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THREAD: Trama-DO or Trama-DON'T?
What to know about #tramadol
1/7 Tramadol has multiple mechanisms of action:
- via serotonin & norepinephrine reuptake inhibition
- after metabolism to M1 metabolite, via opioid agonism
https://bit.ly/3t5o7jC #chronicpain #arthritis #MedEd
What to know about #tramadol
1/7 Tramadol has multiple mechanisms of action:
- via serotonin & norepinephrine reuptake inhibition
- after metabolism to M1 metabolite, via opioid agonism
https://bit.ly/3t5o7jC #chronicpain #arthritis #MedEd
2/7 People metabolize #tramadol variably 
- Some who are ‘ultra rapid’ produce more M1 (opioid);
- Some ‘poor’ metabolizers (~20% with inactive CYP2D6) may have more SSRI/SNRI-like effect
Thus, analgesic & adverse effects are unpredictable
https://www.ncbi.nlm.nih.gov/books/NBK315950 #MedEd
- Some who are ‘ultra rapid’ produce more M1 (opioid);
- Some ‘poor’ metabolizers (~20% with inactive CYP2D6) may have more SSRI/SNRI-like effect
Thus, analgesic & adverse effects are unpredictable
https://www.ncbi.nlm.nih.gov/books/NBK315950 #MedEd
3/7 Tramadol, once called a ‘safer’ opioid, causes tolerance and withdrawal, and is associated with addiction, overdose, and death
Observational studies show people treated with #tramadol, vs other opioids, are
likely to engage in prolonged opiate use #chronicpain #arthritis
Observational studies show people treated with #tramadol, vs other opioids, are
likely to engage in prolonged opiate use #chronicpain #arthritis
4/7 For meaningful improvement of osteoarthritic pain, #tramadol is no better than placebo and likely not as effective as NSAIDs
Cochrane review: https://bit.ly/3owivLz
#chronicpain #arthritis #MedEd
is no better than placebo and likely not as effective as NSAIDs Cochrane review: https://bit.ly/3owivLz
#chronicpain #arthritis #MedEd
5/7 A @cochranecollab review found low quality evidence that for cancer pain, #tramadol is not as effective as morphine https://bit.ly/3r1BeR6
Tramadol is NOT on BC Pharmacare formularies and is NOT covered by the Palliative Benefits Plan (“plan P”)
#chronicpain #arthritis
Tramadol is NOT on BC Pharmacare formularies and is NOT covered by the Palliative Benefits Plan (“plan P”)
#chronicpain #arthritis
6/7 Each of tramadol-acetaminophen costs about $0.67-1.69 compared with $0.12-0.20 for 5mg Morphine Sulphate-IR 
In 2019, 132 220 British Columbians received at least 1 dispensed Rx of tramadol at total cost of
9.452 million
#chronicpain #arthritis #drugcosts
of tramadol-acetaminophen costs about $0.67-1.69 compared with $0.12-0.20 for 5mg Morphine Sulphate-IR In 2019, 132 220 British Columbians received at least 1 dispensed Rx of tramadol at total cost of
9.452 million#chronicpain #arthritis #drugcosts
7/7 WHY prescribe #tramadol?
it's NOT predictable in effect
@cochranecollab found it has MORE ADEs that cause people to stop taking it vs. other analgesics, incl. opioids
it's 
effective than comparators for OA, cancer pain
it costs more than morphine
#medsafety
it's NOT predictable in effect @cochranecollab found it has MORE ADEs that cause people to stop taking it vs. other analgesics, incl. opioids it's effective than comparators for OA, cancer painit costs more than morphine#medsafety
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