myself. I added a recreation section (10/11/06) that includes the side effects and its possible dependence and tolerance. I dint use any sources, but yall above me (and the people ive given this drug to) will probrably agree with me that my added section is fact

— Preceding unsigned comment added by 71.71.71.43 (talk • contribs) (01:27, 12 October 2006)

Unfortunately neither your personal claim (which counts as WP:No original research or those of yoyr friends will count as WP:Reliable sources as far as adding material to an encyclopaedia. And yes material in wikipedia must be sourced. Many drugs could be used "recreationally", but that does not automatically mean that they are, or that so used by a trivial number of people (large number, if can WP:VERIFY woul dneed mentioning of course under WP:NPOV).David Ruben ^Talk 01:14, 12 October 2006 (UTC)

Tell that to any of the DEA-type agencies anywhere in the former Soviet Union. It's one of the most widely abused drugs there, on the same level only with codeine and marijuana. —Preceding unsigned comment added by 128.195.186.70 (talk) 12:55, 20 February 2008 (UTC)

Illegal/Recreational Use

Rephrased the "recreational use" section, as it appeared to advocate illegal use and abuse of the drug. Removed uncited "study" claim of being less addictive than other drugs. Editors with more knowledge should fact check this section. nut-meg 05:11, 23 January 2007 (UTC)

Tramadol Withdrawl

Currently in the main article, the only mention of withdrawal is:

In addition, there are widespread reports by consumers of extremely difficult withdrawal experiences.

For people going through withdrawal, WP will be one of the many sources that people will look at. I have just gone through this experience myself after being on only 150mg/day for about 6 weeks for back pain. I personally found it to be a totally horrible week, that started not too bad before 4 days I'd rather forget, but now a week later I'm out the other side.

WP however needs to have not personal experiences, like mine, but well researched information and in areas like this, preferably from a medical expert. I spent a lot of time looking for medical reference material around this area and found little material that would meet the quality standards for WP, although I found a huge amount of posts denoting personal experiences.

So this is a request for expert help to extend this article to benefit WP readers, especially people who have been on this drug and medical professionals (my own GP had a look at this page checking for info). I am more than willing to help in this task, with guidance. --Mendors 02:34, 4 March 2007 (UTC)

It is addictive, and so are virtually all antidepressants, as well as such things as caffeine. If one must cease the drug, then one must taper off; don't be foolish and stop abruptly. Natually, unpleasantness will be the result. I once had a terrible headache from coffee (caffeine) withdrawal: I had undergone surgery and hadn't had any coffee that a.m. After surgery, my dull headache got progressively worse. I had thought that the norphine I was being given (they gave me MORE after I asked for it) would obviate the caffeine withdrawal headache, but it only went away when I got some coffee! The moral is . . . there is a moral (see above). --PLK

Contradict marker

I placed the contradiction marker on the page, the introduction states it's for "mild to moderate pain", the first section claims "moderate to severe". A citation for one or the other would help. 85.216.229.175 19:10, 15 September 2007 (UTC)

Pain assessment is notoriously impossible to objectively quantify. In medicine, pain scores are always self-reported. There is no contradiction here, although there exists imprecision. But that is intrinsic to descriptions of pain and, ipso facto, pain palliatives.Lesotho 01:27, 16 September 2007 (UTC)

Serious citation gaps

Can someone fill them, in Dependence? Tony 08:16, 17 September 2007 (UTC)

And a general note:

DO NOT SEEK MEDICAL ADVICE ON THIS PAGE: here, we discuss how to improve the article only. Tony 08:19, 17 September 2007 (UTC)

Indeed - {{talkheader}} tag insert at top of this talk page and some blogging (& unsigned) personal experiences removed. David Ruben ^Talk 12:26, 17 September 2007 (UTC)

Why were the country specific brand names removed?

Why were the country specific brand names removed? --Law Lord 22:28, 29 September 2007 (UTC)

What happened to anxiety? Panic attacks?!?

I took tramadol for a few weeks two years ago, and it caused me anxiety and severe panic attacks. I was only able to figure this out because the prescribing information stated that these were potential side effects. I seem to think the Wikipedia article mentioned this back then, but maybe I'm wrong. Point is, anxiety is a well-known potential side effect of tramadol, and I'm wondering why it isn't in the article to begin with. --63.25.116.33 (talk) 01:53, 13 December 2007 (UTC)

That could be serotonin syndrome, since tramadol tends to prevent uptake of serotonin. If there are other substances (not necessarily SSRIs) that are inhibiting uptake or contributing to high serotonergic activity, then perhaps that would trigger the symptoms. Wellbutrin, for instance, is not an SSRI but does have SSRI-like properties, so that could be a questionable cocktail that a lot of doctors might miss. -Rolypolyman (talk) 00:42, 26 December 2007 (UTC)

I'm not convinced that anxiety and severe panic attacks have a proven association with tramadol; it seems to have been observed only very rarely. Rolypoly, do you mean reuptake? Tony (talk) 13:25, 26 December 2007 (UTC)

I need more proof please...

