There are people who think that tramadol is not an opioid.
Tramadol is an opioid. It is different from other opioids due to its unusual characteristics.
Some of these characteristics offer an advantage for tramadol over other opioids, but on the other
hand, these unusual characteristics make tramadol more dangerous than other opioids.
Tramadol is the generic drug name, and there are various brands in Canada: Tramacet,
Zytram, Ralivia, Ultram, and Tridural. Today, I will answer 10 common questions
that people ask about tramadol. So, let’s talk about tramadol today.
Question #1. How does tramadol work? Before I continue, let me remind you that
this video is not intended to replace medical advice. It is for educational purposes only.
If you need medical advice, contact your doctor. In case of emergency, go to the
nearest emergency department or call 911. Tramadol is a synthetic opioid. This means
it is done in laboratory as opposed to naturally occurring opioids such as codeine and morphine
which are found in the opium poppy. When a person takes tramadol, a pill, a tablet, suppository,
or even by injection, tramadol will need to be converted in the liver to a more potent substance
called O-desmetyl-tramadol or M1. Some people do not have the ability to transform tramadol
into M1 and will not produce the more potent form of tramadol. Approximately 5% of Caucasian people
do not have the enzyme to transform tramadol to M1, so they will not respond to tramadol,
even if they are prescribed higher doses. They will only get the side effects.
But tramadol will have an additional effect in the pain system, which is very helpful for
people who have chronic pain. Tramadol will block the reabsorption of serotonin and noradrenaline,
two substances that are needed in the central nerve system in people who have chronic pain. In
chronic pain, we use antidepressants called SNRIs or serotonin-noradernalin reuptake inhibitors
with the intention to increase serotonin and noradrenaline. But tramadol is like taking 3 pills
for one. Or 3 in one. However, it is hard to treat depression with tramadol because the effects will
be unpredictable, so it is safer to prescribe one medication for pain and another for depression.
What seems to be a big advantage specially for people with chronic pain and depression
is what makes tramadol so unpredictable and dangerous. People with chronic pain who take
tramadol usually take other medications that also increase serotonin in their brain, like
antidepressants, anti-migraine, other opioids, anti-nausea and even some herbal supplements.
When too much serotonin accumulates in the brain, there is the risk of “Serotonin Syndrome”,
one of the first symptoms is mental confusion, and if this condition is not recognized quickly,
may progress to severe serotonin syndrome which leads to seizures and death.
Question #2. Is tramadol a good painkiller? Tramadol and M1 will activate opioid receptors in
the brain, spinal cord and the peripheral nerves, and will stop the pain, this is called analgesia.
Tramadol is similar in potency compared to codeine, and for this reason is commonly referred
as a weak opioid. However, the concept of weak and strong opioid is relative. What this really
means is that you need a high dose of tramadol to get the same effects of a low dose morphine. So,
people usually say that tramadol is weak and morphine is strong. In this case, fentanyl is
super strong because you would need micrograms of fentanyl to have the same analgesic effects
of hundreds of milligrams of tramadol. There are various systematic reviews of
randomized trials of tramadol for chronic pain: A Cochrane review published in 2019
showed moderate quality evidence that tramadol alone or in combination with acetaminophen
probably has no important benefit on pain intensity and physical function over placebo
in people with osteoarthritis. A Cochrane review published in 2017 showed
low or very low-quality evidence that tramadol could have some benefit for neuropathic pain.
A Cochrane review published in 2013 showed very low quality evidence that tramadol
makes little difference for low-back pain compared to a NSAID celecoxib.
A systematic review published in 2020 showed low quality evidence that tramadol as a single agent
was not better than placebo for patients with fibromyalgia.
Question #3. What is the proper dose of tramadol? How do I know if I need a higher dose?
We usually start tramadol with the lowest possible dose. Tramadol can be found as a short-acting or
long-acting medication. The short-acting usually starts in 30 minutes and last about 4 hours. The
long-acting tramadol takes longer to start but lasts about 8 to 12 hours. In some parts of the
world there is an extended-release tramadol that is taken once a day as the effects last
24 hours. And there are also some pills that contain a mix of short and long-acting tramadol.
I recommend that you ask your doctor or your pharmacist and find out what type of tramadol
preparation you are receiving, as there are many different options in the market.
Because of the risks of serotonin syndrome that I explained before, tramadol has maximum dose
allowed. It depends on the brand of tramadol. For short-acting tramadol pills, if the pill
contains 37.5 mg of tramadol, then we recommend taking no more than 10 per day.
