651
|
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.
Collapse
Affiliation(s)
- Micaela Tjäderborn
- Division of Clinical Pharmacology, Linköping University, Linköping, Sweden.
| | | | | | | |
Collapse
|
652
|
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]
|
653
|
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]
|
654
|
Giorgi M, Saccomanni G, Andreoni V. Pharmacokinetics of Tramadol after Epidural Administration in Horses. J Equine Vet Sci 2010. [DOI: 10.1016/j.jevs.2009.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
655
|
Giorgi M, Del Carlo S, Saccomanni G, Łebkowska-Wieruszewska B, Turini V, Kowalski C. Biopharmaceutical profile of tramadol in the dog. Vet Res Commun 2009; 33 Suppl 1:189-92. [PMID: 19585256 DOI: 10.1007/s11259-009-9278-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Giorgi
- Dipartimento di Clinica Veterinaria, Università degli Studi di Pisa, Viale delle Piagge 2, 56124, Pisa, Italy.
| | | | | | | | | | | |
Collapse
|
656
|
|
657
|
Grosek S, Mozina M, Grabnar I, Primozic J. Diagnostic and therapeutic value of naloxone after intoxication with tramadol in a young girl. Pediatr Int 2009; 51:842-3. [PMID: 20158629 DOI: 10.1111/j.1442-200x.2009.02923.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Stefan Grosek
- Department of Paediatric Surgery and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | | | | | | |
Collapse
|
658
|
Abstract
SummaryThere is a high prevalence of pain in older people. Optimal assessment and management of pain in this population is challenging. The pharmacokinetics and pharmacodynamics of analgesic medications are affected by ageing and frailty, as well as by intercurrent medical conditions and their treatments. This review describes what is currently understood about the impacts of old age and frailty on the clinical pharmacology of commonly used analgesics, to provide a rational basis for the use of these medicines. In view of the wide age-related inter-individual variability in pharmacokinetics and pharmacodynamics of analgesic medications, monitoring of clinical response and adverse effects is essential to optimize pain control in older people.
Collapse
|
659
|
Leppert W. Tramadol as an analgesic for mild to moderate cancer pain. Pharmacol Rep 2009; 61:978-92. [DOI: 10.1016/s1734-1140(09)70159-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 11/09/2009] [Indexed: 11/15/2022]
|
660
|
Affiliation(s)
- Shu-Feng Zhou
- Discipline of Chinese Medicine, School of Health Sciences, RMIT University, Victoria, Australia.
| |
Collapse
|
661
|
Dhanjal JK, Wilson DV, Robinson E, Tobin TT, Dirokulu L. Intravenous tramadol: effects, nociceptive properties, and pharmacokinetics in horses. Vet Anaesth Analg 2009; 36:581-90. [DOI: 10.1111/j.1467-2995.2009.00492.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
662
|
Shao L, Wang F, Hewitt MC, Barberich TJ. μ-Opioid/5-HT4 dual pharmacologically active agents—Efforts towards an effective opioid analgesic with less GI and respiratory side effects (Part I). Bioorg Med Chem Lett 2009; 19:5679-83. [DOI: 10.1016/j.bmcl.2009.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/01/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
|
663
|
Rodríguez-Silverio J, Arrieta J, Flores-Murrieta FJ. Synergistic interaction between tramadol and dipyrone in thermal paw stimulation model in the rat. Drug Dev Res 2009. [DOI: 10.1002/ddr.20327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
664
|
Noehr-Jensen L, Zwisler ST, Larsen F, Sindrup SH, Damkier P, Brosen K. Escitalopram Is a Weak Inhibitor of the CYP2D6-Catalyzed O-Demethylation of (+)-Tramadol but Does Not Reduce the Hypoalgesic Effect in Experimental Pain. Clin Pharmacol Ther 2009; 86:626-33. [DOI: 10.1038/clpt.2009.154] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
665
|
Abstract
