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Tramadol is a synthetic opioid that’s prescribed for the management of moderate to severe pain. Its mechanism of action is markedly different from those of the morphine-based analgesics whose effects it mimics, and for that reason, the drug was believed to have a low potential for abuse when it was first released on the market. More and more physicians and other health care professionals, however, have come to recognize its addictive potential.

This drug was developed and initially marketed by the German pharmaceutical company Grünenthal GmbH in 1977. Since that time, it has become a generic. Today, it is manufactured by many different drug companies.

Tramadol is sold under the brand names Conzip, Rybix, Ryzolt, Ultracet and Ultram in the United States. The drug doesn’t have any popular street names.

Federal Classification?

While the medication is not currently a federally controlled narcotic, an increasing number of states are classifying Tramadol as a Schedule IV controlled substance under state law. Arkansas, Kentucky, Illinois, Mississippi, New York, North Dakota, Ohio, Oklahoma, Tennessee, West Virginia, Wyoming and the U.S. military have laws in place restricting access to Tramadol, while other states have legislation pending that will restrict its access once the laws have passed. In many other states, however, Tramadol remains a Schedule II medication and is readily available through doctors’ prescriptions or over the Internet.

How Does Tramadol Work?

Tramadol’s physiological actions are more similar to those of several popular antidepressants than they are to opioid drugs. Although Tramadol binds to μ-opioid receptor agonists, Tramadol also selectively inhibits the reuptake of the neurotransmitters serotonin and norepinephrine. These neurotransmitters are primarily responsible for feelings of well-being and happiness. The result is that Tramadol doesn’t diminish pain so much as it changes the way that individuals experience pain.

Just as the case with other selective serotonin reuptake inhibitors (SSRIs), there is often a rebound effect when patients stop taking Tramadol all of a sudden, which can lead to symptoms of severe depression. For that reason, patients who no longer need Tramadol to control pain should always work out a scheme with their physicians to taper off the medications slowly.

What Does It Look Like and How Is It Used?

TramadolTramadol is supplied in either pill, capsule form or a liquid for injection. The pills are white and are either round or oblong-shaped, and come in a variety of dosages from 25 mg to 250 mg. The most common dosing unit is the 50 mg pill, and the standard dosage is one to two pills every four to six hours. Taking more than 400 mg in a single 24 hour period can put patients at risk for seizures.

The pills are imprinted with the names of their manufacturers. Tablets also come in an extended release form as well as in a form that disintegrates immediately in the mouth.

Risks

Tramadol affects the people who take it in widely divergent ways. While some people experience psychoactive effects with Tramadol, including euphoria and highs similar to those experienced with narcotic medications like oxycodone, many others do not.

Tramadol’s affinity for opioid receptors is much lower than that of other opioids, which means that the “highs” it produces are typically not as intense. However, the behavior as a selective serotonin reuptake inhibitor can lead to more pronounced shifts in mood. Many people taking this drug experience an elated mood as well as decreased levels of anxiety. These effects, even without the more pronounced opioid-type “high,” are often enough to get many users addicted.

This drug also lowers the seizure threshold. Physicians estimate that approximately 0.87% of persons prescribed the drug will experience at least one seizure related to the use of the medication. Risk factors for Tramadol-related seizures include a history of drug abuse and combining the use with other medications that depress the central nervous system. Tramadol potentiates the effects of central nervous system depressants like alcohol and antihistamines. People taking this drug should avoid the use of alcohol and drugs like prescription cold medications, sedatives, tranquilizers, sleeping medications, prescription pain medicine, anti-seizure medications, barbiturates and muscle relaxants.

Tramadol is associated with far more severe side effects than other opioid-type drugs. These side effects include:

  • Nausea, vomiting and other gastrointestinal symptoms
  • Orthostatic hypotension resulting in dizziness and vertigo
  • Headaches
  • Tremors
  • Insomnia

Overdose

Physicians who prescribe Tramadol caution their patients not to take more than 400 mg a day of the medication because of its seizure threshold-lowering effects. People showing signs of addictive behavior, however, will typically exceed safe dosage recommendations. Tramadol is often combined with acetaminophen, so people who overdose on the medication may suffer damage to their livers as well, related to the effects of acetaminophen.

The symptoms of overdose include:

  • Extreme lethargy
  • Depressed respiration
  • Pinpoint pupils
  • Cyanotic lips and fingernails
  • Seizures

Overdose is a medical emergency. Bystanders should immediately call 911 and the overdose victim should be transported by ambulance to a medical treatment center as soon as possible. The overdose victim should not be transported by private transportation, because of the possibility of respiratory arrest in transit. While you are waiting for emergency medical personnel, roll the overdose victim on his or her side so the victim won’t aspirate in case vomiting occurs.

Long-Term Effects

Tramadol works to change the actual chemistry of users’ brains by controlling the secretion of neurotransmitters. This means that users are far more likely to develop Tramadol tolerance in a relatively short period of time. For this reason, the medical community does not recommend the use for long-term management of chronic pain.

Additionally, the use of Tramadol is associated with the signs of physical dependence in many, though not all of its users. For users who develop physical dependence, withdrawal can include sweating, severe gastrointestinal symptoms, sneezing and respiratory symptoms, restless leg syndrome and general feelings of malaise. Tramadol withdrawal typically lasts seven days, which is longer than the three to four day withdrawal associated with other opioids.

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