601
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Imani F, Entezary SR, Alebouyeh MR, Parhizgar S. The maternal and neonatal effects of adding tramadol to 2% lidocaine in epidural anesthesia for cesarean section. Anesth Pain Med 2011; 1:25-9. [PMID: 25729652 PMCID: PMC4335753 DOI: 10.5812/kowsar.22287523.1271] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 05/12/2011] [Accepted: 05/16/2011] [Indexed: 12/02/2022] Open
Abstract
Background: Opioid analgesics are commonly added to epidural local anesthetics to improve analgesia during surgery. Objectives: The goal of this study was to evaluate the maternal and neonatal effects of adding different doses of tramadol to 2% lidocaine in the epidural anesthesia for cesarean section. Patients and Methods: Ninety pregnant patients who were candidates for cesarean section under epidural anesthesia were randomly categorized into three groups. Group L received 2% lidocaine. In the LT50 and LT100 groups, 50 and 100 mg of tramadol were added to epidural 2% lidocaine. For additional analgesia during surgery, 2% lidocaine through epidural catheter or IV sufentanil were administered. Analgesia after surgery was provided by IV injection of meperidine. Onset and duration of sensory and motor blockades, total drug consumption, neonatal Apgar score, and complications were recorded. Results: In the LT100 group, onset of complete sensory and motor blockade at T6 was less than in the two other groups, but the highest level of sensory blockade and two segment regression and duration of motor blockades between the LT50 and LT100 groups were not significantly different, although they were higher and more prolonged than in the L group. Average lidocaine and sufentanil consumption during surgery between the LT50 and LT100 groups were not significantly different but were lower than in the L group. The incidence of maternal complications and neonatal Apgar scores were not significantly different between the three groups. In the LT50 and LT100 groups, the time until the first request for analgesics after surgery was prolonged, and average meperidine consumption was less than in the L group. Conclusions: The addition of tramadol to epidural 2% lidocaine offers advantages in cesarean section.
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Affiliation(s)
- Farnad Imani
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Saeid Reza Entezary
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author at: Saeid Reza Entezary, Department of Anesthesiology and pain Medicine, Rasoul-Akram Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121329031, Fax: +98-2166509059. E-mail:
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Suzan Parhizgar
- Department of Anesthesiology, Texas Tech University, Health Science Center, Lubbock, Texas, USA
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602
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Stewart AJ, Boothe DM, Cruz-Espindola C, Mitchum EJ, Springfield J. Pharmacokinetics of tramadol and metabolites O-desmethyltramadol and N-desmethyltramadol in adult horses. Am J Vet Res 2011; 72:967-74. [DOI: 10.2460/ajvr.72.7.967] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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603
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Elkalioubie A, Allorge D, Robriquet L, Wiart JF, Garat A, Broly F, Fourrier F. Near-fatal tramadol cardiotoxicity in a CYP2D6 ultrarapid metabolizer. Eur J Clin Pharmacol 2011; 67:855-8. [PMID: 21691803 DOI: 10.1007/s00228-011-1080-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/31/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tramadol is a synthetic, centrally acting analgesic for the treatment of moderate to severe pain. The marketed tramadol is a racemic mixture containing 50% (+)tramadol and 50% (-)tramadol and is mainly metabolized to O-desmethyltramadol (M1) by the cytochrome P450 CYP2D6. Tramadol is generally considered to be devoid of any serious adverse effects of traditional opioid receptor agonists, such as respiratory depression and drug dependence. CASE REPORT A 22-year-old Caucasian female patient was admitted to our ICU in refractory cardiac arrest requiring extracorporeal membrane oxygenation. This aggressive support allowed resolution of multi-organ dysfunction syndrome. Repeated blood analyses using liquid chromatography-tandem mass spectrometry confirmed high concentrations of both tramadol and its main metabolite O-desmethyltramadol. Genotyping of CYP2D6 revealed the patient to be heterozygous for a duplicated wild-type allele, predictive of a CYP2D6 ultrarapid metabolizer (UM) phenotype, confirmed by calculation of the tramadol/M1 (MR1) metabolic ratio at all time points. DISCUSSION We here report a case of near-fatal isolated tramadol cardiotoxicity. Because of the inhibition of norepinephrine reuptake, excessive blood epinephrine levels in this CYP2D6R UM patient following excessive tramadol ingestion could explain the observed strong myocardial stunning. This patient admitted intermittent tramadol consumption to gain a "high" sensation. In patients with excessive morphinomimetic effects, levels of tramadol and its main metabolite M1could be measured, ideally combined with CYP2D6 genotyping, to identify individuals at risk of tramadol-related cardiotoxicity. Tramadol treatment could be optimized in these at-risk individuals, consequently improving patient outcome and safety.
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Affiliation(s)
- Ahmed Elkalioubie
- Service de Réanimation Polyvalente, Hôpital Roger Salengro, CHRU Lille, Rue Emile Laine, 59037, Lille Cedex, France.
