March 28, 2023

Tramadol treats acute or chronic pain and works on the same opioid receptors as hydrocodone, oxycodone and Fentanyl. Additionally Tramadol boasts some of the same activities as the SSRI class of antidepressants including Celexa, Lexapro, Zoloft and Paxil.

Hello dr. ken lando thanks for watching let’s talk about tramadol tramadol is a medication used for attitude or chronic pain of moderate to moderately severe intensity it’s used for adults it was approved by the food and drug administration in 1995 and then they approved an extended-release version in 2005 and it’s now off patent it was originally developed in

1962 by researchers at gru ninh thal that’s a big german pharmaceutical company they were working on an alternative to coding as a cough suppressant but after they developed the drug the company was the one that developed the lid amide and the company was sidetracked for a number of years and then finally dr. schenk working for the same company well he found

The tramadol was effective for different kind of pain and it was less addictive than the opioids so it was approved in germany in 1977 as trammel and the clinical studies at that time seemed to show that it offered all of the benefits of the more powerful more addictive drugs but with few of the downsides of dependency but remember that’s when it was used as an

Injection it’s metabolized completely differently when it’s taken as a pill and it causes havoc when it’s taken as a pill it was originally derived from the opium poppy plant resin but the kind that we have nowadays is synthetically manufactured the closest relative is coding it’s used as an alternative to the narcotics and the opioids offers the benefits of the

More powerful addictive drugs but supposedly doesn’t make a person dependent when it’s used as an injection and when it’s uses as an injection it’s considerably weaker than its when it’s given as a pill when it’s given as a pill it goes from the mouth to the stomach and intestines it’s absorbed it goes right to the liver and in the liver that it’s activated when

It works it works as a new opioid receptor agonist in other words it works the same way as hydrocodone or oxycodone or fentanyl and in addition it works pretty much the same as the selective serotonin reuptake inhibitors and the selective norepinephrine reuptake inhibitors in other words it seems to work like prozac and zoloft and effexor or cymbalta in addition

To the narcotic activity or to the pain killing activity well tramadol itself doesn’t work on that opioid receptor it has to be metabolized that’s where the liver comes in that’s why the oral version is so much more potent it’s metabolized to death methi tramadol that’s 200 to 700 times more likely to bind at the mu opioid receptor so it’s multiple times more

Potent as a painkiller when it’s taken by mouth than when it’s given by injection well prior to the approval here in the united states the advisory committee to the food and drug administration said you know all the evidence shows that this drug in injection over in europe lots of years of experience it seems like the drug doesn’t cause any problems but that’s

The extra cautious let’s set up a steering committee actually the first of its kind let’s set up a steering committee to look and see whether this acts as a psychoactive medication whether there’s going to be any kind of problems with addiction or other kind of problems so the company was told to set up this committee the company that made the drug ortho macneil

At the time well they evaluated it and said there’s no recommendation that we have and actually it gives us a competitive edge over some of the controlled substances so unfortunately within years of it becoming available there were cases of abuse that were reported to the fda they were reported by a of medical organizations and my individuals but the fda sort of

Was adamant that the drug was not widely abused remember here in the united states it’s principally a pill over in europe principally an injection at the time so they left it as an unscheduled unclassified uncontrolled substance from 1995 until 2014 it is highly addictive it’s easier to obtain there was less concern by the doctors so lots of prescriptions and

In the united states as the opioids became more difficult to obtain as restrictions were put on hydrocodone oxycodone well there was more abuse of tramadol because it wasn’t really scheduled the same way it’s commonly abused by addicts and even health care professionals and chronic pain patients lots of people end up in the emergency room from using this kind

Of a drug the dea suggested to the fda as long ago as 2010 hey you oughta consider this controlled substance but it wasn’t until august of 2014 that the fda made it a controlled substance they call it a class for drug what that means is that you can get the original prescription and up to five refills now here in the united states we consume probably 80 to 90%

