What Is Tramadol Hydrochloride and How Does It Work?
Tramadol hydrochloride is a centrally acting opioid analgesic used to treat moderate to severe pain. Although the mechanism of action is not well understood, two distinct and possible synergistic actions are thought to be responsible for the drug’s analgesic properties. The drug acts as an opioid agonist with selectivity for the μ-receptor, thus acting against nociception, and as an inhibitor against the reuptake of norepinephrine, which stimulates intrasynaptic serotonin release.1 Tramadol hydrochloride is well-tolerated and is therefore used to manage both acute pain, such as postoperative pain, and chronic pain, such as back pain.
Analgesic: Tramadol hydrochloride is used to treat a variety moderate to severe acute and chronic pains. Examples of indications that call for tramadol hydrochloride use include postoperative pain, diabetic neuropathy, spine or back pain, and restless leg syndrome.
Note: This drug essentially changes how the brain reacts and responds to pain, and can be habit forming.
Side Effects and Drug Interactions
Common side effects in patients taking tramadol hydrochloride include2:
Abdominal or stomach pain
Anxiety, nervousness, or discouragement
Constipation or diarrhea
Cough or dry mouth
Feelings of cold or warmth
Feeling sad or empty
Fatigue or malaise
Rash or itchy skin
Joint pain or loss of strength or weakness
Muscle aches and pains
Redness of the face, neck, arms, and upper chest
Sleepiness or unusual drowsiness
Sore throat or runny or stuffy nose
Patients who suffer from severity of these common side effects should contact their pharmacist or physician right away. Patients who experience a severe allergic reaction (hives, difficulty breathing, swelling of the face, lips, tongue, or throat) should call for emergency help right away. Patients who experience a change in consciousness or responsiveness, trouble breathing, lightheadedness, loss in muscle tone, fainting, pinpointed eye pupils, severe fatigue or sleepiness, shortness of breath, or slow or irregular heartbeat should inform their physician immediately.
Patients who are allergic to tramadol should not take this drug. Tramadol is contraindicated against monoamine oxidase inhibitors (MAOIs).3
This drug can increase the possibility for selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, and other drugs that lower seizure thresholds to cause seizures. Patients on these medications should consult with their physician. Patients who are currently taking central nervous system depressants, carbamazepine, quinidine, ketoconazole, and erythromycin should notify their physician before starting this medication.
This drug should not be used by patients who are pregnant or breastfeeding. Tramadol is highly habit forming and should be used only with physician or pharmacist oversight.
Latest News and Research
A new use for tramadol hydrochloride’s analgesic properties seems to be the treatment of premature ejaculation.4 Various gels and sprays are available for treatment of this condition, although they have been reported to cause decreased sensation in the patient. In a Phase III 12-week study of over 600 male patients across 62 sites, oral tramadol was shown to delay ejaculation and may be advisable for on-demand usage.
Sustained use of tramadol hydrochloride is known to be habit forming, a widespread problem in the U.S. However, a study in Germany shows a low pattern of abuse in their country.5 Indicators used to track tramadol hydrochloride abuse included on online survey of German pharmacies and reports from state pharmacy boards. Prescription fraud was seen more frequently with tilidine/naloxone than with tramadol in the past two years, and then mostly in the city of Berlin. Although tramadol hydrochloride abuse remains problematic in the U.S., there may be lessons to be learned from Germany-based pharmacies.