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604
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Yi S, Chung YJ, Kim TE, Shin HS, Yoon SH, Cho JY, Jang IJ, Shin SG, Yu KS. Pharmacokinetics of Extended-Release Versus Conventional Tramadol/Acetaminophen Fixed-Dose Combination Tablets: An Open-Label, 2-Treatment, Multiple-Dose, Randomized-Sequence Crossover Study in Healthy Korean Male Volunteers. Clin Ther 2011; 33:728-37. [DOI: 10.1016/j.clinthera.2011.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
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605
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Göktay Ö, Satilmiş T, Garip H, Gönül O, Göker K. A Comparison of the Effects of Midazolam/Fentanyl and Midazolam/Tramadol for Conscious Intravenous Sedation During Third Molar Extraction. J Oral Maxillofac Surg 2011; 69:1594-9. [DOI: 10.1016/j.joms.2010.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 07/27/2010] [Accepted: 09/22/2010] [Indexed: 11/30/2022]
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606
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Pharmacokinetics, intraoperative effect and postoperative analgesia of tramadol in cats. Res Vet Sci 2011; 90:503-9. [DOI: 10.1016/j.rvsc.2010.07.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 07/12/2010] [Accepted: 07/20/2010] [Indexed: 11/19/2022]
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607
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Niscola P, Tendas A, Scaramucci L, Giovaninni M, Cupelli L, De Sanctis V, Brunetti GA, Bondanini F, Palumbo R, Lamanda M, Battistini R, Cartoni C, Romani C, Arcuri E. Pain in malignant hematology. Expert Rev Hematol 2011; 4:81-93. [PMID: 21322781 DOI: 10.1586/ehm.10.79] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pain is frequently experienced by patients with hematological malignancies, although it often receives little attention. Different underlying causes and mechanisms may sustain several pain syndromes in hematological malignant patients. Pain may be due to disease itself, to disease-related complications, to iatrogenic causes or may be associated with unrelated medical conditions. The management of pain in this setting requires a multidisciplinary approach, integrating analgesics and causal interventions. An accurate diagnostic assessment and the identification of the underlying causes and pathogenetic mechanisms may dictate the treatment approach. For most pain patients, the WHO's three-step analgesic scale for cancer pain relief can provide adequate relief with oral options, although difficult-to-treat pain syndromes, requiring a more complex treatment approach, may also be observed.
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608
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Pergolizzi JV, Taylor R, Raffa RB. Extended-release formulations of tramadol in the treatment of chronic pain. Expert Opin Pharmacother 2011; 12:1757-68. [PMID: 21609187 DOI: 10.1517/14656566.2011.576250] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Tramadol is a centrally acting analgesic available throughout the world. Its dual opioid and non-opioid mechanisms of action, favorable efficacy and safety clinical profiles and non-controlled regulatory status in most markets contribute to its widespread use. A drawback of the immediate-release formulation of tramadol (four-times-a-day dosing) might be addressed by an extended-release formulation. Extended-release formulations also can offer advantages in the management of chronic pain: convenience, reduced pill burden (possibly leading to improved compliance) and the attenuation of peaks and troughs in serum concentration (possibly leading to reduced adverse effects). AREAS COVERED The authors review tramadol's mechanisms of action and the clinical literature regarding the use of tramadol extended-release formulations for the management of conditions involving chronic pain, such as neuropathic pain syndromes, osteoarthritis and cancer pain. EXPERT OPINION Based on the literature cited, extended-release formulations of tramadol seem to offer a rational and important addition to the analgesic armamentarium. As is true for all such options, the benefits and risks must be assessed for each patient.
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Affiliation(s)
- Joseph V Pergolizzi
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, MD, USA.
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609
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Alsirafy SA, El-Mesidi SM, El-Sherief WA, Galal KM, Abou-Elela EN, Aklan NA. Opioid needs of patients with advanced cancer and the morphine dose-limiting law in Egypt. J Palliat Med 2011; 14:51-4. [PMID: 21244253 DOI: 10.1089/jpm.2010.0220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Morphine is the drug of choice for moderate to severe cancer pain management. The Egyptian Narcotics Control Law limits the amount of morphine prescribed in a single prescription to a maximum of 420 mg for tablets and 60 mg for ampoules. The usual practice in Egypt is to provide that limited amount of morphine on a weekly basis. The aim of this study is to estimate the extent to which Egyptian patients may be undertreated because of this law. METHODS We reviewed the medical records of advanced cancer patients referred to the first palliative care unit in Egypt over a seven-month period. Cancer pain was managed following the WHO guidelines. After modifying the internal institutional policy, patients received adequate amounts of the available opioids without any violations of the law. RESULTS From 117 eligible advanced cancer patients, 58 (50%) patients required strong opioids, 32 (27%) required weak opioids, and 27 (23%) required no regular opioids. The mean last prescribed opioid dose for those who required strong opioids was 194 mg of oral morphine equivalent/24 h (± 180). For this group of patients, a single weekly prescription would supply enough oral morphine for only 26% of them. In the case of parenteral morphine, none of these patients would receive an adequate supply. CONCLUSIONS In view of the current morphine dose-limiting law and practices in Egypt, the majority of patients suffering severe cancer pain would not have access to adequate morphine doses. That dose-limiting law and other restrictive regulations represent an obstacle to cancer pain control in Egypt and should be revised urgently.