INTRODUCTION Tramadol, as a centrally-acting, opioid-like analgesic with serotonin reuptake inhibition property, is one of the most prescribed analgesics in the world. We assessed the incidence of seizure, as it is one of the most important adverse effects. METHODS In a cross-sectional study, 215 cases of tramadol users or abusers who were admitted to Loghman-Hakim Hospital Poisoning Center (LHHPC) in Tehran during a 5-month period, from April 2007 to September 2007, were assessed to evaluate the occurrence of seizure. Patients with positive history of co-ingestion of other drugs, addiction, convulsive disorders, renal diseases, or head trauma with abnormal electroencephalography (EEG) or computerized tomography (CT) scan of the brain were excluded, thus 132 patients were included in the study. For patients who had seizure, CT scan of the brain and EEG were performed, and frequency and type of seizure were identified. Mean tramadol dose was compared between patients with and without seizure. RESULTS Among the patients, 97 (73.5%) were male. Seizure occurred in 61 patients (46.2%) within 24 hours after tramadol ingestion. The majority of patients who had seizure were male (male, 83.6% vs. female, 16.4%). Mean tramadol dose was lower among females than males (males, 2413 mg vs. females, 1706 mg), but the difference was not statistically significant. Of 35 patients with documented seizure type, all showed generalized tonic-clonic seizure and 12 patients had abnormal EEG (35.3%). No statistically significant difference was observed in mean tramadol intake between patients with or without seizure. Analysis of patients with seizure, according to tramadol intake, indicated that most patients used tramadol in the dose range of 500-1000 mg followed in occurrence by 1500-2000 mg, then 100-500 mg, 2500-3000 mg, and 3500-4000 mg. CONCLUSIONS Mean tramadol intake does not differ between patients with and without seizure, and the most common dose range in those with seizure is 500-1000 mg. We thus conclude that the incidence of seizure with tramadol is not dose dependent.
Collapse
|
666
|
Seddighi MR, Egger CM, Rohrbach BW, Cox SK, Doherty TJ. Effects of tramadol on the minimum alveolar concentration of sevoflurane in dogs. Vet Anaesth Analg 2009; 36:334-40. [DOI: 10.1111/j.1467-2995.2009.00468.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
667
|
Di Patti F, Fanelli D. A stochastic reaction scheme for drug/metabolite interaction. J Theor Biol 2009; 259:382-8. [DOI: 10.1016/j.jtbi.2009.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
|
668
|
Pharmacokinetics of Tramadol and Its Metabolites M1, M2, and M5 in Donkeys after Intravenous and Oral Immediate Release Single-Dose Administration. J Equine Vet Sci 2009. [DOI: 10.1016/j.jevs.2009.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
669
|
Pharmacological treatment of overactive bladder: report from the International Consultation on Incontinence. Curr Opin Urol 2009; 19:380-94. [DOI: 10.1097/mou.0b013e32832ce8a4] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
670
|
Pharmacokinetic and urine profile of tramadol and its major metabolites following oral immediate release capsules administration in dogs. Vet Res Commun 2009; 33:875-85. [DOI: 10.1007/s11259-009-9236-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2009] [Indexed: 11/27/2022]
|
671
|
Khooshideh M, Shahriari A. A comparison of tramadol and pethidine analgesia on the duration of labour: a randomised clinical trial. Aust N Z J Obstet Gynaecol 2009; 49:59-63. [PMID: 19281581 DOI: 10.1111/j.1479-828x.2009.00949.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ideal obstetric analgesia should provide analgesic efficacy without attenuation of uterine contractions. AIMS To compare the outcome of intramuscular administration of pethidine and tramadol in labour analgesia. METHODS One hundred and sixty full-term parturients were randomly assigned to two equal groups in active labour. Group P received 50 mg pethidine; and group T, 100 mg tramadol intramuscularly. Primary outcome measure was the duration of the labour. The analgesic efficacy, maternal side-effects, mode of delivery, maternal satisfaction and Apgar score as the secondary outcome were assessed. RESULTS The duration of labour was shorter in group T, for first stage (190 vs 140 min; P < 0.0001) and for second stage (33 vs 25 min; P = 0.001). There were no differences in Groups P and T with respect to median (7 vs 8) and maximum (7.5 vs 8) visual analog scores (VAS) for pain at 10 min and one hour after drug administration. Women in group P had lower VAS pain scores than those in group T in the second stage of labour (8 vs 9; P = 0/009). There was a significantly higher incidence of nausea and vomiting (35% vs 15%; P = 0.003) and drowsiness (80% vs 29%; P < 0.0001) in group P. CONCLUSION Both 100 mg tramadol and 50 mg pethidine provide moderate analgesia in first stage of labour. Tramadol seems to cause a shorter duration of labour and lower incidence of maternal side-effects. However, its analgesic efficacy was not found to be as effective as pethidine, especially in the second stage of labour.
