Tramadol is used to treat moderate to moderately severe pain. It is a man-made (synthetic) analgesic, in other words - pain reliever. Generally the drug is used to relieve pain after certain surgeries (especially after bone and dental ones) and chronic pain (that is associated with cancer, nerve pain, or low-back pain).

Tramadol was approved by FDA in March 1995. It is available in plenty of brand names, such as Ultram (in USA), Zipan or Tridol (in Korea), and in other countries with names similar to Tramadol: Tramal, Tadol, Tradol, Tramed, Tramol and Tridol.

Tramadol is in a class of medications called opiate agonists. So its mechanism of action is similar to morphine, but still not exactly known and fully understood. But it’s known that it definitely has two actions. The drug binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain from throughout the body to the brain. So, it actually blocks pain impulses from reaching the brain. The mechanism is similar with other opioids and NSAIDs (nonsteroidal antiinflammatory drug). However, Tramadol does not have the increased risk of stomach ulceration and internal bleeding, unlike NSAIDs.

The second action - Tramadol inhibits reuptake of norepinephrine and serotonin, altering the way the brain monitors pain signals. In other words, it somehow changes the way the body senses pain.

Like other narcotics used for the treatment of pain, Tramadol may be abused. Besides using the drug for above mentioned conditioned, it has also been suggested that Tramadol could be effective for alleviating symptoms of anxiety and depression. The reason is that it can influence the noradrenergic, GABAergic and serotonergic systems.

How much do you need to treat pain? Average dosage is 50 mg to 100 mg in order to get relief every four to six hours, but not exceeded 400 mg per day (some sources advise not to exceed 300 mg /day). For older patients (more than 75 years of age) – maximum daily dose of the drug is 300 mg. As the initial dose for moderate pain 50 mg of the drug may be enough, in case of more severe pain - 100 mg is usually more adequate and effective.

The most acceptable and safe system of taking Tramadol is to start with 25 mg/day. Then you may increase the dose by 25 mg every 3 days up to100 mg/day (it means taking 25 mg 4 times a day). After this, doses can be increased by 50 mg every 3 days to reach 200 mg day (50 mg 4 times daily). It will eventually improve tolerance.

You can take Tramadol with or without food. Though is better to swallow the tablet whole (not crush or chew it) with a full glass of water. If stomach upset occurs, take the drug after meals or with food or milk. Exactly follow the directions on the prescription label. Do not take more medication than proscribed, as it may cause severe side effects.

Do not stop taking Tramadol without talking to your doctor (your doctor will probably decrease your dose gradually); do not take it longer as proscribed. If you notice any unusual changes in your behavior or mood, or in your physical state – call your doctor.

What are side effects of Tramadol?

It is very important to take Tramadol as you have been told by your health care provider. Not shorter and not longer. As the drug is behavior-addicted. In case you suddenly stop taking Tramadol you may experience withdrawal symptoms such as:

-   nervousness;

-   panic;

-   sweating;

-   chills;

-   uncontrollable shaking of a part of your body;

-   difficulty falling asleep or staying asleep;

-   runny nose, sneezing, or cough;

-   numbness, pain, burning, or tingling in your hands or feet;

-   hair standing on end;

-   nausea;

-    diarrhea;

-    (rarely) hallucinations (seeing things or hearing voices that do not exist).

Tramadol has some adverse effects. They are not serious, but still rather annoying for those experiencing them.

Rare or uncommon side effects:

·    changes in vision

·    difficulty breathing, shortness of breath

·    fast or irregular heartbeat

·    passing urine more frequently than usual, or not passing urine as often as usual

·    redness, blistering, peeling or loosening of the skin, including inside the mouth

·    skin rash, itching

·    seizures (convulsions), hallucinations

More common side effects:

·    anxiety, agitation

·    nausea

·    vomiting

The most frequently reported side effects from the list are constipation or diarrhea, dizziness, sweating, drowsiness, dry mouth, false sense of well being, difficulty sleeping, mood changes, feeling of unreality, or headaches.

Use Tramadol very carefully if you are over 65, you may need your dose adjusted. Do not use it at all if you are pregnant, breastfeeding, or with a history of narcotic dependence. If combined with alcohol, anesthetics, narcotics, tranquilizers or sedative hypnotics Tramadol can increase central nervous system and respiratory depression. So, avoid alcohol while taking the drug. And do not drive or do anything that needs mental alertness until you know how Tramadol affects you. Then it brings you maximum effect.

Valentyna Ant.