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Affiliation(s)
- Samy A Alsirafy
- Palliative Care Medicine Unit, Kasr Al-Aini Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt.
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610
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Abstract
The experience of pain in cancer is widely accepted as a major threat to quality of life, and the relief of pain has emerged as a priority in oncology care. Pain is associated with both the disease as well as treatment, and management is essential from the onset of early disease through long-term survivorship or end-of-life care. Effective relief of pain is contingent upon a comprehensive assessment to identify physical, psychological, social, and spiritual aspects and as a foundation for multidisciplinary interventions. Fortunately, advances in pain treatment and in the field of palliative care have provided effective treatments encompassing pharmacological, cognitive-behavioral, and other approaches. The field of palliative care has emphasized that attention to symptoms such as pain is integral to quality cancer care.
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Affiliation(s)
- Judith A Paice
- Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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611
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Duke AN, Bigelow GE, Lanier RK, Strain EC. Discriminative stimulus effects of tramadol in humans. J Pharmacol Exp Ther 2011; 338:255-62. [PMID: 21467190 DOI: 10.1124/jpet.111.181131] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tramadol is an unscheduled atypical analgesic that acts as an agonist at μ-opioid receptors and inhibits monoamine reuptake. Tramadol can suppress opioid withdrawal, and chronic administration can produce opioid physical dependence; however, diversion and abuse of tramadol is low. The present study further characterized tramadol in a three-choice discrimination procedure. Nondependent volunteers with active stimulant and opioid use (n = 8) participated in this residential laboratory study. Subjects were trained to discriminate between placebo, hydromorphone (8 mg), and methylphenidate (60 mg), and tests of acquisition confirmed that all volunteers could discriminate between the training drugs. The following drug conditions were then tested during discrimination test sessions: placebo, hydromorphone (4 and 8 mg), methylphenidate (30 and 60 mg), and tramadol (50, 100, 200, and 400 mg). In addition to discrimination measures, which included discrete choice, point distribution, and operant responding, subjective and physiological effects were measured for each test condition. Both doses of hydromorphone and methylphenidate were identified as hydromorphone- and methylphenidate-like, respectively. Lower doses of tramadol were generally identified as placebo, with higher doses (200 and 400 mg) identified as hydromorphone, or opioid-like. The highest dose of tramadol increased ratings on the stimulant scale, but was not significantly identified as methylphenidate-like. Tramadol did not significantly increase subjective ratings associated with reinforcement. Taken together, these results extend previous work with tramadol as a potential medication for the treatment of opioid dependence and withdrawal, showing acute doses of tramadol exhibit a profile of effects similar to opioid agonists and may have abuse liability in certain populations.
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Affiliation(s)
- Angela N Duke
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
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612
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Hirouchi M, Tanaka M, Nishimura T. [Pharmacological profiles and clinical roles of tramadol hydrochloride (Tramal(®) capsules 25 mg·50 mg) in the treatment of cancer pain]. Nihon Yakurigaku Zasshi 2011; 137:189-197. [PMID: 21478640 DOI: 10.1254/fpj.137.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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613
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Abstract
Overactive bladder (OAB) is a condition that affects millions of women in the United States (US). Although the etiology is largely unknown, risk factors include Caucasian race, insulin-dependent diabetes mellitus, and history of depression. Patients present with urgency with or without urinary incontinence and often have urinary frequency and nocturia. Most patients can be evaluated in the office setting utilizing simple testing. Current treatments consist of behavioral/lifestyle modification, usually in combination with antimuscarinic drug therapy. Improvements in the adverse effect profiles of antimuscarinic drugs have positively impacted quality of life. When appropriately evaluated, most patients presenting to primary care providers can be effectively treated.