Of all of the hydrocodone and oxycodone everywhere else in the world it’s not really a problem these drugs they’re oxycodone hydrocodone why because they’re abusing the tramadol tramadol widely abused throughout the rest of the world well the world health organization the w-h-o they decided in 1973 that what they have to do is they have to go and make a list of

All of the narcotics and the opioids and and control them and they did that but they did not consider tramadol to fit on that list and as a matter of fact there’s a reason that they even today still don’t consider this a classified substance from the world health organization that’s because controlled substances are difficult to obtain so if you happen to be in

The middle east if you happen to be in africa if you happen to be in asia and you have cancer you have some kind of a problem with pain they don’t have many drugs available they use tramadol so the world health organization has stood firm they do not want this to be considered a controlled substance because that would limit its access now canada is considering the

Medicine for their controlled list in the united kingdom it was a controlled substance as of 200 2013 the world anti-doping agency they consider it a monitoring drug they look at the use of it they found it actually 70 80 percent of all of the use in the olympics our cyclers the us anti-doping agency they’ve already requested hey put this on the prohibited list

Well when the patent for the drug expired then they started mass-producing the drug in india and in china in other parts of the world it’s sold over-the-counter it’s sold without a prescription sold on the street corner it’s regularly added to tea into coffee it’s used by the taxi drivers it’s used as a token a wedding token a gift it’s used as a bride in ireland

That kills more people than heroin it’s used as a daily helper for the poor and the working classes in egypt where it’s more widely abused than heroin or even marijuana widespread use in africa has caused major problem it’s used it’s abused in nigerian saudi it’s used in ukraine and in india it’s caused such a massive problem that they’ve put strict limits on

The drug in ghana the pills are referred to as tram ease or chill pills or ultras or now they call them tomatoes because it reminds them of tomatoes in fact there’s such widespread use in africa than in north cameroon there was dutch neurobiologists who recently thought that it actually was a natural product he found it in trees he found it in the type of a tree

Called the african pincushion tree at a 1% concentration but interestingly it wasn’t present in the south cameroon pincushion trees why well because it was so widely abused in the north by the farmers the farmers even gave it to the cattle that were plowing the fields and then all of the urine and all of the feces were absorbed in the water and then into the tree

And that’s how widespread the abuses well the drug comes it’s immediate release and a delayed release medication immediate release 50 milligram 100 milligram the onset of action is within an hour the peak level and the blood is within 2 2 3 4 hours duration up to 6 hours and you can take up to four of those a day and it’s combined with acetaminophen basically

Tylenol as ultra set now the extended release form comes in 100 200 or 300 milligrams it contains both the immediate acting drug and the delayed acting drug if you’re going to switch from the immediate acting drug to the delayed acting drug and up all of the immediate drug you take in the course of the day rand off to the lowest 100 and then you take that as one

Pill if you’re not you just start at 100 milligrams of the extended-release a day there’s a problem and a problem is that a significant number of people lack an enzyme genetically like an enzyme that’s used in the liver to metabolize the drug and remember the drug has to be metabolized in order for it to become effective so if you don’t get the tramadol switch to

The desk methyl tram at all it’s not going to relieve the pain so in a significant number of people there will be no pain relief from the drug and those very frequently those individuals happen to be from the middle east they’re very rapid metabolizers of the drug they they can just break the drug down quickly and if you happen to take the prozac or the paxil or

The zoloft that can interfere with the activation of the drug – you shouldn’t crush or chew the pills or split the pills especially if we’re talking about the extended release because that could release a whole heck of a lot of the medication all at once well it can create a sense of euphoria and pleasure not as much as with oxycodone or with morphine or fentanyl

But it can lead to addiction the impaired control over the drug use or compulsive use or continued use despite harm for the drug and we know that there’s psychological dependence and physical dependence associated with the drug lots of side effects side effects ranging from nausea and vomiting and constipation to loss of appetite increased heartrate and rash