Collapse
Affiliation(s)
- Maryam Khooshideh
- Department of Obstetrics and Gynaecology, School of Medicine, Zahedan University of Medicical Sciences, Zahedan, Iran
| | | |
Collapse
|
672
|
Brondani JT, Luna LSP, Beier SL, Minto BW, Padovani CR. Analgesic efficacy of perioperative use of vedaprofen, tramadol or their combination in cats undergoing ovariohysterectomy. J Feline Med Surg 2009; 11:420-9. [PMID: 19233698 PMCID: PMC10832834 DOI: 10.1016/j.jfms.2008.10.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2008] [Indexed: 11/21/2022]
Abstract
The analgesic efficacy of tramadol and/or vedaprofen was evaluated in cats submitted for elective ovariohysterectomy, using a randomised double blind placebo controlled design. Forty adult female cats (3.0+/-0.32kg; 1.8+/-0.7 years) were distributed into four groups. Vedaprofen PO (0.5mg/kg), tramadol SC (2mg/kg), both, or placebo was administered 1h before surgery and every 24 and 8h, respectively, for 72h after surgery. Pain score evaluated by interactive visual analogue and composite pain score and hyperalgesia by the von Frey filament test were recorded at 1, 2, 4, 6, 8, 12, 24, 28, 32, 48, 52, 56, 72, 96h and on the 7th day after surgery. Animals treated with combined vedaprofen and tramadol treatment did not need rescue analgesia, did not develop hyperalgesia, and their serum cortisol concentrations and pain scores were lower than placebo until 24 and 72h after surgery, respectively. Combined vedaprofen and tramadol treatment provided more effective postoperative analgesia and prevented hyperalgesia than when used on their own. Multimodal technique is a superior method of treating pain after feline ovariohysterectomy. This work also provides evidence for the benefits of analgesia for up to 3 days following ovariohysterectomy.
Collapse
Affiliation(s)
- Juliana Tabarelli Brondani
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Loureiro Stelio Pacca Luna
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Suzane Lilian Beier
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Bruno Wanatabe Minto
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Carlos Roberto Padovani
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biosciences, São Paulo State University, Botucatu, São Paulo, Brazil
| |
Collapse
|
673
|
Brondani JT, Luna SP, Marcello GC, Padovani CR. Perioperative administration of vedaprofen, tramadol or their combination does not interfere with platelet aggregation, bleeding time and biochemical variables in cats. J Feline Med Surg 2009; 11:503-9. [PMID: 19168382 PMCID: PMC10832828 DOI: 10.1016/j.jfms.2008.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
A randomized double blind and placebo controlled design was used to investigate the hemostatic, biochemical, gastrointestinal and behavioral effects of pre- and postoperative administration of vedaprofen 0.5mg/kg PO (V), tramadol 2mg/kg SC (T), their association (VT) or placebo (P) in 40 adult female cats (3.0+/-0.32kg; 1.8+/-0.7 years) distributed in groups of 10. Platelet aggregation and bleeding time were measured before and 52h after ovariohysterectomy. Serum urea, creatinine, alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transferase concentrations were measured before and 7 days postoperatively. The occurrence of vomiting, frequency and consistency of feces, and behavior were observed for 7 days postoperatively. Morphine (0.5mg/kg, IM) was used as rescue analgesic. Laboratory variables did not change. Vomiting was observed only after morphine administration. Mild euphoria was observed in T and VT. The perioperative use of vedaprofen and/or tramadol did not modify the hemostatic, biochemical and gastrointestinal function in cats.
