Podcast 766: Truth about Tramadol

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Tramadol is often thought of as a mild-opiate to use for analgesia, but it is a more complicated drug</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Tramadol needs to be metabolized into an effective drug making it not pharmacologically reliable</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">3-10% of people cannot metabolize tramadol and it does not work</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Some others over-metabolize tramadol and it causes greater effect</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Studies have shown it is not any better as a acetaminophen or ibuprofen for analgesia, it can lower a seizure threshold, and it acts to inhibit serotonin reuptake</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Recent study evaluated all-cause mortality of tramadol compared to codeine and found tramadol had nearly double the all-cause mortality as those prescribed codeine</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Overall tramadol has many risks and should be critically evaluated before prescribing</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Dhesi M, Maldonado KA, Maani CV. Tramadol. [Updated 2021 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537060/</span></p> <p><span style="font-weight: 400;">Association of tramadol vs codeine prescription dispensation with mortality and other adverse clinical outcomes Xie J, Strauss VY, Martinez-Laguna D, et al. JAMA. 2021;326(15):1504-1515.</span></p> <p><em><span style="font-weight