Peripheral edema tremor abdominal pain decreased alertness and in the elderly it leads to respiratory depression and falls and cognitive impairment and sedation then it leads to suicide then because it has that extra effect on serotonin in order of epinephrine well we find that the serotonin syndrome a change in your mental status agitation hallucinations of coma

Autonomic nervous instability with increased body temperature blood pressures labile goes up goes down heart rate is increased in coordination hyperreflexia nausea vomiting and diarrhea associated with it it can lead to itching opioids lead to itching because they liberate histamine from mast cells however the itch from tramadol comes from an allergy it also can

Lead to hives or bronchoconstriction asthma like reaction can cause major skin problem toxic epidermal necrolysis stevens-johnson syndrome skin falls off you should not use this drug if you’re taking any of the opioids or hypnotic sleeping pills or if you’re drinking alcohol or if you have a history of bronchoconstriction asthma it interacts with a whole heck of

A lot of different kind drugs the drugs ranging from the opioids to the antidepressants the mao antidepressants to try cite the gamepad depressants the serotonin type antidepressants it works against or interacts with the anxiety medicines the migraine headache medicines we call the trip tens or the ergot it interacts with st. john’s wort and antiplatelet drugs

The blood thinners it interacts with lithium and trazodone and flexural and tegretol and if you take too much of the drug it can lead to respiratory depression and stupor and coma and muscles that become flaccid you’ve become cold and pupils constrict you have a decreased heart rate decreased respiratory rate decreased blood pressure and then unfortunately death

Can supervene if you withdraw from the medicine well if you’ve been taking it for long term or at a high dose you can have a withdrawal syndrome begins between 12 and 24 hours after you stop the medicine and unlike with the opioids where the withdrawal syndrome usually lasts maybe three or four days with tramadol lasts for about seven days numbness and tingling and

Ringing in the ears abdominal cramps back pain joint pain confusion hallucinations paranoia extreme anxiety and panic those are the symptoms now you can get withdrawal unfortunately not just for the narcotic component of this but also from the antidepressant or the selective serotonin reuptake inhibitor activity of the medication well if you take the drug and if

You have a reason to have seizures this may bring seizures on it seems to make people especially sensitive to seizures problems especially if you had take an overdose or a high dose or you combine it with alcohol or with certain other kind of drugs or if you’re having a withdrawal reaction shouldn’t be taken if you happen to be pregnant that’s a no-no or if you’re

Going through labor and delivery or you’re breastfeeding or if you’re drinking alcohol or if you’re taking vibe jersey for the irritable bowel syndrome or if you’re taking quinine not appropriate to take this and it doesn’t seem to have any use for fibromyalgia diabetic neuropathy postherpetic neuropathy the nerve pain you get after the shingles it’s not used for

Obsessive-compulsive disorder it’s not used as an antidepressant and it’s causes cross tolerance with other opioids now interestingly enough when we look at the commercial assays for most of the narcotic drugs this doesn’t show up interesting sidelight of this particular medicine is that tramadol in 2015 was found as a possible treatment for premature ejaculation

It seems to lengthen the time between the onset of sexual activities and ejaculation by as much as 2 to 3 minutes which might be important for those people with premature ejaculation the cost of the drug if you get the immediate release form very inexpensive on the other hand if you get the extended release form you get the 100 milligram the cash price is about

128 dollars for 30 pills that’s a month’s supply if you go up to the 200 millimetre milligram form that costs about $210 if you go to 300 milligram it’s about 270 for one month of therapy at one pill a day so here we have a killer it’s considered a narcotic but not an opioid the authorities are beginning to realize that this drug has significant problems associated

With it it’s now considered a schedule for drug and as we make the hydrocodone and oxycodone more difficult to obtain the number of prescriptions of this drug appear to be increasing and this is a drug that can cause a lot of abuse and a lot of harm so i sort of suggest you stay clear of tramadol unless there’s a very good reason to take it thanks watching i’m dr. ken landau you

Transcribed from video
Tramadol By wellnowdoctor