Collapse
Affiliation(s)
- Juliana T. Brondani
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Stelio P.L. Luna
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Gracy C.G. Marcello
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Carlos R. Padovani
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biosciences, São Paulo State University, Botucatu, São Paulo, Brazil
| |
Collapse
|
674
|
Abstract
Lower urinary tract symptoms (LUTS), overactive bladder syndrome (OAB) and detrusor overactivity (DO) are all conditions that can have major effects on quality of life and social functioning. Antimuscarinic drugs are first-line treatment-they often have good initial response rates, but adverse effects and decreasing efficacy cause long-term compliance problems, and alternatives are needed. The recognition of the functional contribution of the urothelium, the spontaneous myocyte activity during bladder filling, and the diversity of nerve transmitters has sparked interest in both peripheral and central modulation of LUTS/OAB/DO pathophysiology. There may be several new possibilities to treat LUTS/OAB/DO. β(3)-AR agonists (YM178), PDE 5 inhibitors (sildenafil, tadalafil, vardenafil), vitamin D analogs (elocalcitol), combinations (α(1)-AR antagonist + antimuscarinic), and drugs with a central mode of action (tramadol, aprepitant) all have Randomized controlled trial (RCT) documented efficacy. Which of these therapeutic principles will be developed to clinically useful treatments remains to be established.
Collapse
Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
| |
Collapse
|
675
|
Giorgi M, Del Carlo S, Saccomanni G, Lebkowska-Wieruszewska B, Kowalski CJ. Pharmacokinetics of tramadol and its major metabolites following rectal and intravenous administration in dogs. N Z Vet J 2009; 57:146-52. [DOI: 10.1080/00480169.2009.36894] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
676
|
Kanaan M, Daali Y, Dayer P, Desmeules J. Uptake/efflux transport of tramadol enantiomers and O-desmethyl-tramadol: focus on P-glycoprotein. Basic Clin Pharmacol Toxicol 2009; 105:199-206. [PMID: 19496778 PMCID: PMC2774482 DOI: 10.1111/j.1742-7843.2009.00428.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract: The analgesic effect of tramadol (TMD) results from the monoaminergic effect of its two enantiomers, (+)-TMD and (−)-TMD as well as its opioid metabolite (+)-O-desmethyl-tramadol (M1). P-glycoprotein (P-gp) might be of importance in the analgesic and tolerability profile variability of TMD. Our study investigated the involvement of P-gp in the transepithelial transport of (+)-TMD, (−)-TMD and M1, using a Caco-2 cell monolayer model. The bidirectional transport of racemic TMD and M1 (1–100 µM) across the monolayers was investigated at two pH conditions (pH 6.8/7.4 and 7.4/7.4) in the presence and absence of P-gp inhibitor cyclosporine A (10 µM) and assessed with the more potent and specific P-gp inhibitor GF120918 (4 µM). Analytical quantification was performed by liquid chromatography coupled to the fluorescence detector. A net secretion of (+)-TMD, (−)-TMD and M1 was observed when a pH gradient was applied (TR: Papp(B − A)/Papp(A − B): 1.8–2.7; P < 0.05). However, the bidirectional transport of all compounds was equal in the non-gradient system. In the presence of P-gp inhibitors, a slight but significant increase of secretory flux was observed (up to 26%; P < 0.05) at both pH conditions. In conclusion, (+)-TMD, (−)-TMD and M1 are not P-gp substrates. However, proton-based efflux pumps may be involved in limiting the gastrointestinal absorption of TMD enantiomers as well as enhancing TMD enantiomers and M1 renal excretion. A possible involvement of uptake carriers in the transepithelial transport of TMD enantiomers and M1 is suggested.