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614
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Population pharmacokinetic modeling of tramadol and its O-desmethyl metabolite in plasma and breast milk. Eur J Clin Pharmacol 2011; 67:899-908. [DOI: 10.1007/s00228-011-1023-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
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615
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Baker BB, Sladky KK, Johnson SM. Evaluation of the analgesic effects of oral and subcutaneous tramadol administration in red-eared slider turtles. J Am Vet Med Assoc 2011; 238:220-7. [PMID: 21235376 DOI: 10.2460/javma.238.2.220] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the dose- and time-dependent changes in analgesia and respiration caused by tramadol administration in red-eared slider turtles (Trachemys scripta). DESIGN Crossover study. ANIMALS 30 adult male and female red-eared slider turtles. PROCEDURES 11 turtles received tramadol at various doses (1, 5, 10, or 25 mg/kg [0.45, 2.27, 4.54, or 11.36 mg/lb], PO; 10 or 25 mg/kg, SC) or a control treatment administered similarly. Degree of analgesia was assessed through measurement of hind limb thermal withdrawal latencies (TWDLs) at 0, 3, 6, 12, 24, 48, 72, and 96 hours after tramadol administration. Nineteen other freely swimming turtles received tramadol PO (5, 10, or 25 mg/kg), and ventilation (V(E)), breath frequency, tidal volume (V(T)), and expiratory breath duration were measured. RESULTS The highest tramadol doses (10 and 25 mg/kg, PO) yielded greater mean TWDLs 6 to 96 hours after administration than the control treatment did, whereas tramadol administered at 5 mg/kg, PO, yielded greater mean TWDLs at 12 and 24 hours. The lowest tramadol dose (1 mg/kg, PO) failed to result in analgesia. Tramadol administered SC resulted in lower TWDLs, slower onset, and shorter duration of action, compared with PO administration. Tramadol at 10 and 25 mg/kg, PO, reduced the V(E) at 12 hours by 51% and 67%, respectively, and at 24 through 72 hours by 55% to 62% and 61 % to 70%, respectively. However, tramadol at 5 mg/kg, PO, had no effect on the V(E). CONCLUSIONS AND CLINICAL RELEVANCE Tramadol administered PO at 5 to 10 mg/kg provided thermal analgesia with less respiratory depression than that reported for morphine in red-eared slider turtles.
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Affiliation(s)
- Bridget B Baker
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
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616
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Use of strong opioids among community-dwelling persons with and without Alzheimer’s disease in Finland. Pain 2011; 152:543-547. [DOI: 10.1016/j.pain.2010.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 11/01/2010] [Accepted: 11/03/2010] [Indexed: 11/22/2022]
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617
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Burnett AL, Goldstein I, Andersson KE, Argiolas A, Christ G, Park K, Xin ZC. Future sexual medicine physiological treatment targets. J Sex Med 2011; 7:3269-304. [PMID: 21029380 DOI: 10.1111/j.1743-6109.2010.02025.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Sexual function in men and women incorporates physiologic processes and regulation of the central and peripheral nervous systems, the vascular system, and the endocrine system. There is need for state-of-the-art information as there is an evolving research understanding of the underlying molecular biological factors and mechanisms governing sexual physiologic functions. AIM To develop an evidence-based, state-of-the-art consensus report on the current knowledge of the major cellular and molecular targets of biologic systems responsible for sexual physiologic function. METHODS State-of-the-art knowledge representing the opinions of seven experts from four countries was developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURES Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS Scientific investigation in this field is needed to increase knowledge and foster development of the future line of treatments for all forms of biological-based sexual dysfunction. This article addresses the current knowledge of the major cellular and molecular targets of biological systems responsible for sexual physiologic function. Future treatment targets include growth factor therapy, gene therapy, stem and cell-based therapies, and regenerative medicine. CONCLUSIONS Scientific discovery is critically important for developing new and increasingly effective treatments in sexual medicine. Broad physiologic directions should be vigorously explored and considered for future management of sexual disorders.
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Affiliation(s)
- Arthur L Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
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618
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The maternal and neonatal effects of adding tramadol to 2% lidocaine in epidural anesthesia for Cesarean section. Anesth Pain Med 2011. [DOI: 10.5812/aapm.1271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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619
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Mak WY, Yuen V, Irwin M, Hui T. Pharmacotherapy for acute pain in children: current practice and recent advances. Expert Opin Pharmacother 2011; 12:865-81. [PMID: 21254863 DOI: 10.1517/14656566.2011.542751] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Acute pain in children may be undertreated. Improved understanding of developmental neurobiology and paediatric pharmacokinetics should facilitate better management of pharmacotherapy. The objective of this review is to discuss current paediatric practice and recent advances with these analgesic agents by using an evidence-based approach. AREAS COVERED Using PubMed an extensive literature review was conducted on the commonly used analgesic agents in children from 2000 to April 2010. EXPERT OPINION A multimodal analgesic regimen provides better pain control and functional outcome in children. The choice of pharmacological treatment is determined by the severity and type of pain. However, more research and evidence is required to determine the optimal drug combinations.
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Affiliation(s)
- Wai Yin Mak
- Queen Mary Hospital-Anaesthesiology, F2 Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
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620
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Abstract
Numerous analgesics are available for use in animals, but only a few have been used or studied in zoologic species. Tramadol is a relatively new analgesic that is available in an inexpensive, oral form, and is not controlled. Studies examining the effect of tramadol in zoologic species suggest that significant differences exist in pharmacokinetics parameters as well as analgesic dynamics. This article reviews the current literature on the use of tramadol in humans, domestic animals, and zoologic species.
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Affiliation(s)
- Marcy J Souza
- Department of Comparative Medicine, College of Veterinary Medicine, University of Tennessee, 2407 River Drive, Knoxville, TN 37996, USA.
