From 1 June, 2010 tramadol will be available fully subsidised on the Pharmaceutical Schedule.
Tramadol has been used widely in hospitals for several years, but experience of its use in primary care is limited. A Prescriber Update article from Medsafe is planned to be circulated, and prescribers are advised to consult the Medicines Safety Datasheet for detailed information.
The following are some important prescribing tips for the safe and appropriate use of tramadol:
” Tramadol is not a first line analgesic. It is classed as a weak opioid on the analgesic ladder and is neither more effective, nor better tolerated, than other weak opioids such as codeine.
” For people coming off dextropropoxyphene, a straight switch to tramadol is not recommended. The patient’s analgesic requirements should be initially assessed with regular paracetamol, and then codeine added if necessary.
” Drug dependence, withdrawal reactions and misuse have all been reported with tramadol, although they are generally less problematic than with other opioids.
” Tramadol acts at opioid receptors and shares some of the typical adverse effects of opioid analgesics, including nausea, constipation and respiratory depression. However, it has additional pharmacological actions which result in a different spectrum of adverse effects and drug interactions.
” Tramadol has serotonergic effects similar to SSRIs, such as fluoxetine and paroxetine. Serotonin toxicity (and syndrome) has been reported after use of tramadol with other serotonergic agents such as antidepressants and St John’s wort.
” Changes in the INR have been reported in people taking warfarin. Monitor INR in these patients if tramadol is added or stopped.
” The seizure threshold is reduced by tramadol and the effect appears to be dose related. Extreme caution is required in people with epilepsy (only consider if epilepsy is well controlled), a history of seizures or those already taking medicines that reduce seizure threshold, such as antipsychotics and antidepressants.
” Tramadol should not be used in people:
o With acute alcohol intoxication or taking hypnotics, analgesics, opioids or psychotropic medicinal products
o Who are receiving monoamine oxidase inhibitors (MAOIs) or have taken them in the past 14 days
o With epilepsy that is not adequately controlled by treatment
o With severe renal impairment (creatinine clearance <10 mL/min)
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