Collapse
Affiliation(s)
- Mouna Kanaan
- Department of Anaesthesiology, Clinical Pharmacology and Toxicology and Multidisciplinary Pain Center, Pharmacology and Intensive care, Geneva University Hospitals, Faculty of Medicine, University of Geneva, CH-1211 Geneva 14, Switzerland
| | | | | | | |
Collapse
|
677
|
Madgulkar AR, Bhalekar MR, Padalkar RR. Formulation design and optimization of novel taste masked mouth-dissolving tablets of tramadol having adequate mechanical strength. AAPS PharmSciTech 2009; 10:574-81. [PMID: 19440844 DOI: 10.1208/s12249-009-9237-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 03/09/2009] [Indexed: 11/30/2022] Open
Abstract
The purpose of this work was to develop novel taste masked mouth-dissolving tablets of tramadol that overcomes principle drawback of such formulation which is inadequate mechanical strength. Tramadol is an opioid analgesic used for the treatment of moderate to severe pain. Mouth-dissolving tablets offer substantial advantages like rapid onset of action, beneficial for patients having difficulties in swallowing and in conditions where access to water is difficult. The crucial aspect in the formulation of mouth-dissolving tablets is to mask the bitter taste and to minimize the disintegration time while maintaining a good mechanical strength of the tablet. Mouth-dissolving tablets of tramadol are not yet reported in the literature because of its extreme bitter taste. In this work, the bitter taste of Tramadol HCl was masked by forming a complex with an ion exchange resin Tulsion335. The novel combination of a superdisintegrant and a binder that melts near the body temperature was used to formulate mechanically strong tablets that showed fast disintegration. A 3(2) full factorial design and statistical models were applied to optimize the effect of two factors, i.e., superdisintegrant (crospovidone) and a mouth-melting binder (Gelucire 39/01). It was observed that the responses, i.e., disintegration time and percent friability were affected by both the factors. The statistical models were validated and can be successfully used to prepare optimized taste masked mouth-dissolving tablets of Tramadol HCl with adequate mechanical strength and rapid disintegration.
Collapse
|
678
|
Preclinical assessment of proconvulsant drug activity and its relevance for predicting adverse events in humans. Eur J Pharmacol 2009; 610:1-11. [DOI: 10.1016/j.ejphar.2009.03.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 02/19/2009] [Accepted: 03/03/2009] [Indexed: 12/20/2022]
|
679
|
Giorgi M, Saccomanni G, Łebkowska-Wieruszewska B, Kowalski C. Pharmacokinetic evaluation of tramadol and its major metabolites after single oral sustained tablet administration in the dog: a pilot study. Vet J 2009; 180:253-5. [DOI: 10.1016/j.tvjl.2007.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 11/22/2007] [Accepted: 12/09/2007] [Indexed: 11/30/2022]
|
680
|
Louly PG, Medeiros-Souza P, Santos-Neto L. N-of-1 double-blind, randomized controlled trial of tramadol to treat chronic cough. Clin Ther 2009; 31:1007-13. [DOI: 10.1016/j.clinthera.2009.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2009] [Indexed: 11/27/2022]
|
681
|
Willaschek C, Wolter E, Buchhorn R. Tramadol withdrawal in a neonate: how should it be treated? Eur J Clin Pharmacol 2009. [DOI: 10.1007/s00228-009-0636-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
682
|
Karlsson M, Berggren AC. Efficacy and safety of low-dose transdermal buprenorphine patches (5, 10, and 20 μg/h) versus prolonged-release tramadol tablets (75, 100, 150, and 200 mg) in patients with chronic osteoarthritis pain: A 12-week, randomized, open-label, controlled, parallel-group noninferiority study. Clin Ther 2009; 31:503-13. [DOI: 10.1016/j.clinthera.2009.03.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2009] [Indexed: 01/26/2023]
|
683
|
Munro G. Pharmacological assessment of the rat formalin test utilizing the clinically used analgesic drugs gabapentin, lamotrigine, morphine, duloxetine, tramadol and ibuprofen: Influence of low and high formalin concentrations. Eur J Pharmacol 2009; 605:95-102. [DOI: 10.1016/j.ejphar.2009.01.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 12/11/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
|
684
|
|
685
|
Patel BN, Sharma N, Sanyal M, Shrivastav PS. An accurate, rapid and sensitive determination of tramadol and its active metabolite O-desmethyltramadol in human plasma by LC–MS/MS. J Pharm Biomed Anal 2009; 49:354-66. [DOI: 10.1016/j.jpba.2008.10.030] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 10/13/2008] [Accepted: 10/15/2008] [Indexed: 11/28/2022]
|
686
|
Miranda H, Puig M, Romero M, Prieto J. Effects of tramadol and dexketoprofen on analgesia and gastrointestinal transit in mice. Fundam Clin Pharmacol 2009; 23:81-8. [DOI: 10.1111/j.1472-8206.2008.00636.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
687
|