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621
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Leppert W. CYP2D6 in the Metabolism of Opioids for Mild to Moderate Pain. Pharmacology 2011; 87:274-85. [DOI: 10.1159/000326085] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/14/2011] [Indexed: 11/19/2022]
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622
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Abstract
Current and upcoming treatment options for premature ejaculation (PE) are of global clinical interest. In 2008, the International Society for Sexual Medicine published an evidence-based definition for PE. While there are no US Food and Drug Administration-approved therapies for PE, the American Urological Association 2004 guidelines state the serotonergic antidepressants paroxetine, sertraline, fluoxetine and clomipramine and the topical lidocaine-prilocaine cream are effective treatment options. However, there are limitations associated with their use, which may be overcome by PE-specific therapies currently in development. Two agents that are in advanced stages of clinical development include: (i) dapoxetine, an on-demand short-acting selective serotonin reuptake inhibitor, and (ii) PSD502, a metered-dose aerosol containing lidocaine and prilocaine, also for on-demand treatment. Another on-demand agent in development is tramadol, a weak opioid that is currently approved for treating pain. Coupled with efficient diagnosis, it is hoped that these newer agents will improve the quality of life for patients who suffer from PE.
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Affiliation(s)
- W J G Hellstrom
- Department of Urology, Tulane University, New Orleans, LA 70112, USA.
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623
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Development of tramadol hydrochloride rectal gel preparations and evaluation of analgesic activity in experimental animals. J Drug Deliv Sci Technol 2011. [DOI: 10.1016/s1773-2247(11)50081-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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624
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Rodríguez-Silverio J, Déciga-Campos M, Reyes-García G, Carrasco-Portugal MDC, Flores-Murrieta FJ. Evaluation of the interaction between tramadol and diclofenac in several models of nociception in the rat. Drug Dev Res 2011. [DOI: 10.1002/ddr.20440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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625
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Deak MC, Winkelman JW. The Pharmacologic Management of Restless Legs Syndrome and Periodic Leg Movement Disorder. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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626
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Nossaman VE, Ramadhyani U, Kadowitz PJ, Nossaman BD. Advances in perioperative pain management: use of medications with dual analgesic mechanisms, tramadol & tapentadol. Anesthesiol Clin 2010; 28:647-666. [PMID: 21074743 DOI: 10.1016/j.anclin.2010.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Recovery from ambulatory surgical procedures can be limited by postoperative pain. Inadequate analgesia may delay or prevent patient discharge and can result in readmission. More frequently, postoperative pain produces discomfort and interrupts sleep, contributing to postoperative fatigue. The development of effective analgesic regimens for the management of postoperative pain is a priority especially in patients with impaired cardiorespiratory, hepatic, or renal function. Tramadol and tapentadol hydrochloride are novel in that their analgesic actions occur at multiple sites. Both agents are reported to be mu-opioid receptor agonists and monoamine-reuptake inhibitors. In contrast to pure opioid agonists, both drugs are believed to have lower risks of respiratory depression, tolerance, and dependence. The Food and Drug Administration has approved both drugs for the treatment of moderate-to-severe acute pain in adults. This article provides an evidence-based account of the role of tramadol and tapentadol in modern clinical practice.
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Affiliation(s)
- Vaughn E Nossaman
- Department of Pharmacology, Tulane University Medical Center, 1430 Tulane Avenue, New Orleans, LA 70129, USA.
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627
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Abstract
Pharmacokinetics of tramadol and metabolites after injective administrations in dogs
The aim of this study was to determine the pharmacokinetics of tramadol and its main metabolites after IV and IM injections. The pharmacokinetic cross-over study was carried out on 6 healthy male beagle dogs. Tramadol was administered by intravenous (IV) and intramuscular (IM) injection at 4 mg/kg. Tramadol and its main metabolites O-desmethyl-tramadol (M1), N-,N-didesmethyl-tramadol (M2) and N-,O-didesmethyl-tramadol (M5) concentrations were measured in plasma samples by a HPLC coupled with fluorimetric detection; pharmacokinetic evaluations were carried out with a compartmental and non-compartmental model for tramadol and its metabolites, respectively. The bioavailability of the drug, ranging between 84-102% (mean 92%), was within the generally accepted values for a positive bioequivalence decision of (80-125%). After the IM injection the mean plasma drug concentration peak was reached after a Tmax of 0.34 h with a Cmax of 2.52 μg/mL. No therapeutic relevant differences were observed between IM and IV administration. The minimal effective plasma concentration was reached after a few minutes and maintained for about 6-7 h in both administrations. M1 plasma concentration was low and the amounts of the other metabolites produced were analogous in both routes of administration. In conclusion, tramadol was rapidly and almost completely absorbed after IM administration and its systemic availability was equivalent to the IV injection. The different onset time and duration of action observed were very small and probably therapeutically irrelevant. The IM injection is a useful alternative to IV injection in the dog.
