Tramadol-Opioid Conversions

[njac]

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Has anyone seen a table comparing Tramadol to various opioids/opiates as far as equianalgesic dosing?

Had a new ER resident call asking on Saturday (pt was taking like 350mg of tramadol a day and *shocker* had a seizure - I didn't get why he was taking it) asking and none of us could find one so when I told her that, before I could get to my recommendation she hung up on me! Good thing I don't remember her name!

But considering the prevalent use of tramadol (and that it isn't scheduled yet, but I hear they are working on that) I think that would be a useful factoid.

 

[BMBiology]

You know tramadol is not exactly an opioid. That's too bad the patient had a seizure while on tramadol. Many people dont remember that for tramadol IR, the max dose is 400mg a day while for tramadol ER, the max dose is 300mg a day. In addition, for pts >75 yr old or renal impairment, the dose should be lower or not given at all.

 

[njac]

Yes, I know Tramadol is not an opioid 😉 That's why I asked for the conversion.

I found the Tramadol-Oxycodone this morning, the first day on my drug info rotation. Whoda thunk it?

(btw, it's approximately 8mg of tramadal = 1 mg of oxycodone; this showed equal efficacy in a study. but higher nausea in the tramadol group.)

 

[RxWildcat]

I wish tramadol was scheduled, its abused big-time here. We have some patients who are prescribed 600mg daily.

 

[psurocks]

this drug is really abused in my area

 

[njac]

we're hearing more and more about tramadol abuse.

One of my friends is a tech at the jail pharmacy and she said those guys say tramadol withdrawal is worse than opioid withdrawal! I'd have to see it to believe it but that's an impressive statement (so anyone who tells you that there's no physical dependence is full of it - kind of like how Oxycontin won't cause dependence either)

 

[BMBiology]

we're hearing more and more about tramadol abuse.

One of my friends is a tech at the jail pharmacy and she said those guys say tramadol withdrawal is worse than opioid withdrawal! I'd have to see it to believe it but that's an impressive statement (so anyone who tells you that there's no physical dependence is full of it - kind of like how Oxycontin won't cause dependence either)

Withdrawal is different from dependence. I can get withdrawal after d/c an SSRI but that does not mean SSRIs are addictive.

Tramadol binds weakly to the mu receptors but it works primarily by binding to the 5-HT/NE reuptake receptors just like venlafaxine. What most doctors and pharmacists don't tell their patients is that tramadol full effect takes about 1 wk so pts end up taking more than prescribed then when the patients come back to the pharmacy for early refills, the pharmacists think OMG, the patient is addicted!!

 

[Pharmavixen]

Interesting...I haven't seen or heard of tramadol abuse yet at the jail where I work here in Canada, probably because it's expensive, and it's not covered by the government insurance.

And true; withdrawal doesn't equal addiction. But looking for refills early is a warning sign, as is abusive behaviour towards the pharmacist.

 

[RxWildcat]

Withdrawal is different from dependence. I can get withdrawal after d/c an SSRI but that does not mean SSRIs are addictive.

Tramadol binds weakly to the mu receptors but it works primarily by binding to the 5-HT/NE reuptake receptors just like venlafaxine. What most doctors and pharmacists don't tell their patients is that tramadol full effect takes about 1 wk so pts end up taking more than prescribed then when the patients come back to the pharmacy for early refills, the pharmacists think OMG, the patient is addicted!!

I think you mean dependence in different from addiction. Withdrawal is part of physical dependence.

 

[shaolinRX]

Tramadol binds weakly to the mu receptors but it works primarily by binding to the 5-HT/NE reuptake receptors just like venlafaxine.

Tramadol is a synthetic opioid analgesic....My impression of its primary MOA was that of its mu opiate receptor binding; with 5HT/NE reuptake being an adjuvant action (it has been shown that other opioid analgesics do this also).

At any rate, I googled a bit and found a link comparing tramadol to a few others (don't know how reliable the source is, however): http://www.emedexpert.com/compare/tramadol.shtml

 

[BMBiology]

I think you mean dependence in different from addiction. Withdrawal is part of physical dependence.

It is really a matter of semantic. Just dont think withdrawal equates to an addiction.