Abdel-Hamid IA, Jannini EA, Andersson KE. Premature ejaculation: focus on therapeutic targets. Expert Opin Ther Targets 2009; 13:175-93. [DOI: 10.1517/14728220802663549] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
688
|
Shadnia S, Soltaninejad K, Heydari K, Sasanian G, Abdollahi M. Tramadol intoxication: a review of 114 cases. Hum Exp Toxicol 2009; 27:201-5. [PMID: 18650251 DOI: 10.1177/0960327108090270] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tramadol as a centrally acting analgesic is extensively used in the management of moderate to severe pain. It slightly affects opioid receptors and inhibits the reuptake of norepinephrin and serotonin in the CNS. There are reports about toxicity and abuse of tramadol. The objective of the present study was to evaluate epidemiology of intentional tramadol intoxications. All poisoning cases that admitted to Loghman-Hakim Hospital Poison Center from April to May 2007 were studied. A total of 114 cases (82 men and 32 women) of intentional tramadol intoxications with the median age of 23.66 +/- 6.87 years (range 16-54 years) were identified. Other illicit drugs were found to be used in combination with tramadol in some of the cases, which among them benzodiazepines were the most common. Tramadol overdose has been one of the most frequent causes of drug poisoning in the country in the recent years, especially in male young adults with history of substance abuse and mental disorders. Nausea, vomiting, Central Nervous System (CNS) depression, tachycardia, and seizure are the most common findings in this kind of poisoning. Cardiopulmonary arrest was found as the cause of death in cases who had ingested more than 5000 mg tramadol.
Collapse
Affiliation(s)
- S Shadnia
- Loghman-Hakim Hospital Poison Center, Faculty of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
689
|
Nicholson B. Benefits of Extended-Release Opioid Analgesic Formulations in the Treatment of Chronic Pain. Pain Pract 2009; 9:71-81. [DOI: 10.1111/j.1533-2500.2008.00232.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
690
|
Di Patti F, Fanelli D, Pedersen R, Giuliani C, Torricelli F. Modelling the pharmacokinetics of tramadol: On the difference between CYP2D6 extensive and poor metabolizers. J Theor Biol 2008; 254:568-74. [DOI: 10.1016/j.jtbi.2008.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 06/09/2008] [Accepted: 06/11/2008] [Indexed: 11/16/2022]
|
691
|
Raimundo JM, Pontes LB, Antunes F, Sudo RT, Trachez MM, Zapata-Sudo G. COMPARATIVE EFFECTS OF TRAMADOL ON VASCULAR REACTIVITY IN NORMOTENSIVE AND SPONTANEOUSLY HYPERTENSIVE RATS. Clin Exp Pharmacol Physiol 2008; 35:1197-203. [DOI: 10.1111/j.1440-1681.2008.04979.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
692
|
Gjelstad A, Rasmussen KE, Pedersen-Bjergaard S. Electromembrane extraction of basic drugs from untreated human plasma and whole blood under physiological pH conditions. Anal Bioanal Chem 2008; 393:921-8. [DOI: 10.1007/s00216-008-2344-x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/06/2008] [Accepted: 08/08/2008] [Indexed: 12/01/2022]
|
693
|
Ali M, Pagnano MW, Horlocker T, Lennon RL. How I Manage Pain after Total Hip Arthroplasty. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.sart.2008.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
694
|
Bonjardim LR, da Silva AP, Gameiro GH, Tambeli CH, Ferraz de Arruda Veiga MC. Nociceptive behavior induced by mustard oil injection into the temporomandibular joint is blocked by a peripheral non-opioid analgesic and a central opioid analgesic. Pharmacol Biochem Behav 2008; 91:321-6. [PMID: 18755210 DOI: 10.1016/j.pbb.2008.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 07/12/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to improve the mustard oil (MO) induced temporomandibular joint (TMJ) nociception model and to investigate the potential analgesic activity of systemic dipyrone and tramadol on the nociceptive behavioral responses induced by injection of low concentrations of the MO into the rat TMJ region. TMJ injection of 2.5% MO produced a significant nociceptive behavior expressed by head flinching and orofacial rubbing. This activity was related to the MO injection since mineral oil (vehicle) did not elicit response. Local application of the lidocaine N-ethyl bromide quaternary salt, QX-314 (2%) and systemic administration of morphine (4 mg/kg) significantly reduced the MO-induced nociceptive responses, validating the nociceptive character of the behaviors. The pretreatment with systemic dipyrone (19, 57 or 95 mg/kg) as well as tramadol (5, 7.5 or 10 mg/kg) was effective in decreasing the nociceptive behavioral responses induced by the injection of MO into the rat TMJ. In conclusion, TMJ injection of low concentrations of MO in rats produces well defined and quantifiable nociceptive behaviors constituting a reliable behavioral model for studying TMJ pain mechanisms and testing analgesic drugs. The results also suggest that dipyrone and tramadol could be effective analgesic options in the management of TMJ pain.