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628
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Godoy ALPC, De Moraes NV, Martinez EZ, Carvalho TMDJP, Marques MP, Lanchote VL. Simultaneous analysis of tramadol, O-desmethyltramadol, and N-desmethyltramadol enantiomers in rat plasma by high-performance liquid chromatography-tandem mass spectrometry: Application to pharmacokinetics. Chirality 2010; 23:287-93. [DOI: 10.1002/chir.20914] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 07/01/2010] [Indexed: 11/11/2022]
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629
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Khandave SS, Sawant SV, Joshi SS, Bansal YK, Kadam SS. Comparative bioequivalence studies of tramadol hydrochloride sustained-release 200 mg tablets. DRUG DESIGN DEVELOPMENT AND THERAPY 2010; 4:367-74. [PMID: 21151623 PMCID: PMC2998808 DOI: 10.2147/dddt.s15133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Tramadol hydrochloride is available as 50 mg immediate-release (IR) and 100 mg, 200 mg, and 300 mg sustained-release (SR) tablets. The recommended dose of tramadol is 50–100 mg IR tablets every 4–6 hours. The tramadol SR 200 mg tablet is a better therapeutic option, with a reduced frequency of dosing, and improved patient compliance and quality of life. The present study evaluated the bioequivalence of a generic tramadol SR 200 mg tablet. Methods A comparative in vitro dissolution study was performed on the test and reference products, followed by two separate single-dose bioequivalence studies under fasting and fed conditions and one multiple-dose bioequivalence study under fasting conditions. These bioequivalence studies were conducted in healthy human subjects using an open-label, randomized, two-treatment, two-period, two-sequence, crossover design. The oral administration of the test and reference products was done on day 1 for both the single-dose studies and on days 1–5 for the multiple-dose study in each study period as per the randomization code. Serial blood samples were collected at predefined time points in all the studies. Analysis of plasma concentrations of tramadol and O-desmethyltramadol (the M1 metabolite) was done by a validated liquid chromatography-mass spectrometry analytical method. The standard acceptance criterion of bioequivalence was applied on log-transformed pharmacokinetic parameters for tramadol and its M1 metabolite. Results The ratios for geometric least-square means and 90% confidence intervals were within the acceptance range of 80%–125% for log-transformed primary pharmacokinetic parameters for tramadol and its M1 metabolite in all the three studies. Conclusion The test product is bioequivalent to the reference product in terms of rate and extent of absorption, as evident from the single-dose and multiple-dose studies. Both the treatments were well tolerated.
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Affiliation(s)
- Suhas S Khandave
- Accutest Research Laboratories (I), Private Limited, Koparkhirne, Navi Mumbai, Maharashtra, India.
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630
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Review: Pharmacogenetic aspects of the effect of cytochrome P450 polymorphisms on serotonergic drug metabolism, response, interactions, and adverse effects. Forensic Sci Med Pathol 2010; 7:162-84. [PMID: 21052868 DOI: 10.1007/s12024-010-9188-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2010] [Indexed: 12/26/2022]
Abstract
The field of pharmacogenetics contains a wealth of potential for the enhancement of clinical practice by providing a more effective match between patient and drug, consequently reducing the probability of an adverse drug reaction. Although a relatively novel concept in the forensic context, pharmacogenetics has the capability to assist in the interpretation of drug related deaths, particularly in unintentional drug poisonings where the cause of death remains unclear. However, the complex pharmacology of the drugs when subjected to genetic variations in metabolism makes interpretation of the expected response and adverse events difficult. Many possess multiple metabolic pathways, narrow therapeutic indices and active metabolites or enantiomers which may be eliminated via different pathways to the parent drug. A number of these drugs, which are metabolised primarily by the CYP450 system, are also associated with serotonin syndrome, or serotonin toxicity, especially when used concomitantly with other serotonin active drugs which rely on the same metabolic pathways for drug elimination. A comprehensive understanding of polymorphic drug metabolism and its expected outcomes is therefore essential when interpreting the involvement of drugs in adverse reactions. This review examines the genetically variable CYP450-mediated metabolism of a number of serotonin-active drugs that are often implicated in cases of serotonin toxicity, to assess the impact of pharmacogenetics on drug metabolism, response, interactions and adverse effects.
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631
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Iravani FS, Akhgari M, Jokar F, Bahmanabadi L. Current trends in tramadol-related fatalities, Tehran, Iran 2005-2008. Subst Use Misuse 2010; 45:2162-71. [PMID: 20394504 DOI: 10.3109/10826081003692098] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tramadol is a widely prescribed drug. Abuse of tramadol as well as tramadol-related deaths have been increasing in Iran. The objective of the present study is to evaluate the trends of tramadol-related deaths that occurred between 2005 and 2008 in Tehran, Iran. Biological samples obtained during the autopsy were analyzed. Tramadol was detected in 294 cases by itself or together with other drugs. The majority of the cases were young male adults. Tramadol-related deaths in 2008 were 32.5 times more than in 2005. These results suggest that tramadol-related fatalities are growing in Iran especially among substance abusers.
