Dangers of Tramadol

By Femi Ogunyemi

Tramadol is typically used for the management of moderate to severe pain, such as for after surgery and for ongoing pain from arthritis. When it was approved in 1995, tramadol was thought to be safer and have a lower risk of addiction than other narcotic pain relievers, with fewer gastrointestinal side effects for older adults who needed long-term pain relief.

But as the number of prescriptions soared – reports of drug abuse and addiction problems also increased. Last year, tramadol was reclassified by the Drug Enforcement Administration as a Schedule IV controlled substance, similar to Valium and Xanax. With the paucity of strong pain medications in Nigeria (thanks to the excessive regulation and control by FMOH and NAFDAC) tramadol use is on the increase in Nigeria.

Dosage

In Nigeria I have encountered patients on inappropriate doses, patients on other conflicting medications and some addicted patients seeking detoxicification. Many users/prescribers are unaware that doses over 400mg daily can predispose to convulsions and this limit can be adjusted downwards in certain scenarios.

In two reports analyzing emergency room visits involving tramadol, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) found that visits due to adverse reactions to the drug rose 145 percent, from about 11,000 visits in 2005 to nearly 27,000 visits in 2011; visits because of abuse or misuse rose 250 percent during the same period – from just over 6,300 visits in 2005 to almost 21,700 visits in 2011.

In both categories, many more women ended up in the ER than men. Women’s visits for adverse reactions, for example, spiked from about 7,600 visits in 2005 to more than 19,000 visits in 2011. By comparison, men’s visits went from about 2,500 in 2005 to around 8,000 in 2011.

By age, the greatest increase in ER visits because of tramadol-related misuse or abuse occurred among patients 55 or older, SAMHSA reported. This group experienced a 480 percent jump, from just 900 visits in 2005 to more than 5,000 in 2011. Patients ages 45 to 54 also saw a big increase – of 389 percent, researchers said in a statement.

In addition, patients ages 65 or older accounted for the largest number – 35 percent – of tramadol-related ER visits involving adverse reactions, according to the report, and half of them ended up being hospitalised.

Adverse reactions

“Tramadol is important for people with moderate to severe chronic pain, but older adults who end up in the ER are often on additional medications that can interact with tramadol, especially antidepressant medication,” he said in an interview.

Severe adverse reactions can include seizures and a potentially fatal reaction called serotonin syndrome. Many doctors prescribe tramadol because it’s considered safer than stronger opiates – which can cause oversedation and falls – or NSAIDs, such as ibuprofen or naproxen, which can cause stomach bleeding or kidney problems.

Dangerous side effects include a fast heartbeat, difficulty breathing, convulsions, lightheadedness, unusual drowsiness, confusion, fever and coma. Don’t take tramadol if you are taking medication for migraines, depression, anxiety, muscle spasms, mental illness, nausea and vomiting, all of which can increase the risk for seizures.

Discuss taking tramadol with your doctor to make sure there are no other risks that should be considered and to be sure that taking it is a beneficial option for you. Never take more than what is prescribed. If you’re still in pain, talk with your doctor. Don’t just increase your dose.

Never stop taking tramadol suddenly without speaking with your doctor first, especially if you’ve been on the medication for a while. Suddenly stopping can cause uncomfortable withdrawal symptoms. Adverse reactions to tramadol have always been well recognised by Pain experts, but are only now becoming well publicised. Prescribers, take care; users be aware