Collapse
|
695
|
Abstract
Several studies have demonstrated the impact of CYP2D6 polymorphism on the pharmacokinetics of tramadol. However, the relationship between the O-demethylation of tramadol and O-desmethyltramadol (M1) and CYP2D6 activity has not previously been investigated with tramadol in multimedicated outpatients under steady-state conditions. Hence, the aim of this study was to determine if the well documented pharmacokinetics of tramadol regarding CYP2D6 could be verified in a study including 88 multimedicated Faroese patients, treated with tramadol at steady-state conditions. Further, the study aimed to investigate whether the previously observed frequency of CYP2D6 poor metabolizers (PMs) in the Faroese, which was shown to be double that of other Europeans, was evident in a patient group medicated with a CYP2D6 substrate. The patients were CYP2D6-phenotyped by the intake of sparteine, followed by urine collection over 12 hours. Sparteine and its metabolites were assayed by gas chromatography. Genotype analyses for the CYP2D6 3, 4, 6, and 9 alleles were performed by polymerase chain reaction and Taqman technology. Plasma and urinary concentrations of (+/-)-tramadol and (+/-)-M1 were determined by high-performance liquid chromatography. With use of CYP2D6 phenotyping, 10 patients (11.5% [95% confidence interval (CI), 5.7-20.1%]) were classified as CYP2D6 PMs, and 8 (9.3% [95% CI, 4.1-17.3%]) of these were genotyped as CYP2D6 PMs. The PM frequency was not statistically significantly higher than that in other European populations (7%-10%). The concentrations of (+)-M1 when corrected for dose (nM/mg) and the (+)-M1/(+)-tramadol ratio were approximately 14-fold higher in the extensive metabolizers (EMs) than in the PMs. In conclusion, the impact of the CYP2D6 polymorphism on the pharmacokinetics of tramadol was clearly demonstrated in a group of multimedicated patients treated with tramadol under steady-state conditions. Further, the frequency of PMs was not higher than that in other European populations, as previously shown in different Faroese groups, possibly because of discontinued tramadol treatment in Faroese patients who were PMs.