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Affiliation(s)
- Fariba Sardari Iravani
- Forensic Toxicology Department, Scientific and Educational Research Center of Legal Medicine Organization, Tehran, Iran
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632
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Tsukahara-Ohsumi Y, Tsuji F, Niwa M, Nakamura M, Mizutani K, Inagaki N, Sasano M, Aono H. SA14867, a newly synthesized kappa-opioid receptor agonist with antinociceptive and antipruritic effects. Eur J Pharmacol 2010; 647:62-7. [DOI: 10.1016/j.ejphar.2010.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 08/20/2010] [Indexed: 12/01/2022]
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633
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Cannon CZ, Kissling GE, Hoenerhoff MJ, King-Herbert AP, Blankenship-Paris T. Evaluation of dosages and routes of administration of tramadol analgesia in rats using hot-plate and tail-flick tests. Lab Anim (NY) 2010; 39:342-51. [DOI: 10.1038/laban1110-342] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 08/11/2010] [Indexed: 11/09/2022]
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634
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635
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Saccomanni G, Del Carlo S, Giorgi M, Manera C, Saba A, Macchia M. Determination of tramadol and metabolites by HPLC-FL and HPLC–MS/MS in urine of dogs. J Pharm Biomed Anal 2010; 53:194-9. [DOI: 10.1016/j.jpba.2010.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/12/2010] [Accepted: 03/12/2010] [Indexed: 11/27/2022]
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636
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Tramadol acts as a weak reinforcer in the rat self-administration model, consistent with its low abuse liability in humans. Pharmacol Biochem Behav 2010; 96:279-86. [DOI: 10.1016/j.pbb.2010.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 05/11/2010] [Accepted: 05/14/2010] [Indexed: 11/21/2022]
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637
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[Opioid rotation: a therapeutic choice in the management of refractory cancer pain]. Med Clin (Barc) 2010; 135:617-22. [PMID: 20673681 DOI: 10.1016/j.medcli.2010.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 06/15/2010] [Indexed: 11/20/2022]
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638
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Vasovic V, Vukmirovic S, Pjevic M, Mikov I, Mikov M, Jakovljevic V. Influence of bile acid derivates on tramadol analgesic effect in mice. Eur J Drug Metab Pharmacokinet 2010; 35:75-8. [DOI: 10.1007/s13318-010-0011-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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639
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Baniadam A, Afshar FS, Ahmadian F. Analgesic effects of tramadol hydrochloride administered via caudal epidural injection in healthy adult cattle. Am J Vet Res 2010; 71:720-5. [DOI: 10.2460/ajvr.71.7.720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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640
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Brattwall M, Turan I, Jakobsson J. Pain management after elective hallux valgus surgery: a prospective randomized double-blind study comparing etoricoxib and tramadol. Anesth Analg 2010; 111:544-9. [PMID: 20584877 DOI: 10.1213/ane.0b013e3181e3d87c] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pain is a common complaint after day surgery, and there is still a controversy surrounding the use of selective cyclooxygenase-2 (COX-2) inhibitors. In the present prospective, randomized, double-blind study we compared pain management with a selective (COX-2) inhibitor (etoricoxib) with pain management using sustained-release tramadol after elective hallux valgus surgery. METHODS One hundred ASA 1 to 2 female patients were randomized into 2 groups of 50 patients each; oral etoricoxib 120 mg x 1 x IV + 90 mg x 1 x day V-VII and oral tramadol sustained-release 100 mg x 2 x VII. Pain, pain relief, satisfaction with pain management, and need for rescue medication were evaluated during the first 7 postoperative days. A computed tomography scan evaluating bone healing was performed 12 weeks after surgery. A clinical evaluation of outcome (healing, mobility, and patient-assessed satisfaction) was performed 16 weeks after surgery. RESULTS Two patients withdrew before discharge from the hospital. Ninety-eight patients, 81 ASA 1 and 17 ASA 2 (82 nonsmokers and 14 smokers), mean age 49 years (19-65), weight 64 (47-83) kg, and height 167 (154-183) cm were evaluated. Overall pain was well managed, but the mean visual analog scale (VAS) was significantly lower among etoricoxib patients evaluated during the entire 7-day period studied (12.5 + or - 8.3 vs. 17.3 + or - 11, P < 0.05). patient's grading of pain relief (92 + or - 12 vs. 85 + or - 15, P < 0.05) and satisfaction with pain medication (47/49 vs. 39/49, P < 0.05) was higher among etoricoxib patients. Patients receiving tramadol reported significantly more side effects. Six patients, all in the tramadol group, discontinued the study because of side effects (P < 0.05). At 14-day follow-up 1 patient in the etoricoxib group and 5 patients in the tramadol group exhibited minor irritation in the wound area. The 12-week computed tomography scan showed good healing in 82 patients, 43 in the etoricoxib group, and 39 in the tramadol group. The study found ongoing healing in 11 patients, 4 in the etoricoxib group and 7 in the tramadol group. The 16-week patient-assessed Health Profile Quality of life revealed high patient satisfaction overall; 47 patients in each study group rated the outcome as satisfactory and the mean change in the patient-assessed quality of life VAS score was 6.2 and 2.6 for the etoricoxib and tramadol groups, respectively. Clinical follow-up at 16 weeks showed high functionality and no signs or symptoms of improper healing in any patient. CONCLUSION Etoricoxib was found to be more effective and associated with fewer side effects in comparison with tramadol sustained release as a component of multimodel analgesia after elective hallux valgus surgery. There were no signs of impaired wound or bone healing associated with the use of etoricoxib.
