A List of Tramadol Side Effects and Warning Signs

Tramadol is one of the most potent analgesics available today to treat moderately severe pain; however, like all pharmacological medications, tramadol is also harmful in large doses (or even in normal dosage in some genetically susceptible individuals). Analgesics are the traditional pain medications that we all consume for different types of aches and pains. Common over-the-counter pain medications such as Aspirin and Tylenol are classified as NSAIDs (Non-steroidal anti-inflammatory drugs) and can treat most trivial muscular pains. However, moderate to severe pain (for example pain as a result of surgery or a fracture) is normally not responsive to over-the-counter pain medications.

For these situations, opioids are normally prescribed by healthcare professionals. Tramadol is considered superior to most opioids in terms of its clinical effectiveness and comparatively lower addiction potential when compared to other opioids such as morphine or codeine. It is indeed a top choice for the short-term management of post-operative or acute pain.

Tramadol Side Effects

Tramadol is a potent drug and the risk of developing reactions or side effects is a fair concern for clinicians as well as patients. Tramadol exerts its action by affecting opioid receptors and although the mechanism of action is pretty similar to morphine and other opioids, tramadol also inhibits the uptake of serotonin and norepinephrine (neurochemicals in the brain) which are in part responsible for superior therapeutic efficacy when compared to morphine and codeine.

The most common side effects observed with tramadol include nausea, vomiting, dizziness, dry mouth, and sedation. These are generally well-tolerated and do not require any dose modification. However, the severity can be minimized by dose adjustment. For example, M. Cossmann^[1] suggested in his report that the overall risk of developing nausea and vomiting are 17.8% and 7.0% respectively when the drug is administered intravenously. However, with oral intake the risk is only 4.2% and 0.5% respectively. He further suggested that the overall risk of complications with tramadol is only 1% to 6% (depending upon the dosage and manner of administration).

If you are prescribed tramadol, you may want to acquaint yourself with some potential but uncommon side effects of tramadol:

• Allergic Reactions: The risk of an allergic reaction is mild to moderate with tramadol in most individuals. The allergic reaction may be limited to trivial itching to as severe as development of hives, swelling of the face and mouth, difficulty in breathing and in extreme cases angioedema (life-threatening swelling of vocal cords).

  In case of any such response, speak to your healthcare provider immediately. In most cases, the cause of allergy is genetic susceptibility to opioid active chemicals, therefore suggesting the likelihood of an allergic response to all other opioids as well.

• Cardiac abnormalities: The symptoms may range from agitation and palpitation to rhythm abnormalities and conduction defects. However, A Whelton^[2] suggested in his report published in The American Journal of Therapeutics that the risk of such side effects is minimal if tramadol is consumed within the recommended dosage.
• CNS (Central Nervous System) defects: Despite the fact that the primary action of tramadol is on brain receptors, the risk of CNS side effects is quite low. In his research paper published in Drugs, CR Lee^[3] suggested that the dependence or addiction potential with regular intake (For a period of about 6 months) is fairly low; however, with prolonged consumption, the probability of addiction becomes fairly high, as with other opioids. With prolonged use, some people may also report hallucinations, vivid dreaming and mood alterations.
• Respiratory defects: Respiratory depression is one well-defined complication when tramadol is consumed via the infusion route (as part of anesthesia protocol). However, the risk of depression is minimal when tramadol is consumed via a controlled intravenous route during childbirth^[4]. Other respiratory side effects are not commonly reported. The vast majority of moderate to severe side effects can be minimized or prevented by adjustment of dosage and drug administration. A rapid rise of the active drug level in the serum is associated with a much higher risk of complications.
• Gastric symptoms: Due to its receptor mediated effects, the use of tramadol carries risk of gastric complications. Many individuals report constipation within the first few weeks (or months) after starting oral therapy with tramadol. However, with prolonged use, constipation and other gastric issues like nausea and vomiting are ameliorated.

Tramadol Warnings

One of the biggest concerns of clinicians when prescribing tramadol to patients for long periods of time is the potential for addiction. This is because most opioids activate addiction pathways in the brain which result in the requirement of higher dosages to produce similar a degree of relief. This results in a persistent and sometimes uncontrollable craving to consume the drug, as well as severe withdrawal reactions if the drug is not consumed.

The risk of addiction to tramadol is minimal as suggested by a number of studies. However, for best results, it is best to follow the standard protocol, given below.

• Absolute Contraindications - Absolute contraindications are conditions in which the consumption of tramadol must be avoided at all costs, and include:
  • History of known allergy to tramadol or drugs with similar composition.
  • History of addiction to alcohol or other narcotics.
  • Prior history of attempted suicide or suicidal thoughts.
• Relative Contraindications - Relative contraindications specify that the simultaneous intake of tramadol must be avoided with:
  • Other pain medications, especially narcotics.
  • Sleep medications, tranquilizers or sedatives.
  • Alcohol or alcoholic beverages.
  • Antipsychotic medications.
  • Prior history of seizures or with seizure medications
  • Pregnancy or breast feeding is also a relative contraindication and since tramadol is classified as a Class C drug, it is suggested by clinicians that the consumption of tramadol during pregnancy (or while lactating) should be avoided unless the benefits outweigh the side effects.

How to Minimize the Risk of Side Effects

To minimize health risks, it is highly recommended to take tramadol according to the prescription of your doctor. Long-term and unnecessary usage in high quantities is associated with the risk of addiction and the development of life threatening toxicity. Other helpful tips include:

• Swallow the tablet with water (any attempt to chew, crush or dissolve the tablet in water may result in the active chemicals being released too quickly in the serum).
• Use the medication orally only. Intake from an intranasal, intravenous, or intramuscular route may increase the risk of toxicity or even death (unless administered by a healthcare professional)
• In long-term users, do not suddenly stop taking the medication as this exposes you to the risk of withdrawal effects. Seek advice from your doctor when attempting to wean yourself from the drug.
• Store the medication at room temperature, away from potential abusers.

Although the risk of complications is low with moderate and short-term intake of tramadol, it is strongly suggested to see a healthcare professional if:

• You experience moderate or persistent side effects that interfere with your day to day life.
• Your overall health or daily life is affected.

References:

1. Cossmann, M., Kohnen, C., Langford, R., & McCartney, C. (1997). Tolerance and safety of tramadol use. Results of international studies and data from drug surveillance. Drugs, 53, 50.
2. Whelton, A. (2000). Renal and related cardiovascular effects of conventional and COX-2-specific NSAIDs and non-NSAID analgesics. American journal of therapeutics, 7(2), 63.
3. Lee, C. R., McTavish, D., & Sorkin, E. M. (1993). Tramadol. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states. Drugs, 46(2), 313.
4. Cossmann, M., Kohnen, C., Langford, R., & McCartney, C. (1997). Tolerance and safety of tramadol use. Results of international studies and data from drug surveillance. Drugs, 53, 50.