I have been researching this medication for years upon years, trying to decipher all of the available information. I'm trying to understand HOW IN THE WORLD Ultram (tramadol) is an "opiate". I see "proof" on both sides of the isle, some information proving that it is an opiate and some proving that it isn't. Personally, I do not believe that Ultram/Tramadol is an opiate, or derived from any form of opiate.

Now, from personal experience, as a chronic pain sufferer, and also having spoken with countless friends in my chronic pain online support group, NONE of us see, or rather feel (effects on the body, that is) that this medication is an opiate. The one and only time that I took it, I did not feel relief from pain at all, and having been on hydrocodone for years prior to starting the Ultram/Tramadol, could feel nothing from it (even at triple doses).

I understand that most internet information reports that Ultram/Tramadol "acts" as an opiate, but isn't actually an opiate. That in and of itself makes NO sense to me.

1. Can someone, provide me relative proof that this drug either is/is not an opiate? And I don't mean telling me "it's an opiate, because "so-and-so" says it is. (i.e. In the chemical breakdown; opium, or a derivative of it, is there.)

2. IF Ultram/Tramadol is an opiate, how can it be sold w/o a prescription over the internet? (And before you go there, I know it is being/can be done for a fact.)

3. IF it is an opiate, I understand that it is a synthetic form. How does this affect the medication?

4. What are the benefits/drawbacks with using synthetic opiates? Do synthetics not work as well, or do "naturally" derived chemical compounds work better? For Example: I was on hydrocodone for 6 yrs. and could feel when it hit my system. With the current medication that I am on, it is similar to Ultram, in that it is synthetic, and I never feel it hit my system. Why is that? (Note: This medication is for my chronic pain, NOT recreational/illicit drug use!)

I know these are a lot of questions, but I've been doing research for a long time on this medication, and I do have a good source with which to provide information to update the article with a qualified resource, but before I do, I'd like to just know a few things. I haven't ever added to any article in WP before, and am a bit nervous/uninformed about how to do it. Any info on that would be much appreciated as well.

Many thanks for anyone that is willing to tackle my questions.

Mom2-4Kids (talk) 19:23, 24 January 2008 (UTC)

I can certainly understand your questions and I'm sure someone (if no one else maybe even me) would be happy to take a stab at answering them. This is not the place to do so, however, as this is a page for discussing changes to the Tramadol article and not answering questions about the drug. May I suggest you post your questions over at the Science Reference Desk? Those folks specialize in just this sort of thing. --George (talk) 13:53, 25 January 2008 (UTC)

Tramadol should not be bought over the Internet; such a practice is illegal in many jurisdictions, and medically questionable everywhere, for a number of reasons.

As I understand it, as a layperson, T is an opiate analogue, synthesised in the lab. Its properties differ from those of other opiates, but there is a degree of commonality. For example, it, too, can cause constipation; but its bioavailability and pharmacokinetics are specific (of course, T is typically "slow release", too); and it's serotonergic, too, of course, which natural opiates are not.

Some of your points may relate to the improvement of the article, but some appear to be seeking medical advice. Please restrict your postings to the former. Tony (talk) 02:58, 25 January 2008 (UTC)

It would be more correct to call Tramadol a synthetic selective opioid receptor agonist. It only affects some of the receptors that opiates affect (2 out of 3, I believe?). Therefore, it lacks the sedative effect typical for natural opiates. It is widely abused as an opiate replacement by addicts all over the world. —Preceding unsigned comment added by 128.195.186.70 (talk) 13:01, 20 February 2008 (UTC)

TRAMADOL IN HEROIN WITHDRAWL TREATMENT

My doctor prescribed TRAMADOL for treatment of light heroin addiction. The information contained in the product packaging states that it is a synthetic opiate and " should not be used for treatment of heroin withdrawl symptoms ". Why not ? I found it efficient making the transition from small amounts of heroin to nothing at all very easy. It is true to say that some small discomfort was experienced when the course of Tramadol came to an end, but I think that was more psychological than physical. The dose was 100mg three times daily for a week reducing to twice daily for another week, and finally once in the early morning for a third week. Then reduce this to 50mg once a day and after one month to nothing. It is effective'as long as your heroin intake was low to start with - ( 1/4 gm daily maximum) and smoked, not by injection, I would not be able to tell how well TRAMADOL would perform when dealing with more serious addiction. —Preceding unsigned comment added by 83.50.119.21 (talk) 18:21, 25 April 2008 (UTC)

Tramadol and GABA

Looking for a source for tramadol's effect on GABA systems. And a source for seizures being due to the non-metabolized tramadol (M). If anyone has one, please share. Thanks. --Jmcclare (talk) 00:30, 29 April 2008 (UTC)