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Affiliation(s)
- Metha Brattwall
- Foot & Ankle Surgical Centre, Storängsvägen 10, 11542 Stockholm, Sweden
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641
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Analysis of the opioid–opioid combinations according to the nociceptive stimulus in mice. Pharmacol Res 2010; 61:511-8. [DOI: 10.1016/j.phrs.2010.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 02/24/2010] [Accepted: 02/24/2010] [Indexed: 01/10/2023]
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642
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Tashakori A, Afshari R. Tramadol overdose as a cause of serotonin syndrome: a case series. Clin Toxicol (Phila) 2010; 48:337-41. [DOI: 10.3109/15563651003709427] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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643
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644
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Silva MDF, Schramm SG, Kano EK, Koono EEM, Porta V, dos Reis Serra CH. Bioequivalence evaluation of single doses of two tramadol formulations: A randomized, open-label, two-period. Clin Ther 2010; 32:758-65. [DOI: 10.1016/j.clinthera.2010.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2010] [Indexed: 10/19/2022]
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645
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Niscola P, Scaramucci L, Romani C, Giovannini M, Tendas A, Brunetti G, Cartoni C, Palumbo R, Vischini G, Siniscalchi A, Fabritiis PD, Caravita T. Pain management in multiple myeloma. Expert Rev Anticancer Ther 2010; 10:415-425. [DOI: 10.1586/era.10.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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646
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Vettorato E, Zonca A, Isola M, Villa R, Gallo M, Ravasio G, Beccaglia M, Montesissa C, Cagnardi P. Pharmacokinetics and efficacy of intravenous and extradural tramadol in dogs. Vet J 2010; 183:310-5. [DOI: 10.1016/j.tvjl.2008.11.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 10/24/2008] [Accepted: 11/02/2008] [Indexed: 11/26/2022]
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647
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Pharmacokinetics, safety and tolerance of single- and multiple-dose of a novel compound tramadol hydrochloride injection (35 mg tramadol hydrochloride, 45 mgl promethazine hydrochloride) in Chinese healthy subjects. Eur J Drug Metab Pharmacokinet 2010; 34:193-200. [PMID: 20166438 DOI: 10.1007/bf03191173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The pharmacokinetics of Tramadol and Promethazine after a single dose of 40, 80 and 120 mg intramuscular injecting CTHI was evaluated in healthy volunteers. Physical exam, vital signs, clinical laboratory tests and electrocardiogram measurements were monitored to assess the safety and tolerance of the drug. The plasma levels of Tramadol and Promethazine in serial samples were measured by a validated HPLC-MS method. No subject showed any drug-related clinically significant changes on physical examination, vital signs or laboratory tests.
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648
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Tjäderborn M, Jönsson AK, Ahlner J, Hägg S. Tramadol dependence: a survey of spontaneously reported cases in Sweden. Pharmacoepidemiol Drug Saf 2010; 18:1192-8. [PMID: 19827010 DOI: 10.1002/pds.1838] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Tramadol is a weak opioid analgesic, which is generally considered to be safe. However, conflicting data exist on the dependence potential of tramadol. OBJECTIVE The aim of this study was to investigate occurrence of tramadol dependence and associated risk factors using spontaneously reported adverse drug reactions. METHODS The Swedish database for spontaneously reported adverse drug reactions, Swedish Drug Information System (SweDIS), was searched for reports on tramadol dependence from 1 January 1995 until 31 December 2006. Selection was conducted based on the DSM-IV definition of dependence. Available information was scrutinised and registered and then presented descriptively. RESULTS A total of 104 reports of tramadol dependence were identified, of which 60 (58%) concerned women. The median age (range) was 45 (15-84) years. Information on a history of substance abuse was present in 31 patients (30%) and 41 patients (39%) had a documented past or current use of a drug of abuse. Prescribed doses of tramadol ranged between 50-800 mg/day, and ingested doses between 50-4000 mg/day. Time of onset ranged from some weeks up to 4 years. In 72 (69%) cases the reaction was classified as serious, mainly due to hospitalisations for detoxification or discontinuation of tramadol. CONCLUSIONS There is an occurrence of tramadol dependence in association with analgesic treatment within the recommended dose range. In susceptible patients a severe and serious dependence syndrome may develop. A history of abuse or use of a drug of abuse seems to be an important risk factor.
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Affiliation(s)
- Micaela Tjäderborn
- Division of Clinical Pharmacology, Linköping University, Linköping, Sweden.
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649
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Mattia C, Coluzzi F. Tramadol: a wonder drug for the treatment of chronic pain? ACTA ACUST UNITED AC 2010. [DOI: 10.2217/ijr.09.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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650
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Multidrug poisoning involving nicotine and tramadol. Forensic Sci Int 2010; 194:e17-9. [DOI: 10.1016/j.forsciint.2009.09.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 09/15/2009] [Accepted: 09/21/2009] [Indexed: 11/19/2022]
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