If the short acting tramadol pill contains 50 mg, then we recommend no more than 8 per day.
For the long-acting tramadol, they come in pills of 50, 100, 150, 200 and 225 mg, depending on the
brand. The maximum dose is 400 mg per day. The dose limit is mainly because of the risks of
serotonin syndrome that can lead to death. Question #4. Can I take tramadol with other
painkillers like acetaminophen or gabapentin? Some tramadol pills come already
mixed with acetaminophen. For example, Tramacet, the pill contains tramadol plus
acetaminophen. So, you need to be careful if you take additional doses of acetaminophen
because the maximum that your liver can tolerate is around 4,000 mg a day. Acetaminophen
is the type of drug that is hidden in a lot of other medications, like cold, cough, headaches,
etc. It is very important that you don’t take more than 4,000 to preserve your liver function.
People who take gabapentin can also take tramadol, but you need to be very careful
because the two medications can cause sedation, sleepiness and poor concentration. And combining
the two will only accentuate these side effects. Question #5. Is tramadol a risky pain medication?
The short answer is yes. Tramadol can cause death because it is an opioid, and opioids can
cause the person to stop breathing while they are sleeping. This is even more common when tramadol
is taken with other sedating drugs like gabapentin, baclofen, benzodiazepines,
antidepressants, anti-psychotics, alcohol and even when the person is taking other opioids.
Naloxone is an antidote used to revert an opioid overdose. However, overdose by tramadol
is not completely reverted by administration of naloxone.
The other risk of tramadol, that we already mentioned is serotonin syndrome, and this is
common in people who take other medications that also increase serotonin in the brain.
If you want to read the script of this video, there is a link in the description below.
Question #6. Is tramadol safe during pregnancy and breastfeeding?
Tramadol crosses the placenta. We do not have any evidence that it causes any malformation
to the fetus. However, prolonged use during pregnancy can result in withdrawal symptoms
in the neonate, and we know that neonatal opioid withdrawal can be life-threatening. So,
we recommend that pregnant woman to discontinue opioid as soon as they know they are pregnant,
but this tapering should be done very slow and under medical supervision to avoid uterine
contractions and premature labor or miscarriage. For breastfeeding women, tramadol is found in
the breast milk, and in some cases, the doses are quite high and could cause
serious overdose to the baby leading to brain damage due to lack of oxygen, or even death.
Question #7. Will tramadol help me sleep or keep me awake?
Opioids are known as narcotics because they produce a state of stupor, paralysis,
sleepiness and relaxation. Morphine, which has been used for thousands of years was named after
Morpheus, the Greek god of dreams. However, tramadol has those unusual
characteristics that I mentioned before, increasing serotonin and noradrenaline,
and in some people it will disrupt the sleep causing insomnia and poor quality sleep.
Question #8. Can I drive if I use tramadol? When the person is starting treatment with
tramadol, it is better to avoid driving or operating heavy machinery until the dose is
stable and no more adjustments are being made in the dose. Once the person is on a stable
dose, the doctor can reassess if the person is too drowsy and dizzy.
Drowsiness and dizziness are the two most common adverse effects of tramadol. But most people will
adapt to tramadol and these adverse effects will diminish over time. Then,
when the person is not feeling sleepy or drowsy anymore, then they can resume driving.
Question #9. Do I need to stop using alcohol if I am prescribed tramadol?
Both alcohol and tramadol inhibit the brain function and cause the same effects of sleepiness,
dizziness and can also make the person stop breathing, which may lead to overdose and death.
Question #10. Can people abuse tramadol? Yes, tramadol is a drug that can be abused.
It is an opioid, and some people may have euphoria similar to other opioids like oxycodone,
or fentanyl. A person who uses tramadol regularly will have withdrawal symptoms
if they stop taking it abruptly. These withdrawal symptoms are very unpleasant.
Tolerance to tramadol develops very quickly. Even when the pain condition has resolved
the individual will continue using tramadol just to avoid these withdrawal symptoms.
A small proportion of people will develop an opioid use disorder, which is basically
losing control of how much tramadol they are taking. This is a serious mental health disease,
and it has to be treated as soon as possible. Opioid Use Disorder or OUD occurs in about
5% of people who use opioids everyday. If you like this video press the thumbs up
button here, don’t forget to subscribe to this channel and turn on the notifications button.
Watch my next video here. Thank you for watching. God bless you. Good bye!