Collapse
|
696
|
Thomas SH, Shewakramani S. Prehospital Trauma Analgesia. J Emerg Med 2008; 35:47-57. [DOI: 10.1016/j.jemermed.2007.05.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 03/06/2007] [Accepted: 05/09/2007] [Indexed: 10/22/2022]
|
697
|
Launiainen T, Vuori E, Ojanperä I. Prevalence of adverse drug combinations in a large post-mortem toxicology database. Int J Legal Med 2008; 123:109-15. [PMID: 18584194 DOI: 10.1007/s00414-008-0261-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 05/27/2008] [Indexed: 01/01/2023]
Abstract
The prevalence of important adverse drug combinations was studied among the 37,367 cases included in the Finnish post-mortem toxicology database during 2000-2006. The new SFINX interaction database (Swedish, Finnish, INteraction X-referencing) was utilised to identify adverse drug combinations. Consequently, the 24 drugs chosen for the study generated 96 two-compound combinations possessing potentially severe interactions. The total number of hits for the combinations found in the post-mortem database was 267, which accounts for approximately 0.71% of all cases. The potential role of adverse drug interaction (ADI) in these cases was evaluated from the background information and death certificate. The possible ADI cases comprised 23% of all hits and 0.17% of all cases analysed. In cases with a pharmacodynamic mechanism, the most prominent combinations were medicines causing serotonin syndrome or a beta(1)-blocker with verapamil or diltiazem. In cases with a pharmacokinetic mechanism, half of the cases involved digoxin in combination with verapamil. In one third of the possible ADI cases, a forensic pathologist had noted the studied compounds as an underlying or contributing cause of death, although the agents' specific role in ADIs was rarely recognised.
Collapse
Affiliation(s)
- Terhi Launiainen
- Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014, Helsinki, Finland.
| | | | | |
Collapse
|
698
|
Nesin EN, Gura EV, Kolbun MD. Combination of pharmacological analgesics and microwave irradiation of an acupuncture point for suppression of visceral pain in mice: Role of the opioid and serotonergic cerebral systems. NEUROPHYSIOLOGY+ 2008. [DOI: 10.1007/s11062-008-9004-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
699
|
Ko JCH, Abbo LA, Weil AB, Johnson BM, Inoue T, Payton ME. Effect of orally administered tramadol alone or with an intravenously administered opioid on minimum alveolar concentration of sevoflurane in cats. J Am Vet Med Assoc 2008; 232:1834-40. [DOI: 10.2460/javma.232.12.1834] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
700
|
Filitz J, Ihmsen H, Günther W, Tröster A, Schwilden H, Schüttler J, Koppert W. Supra-additive effects of tramadol and acetaminophen in a human pain model ☆. Pain 2008; 136:262-270. [PMID: 17709207 DOI: 10.1016/j.pain.2007.06.036] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 06/26/2007] [Accepted: 06/28/2007] [Indexed: 02/04/2023]
Abstract
The combination of analgesic drugs with different pharmacological properties may show better efficacy with less side effects. Aim of this study was to examine the analgesic and antihyperalgesic properties of the weak opioid tramadol and the non-opioid acetaminophen, alone as well as in combination, in an experimental pain model in humans. After approval of the local Ethics Committee, 17 healthy volunteers were enrolled in this double-blind and placebo-controlled study in a cross-over design. Transcutaneous electrical stimulation at high current densities (29.6+/-16.2 mA) induced spontaneous acute pain (NRS=6 of 10) and distinct areas of hyperalgesia for painful mechanical stimuli (pinprick-hyperalgesia). Pain intensities as well as the extent of the areas of hyperalgesia were assessed before, during and 150 min after a 15 min lasting intravenous infusion of acetaminophen (650 mg), tramadol (75 mg), a combination of both (325 mg acetaminophen and 37.5mg tramadol), or saline 0.9%. Tramadol led to a maximum pain reduction of 11.7+/-4.2% with negligible antihyperalgesic properties. In contrast, acetaminophen led to a similar pain reduction (9.8+/-4.4%), but a sustained antihyperalgesic effect (34.5+/-14.0% reduction of hyperalgesic area). The combination of both analgesics at half doses led to a supra-additive pain reduction of 15.2+/-5.7% and an enhanced antihyperalgesic effect (41.1+/-14.3% reduction of hyperalgesic areas) as compared to single administration of acetaminophen. Our study provides first results on interactions of tramadol and acetaminophen on experimental pain and hyperalgesia in humans. Pharmacodynamic modeling combined with the isobolographic technique showed supra-additive effects of the combination of acetaminophen and tramadol concerning both, analgesia and antihyperalgesia. The results might act as a rationale for combining both analgesics.
Collapse
Affiliation(s)
- Jörg Filitz
- Department of Anesthesiology, University Hospital Erlangen, Krankenhausstraße 12, D-91054 Erlangen, Germany
| | | | | | | | | | | | | |
Collapse
|