| Pharmaceutical Information |
| Drug Name |
Tramadol |
| Drug ID |
BADD_D02254 |
| Description |
Tramadol is a centrally acting synthetic opioid analgesic and SNRI (serotonin/norepinephrine reuptake-inhibitor) that is structurally related to [codeine] and [morphine]. Due to its good tolerability profile and multimodal mechanism of action, tramadol is generally considered a lower-risk opioid option for the treatment of moderate to severe pain. It is considered a Step 2 option on the World Health Organization's pain ladder and has about 1/10th of the potency of [morphine].
Tramadol differs from other traditional opioid medications in that it doesn't just act as a μ-opioid agonist, but also affects monoamines by modulating the effects of neurotransmitters involved in the modulation of pain such as serotonin and norepinpehrine which activate descending pain inhibitory pathways.[A182279] Tramadol's effects on serotonin and norepinephrine mimic the effects of other SNRI antidepressants such as [duloxetine] and [venlafaxine].
Tramadol exists as a racemic mixture consisting of two pharmacologically active enantiomers that both contribute to its analgesic property through different mechanisms and are also themselves metabolized into active metabolites: (+)-tramadol and its primary metabolite (+)-O-desmethyl-tramadol (M1) are agonists of the μ opioid receptor while (+)-tramadol inhibits serotonin reuptake and (-)-tramadol inhibits norepinephrine reuptake. These pathways are complementary and synergistic, improving tramadol's ability to modulate the perception of and response to pain.[A4269,A183842]
Tramadol has also been shown to affect a number of other pain modulators within the central nervous system as well as non-neuronal inflammatory markers and immune mediators.[A183728,A183734,A183761,A17159,A182300] Due to the broad spectrum of targets involved in pain and inflammation, it's not surprising that the evidence has shown that tramadol is effective for a number of pain types including neuropathic pain, post-operative pain, lower back pain, as well as pain associated with labour, osteoarthritis, fibromyalgia, and cancer. Due to its SNRI activity, tramadol also has anxiolytic, antidepressant, and anti-shivering effects which are all frequently found as comorbidities with pain.[A182300]
Similar to other opioid medications, tramadol poses a risk for development of tolerance, dependence and abuse. If used in higher doses, or with other opioids, there is a dose-related risk of overdose, respiratory depression, and death.[A183830,F4679] However, unlike other opioid medications, tramadol use also carries a risk of seizure and serotonin syndrome, particularly if used with other serotonergic medications.[A183836,A179926] |
| Indications and Usage |
Tramadol is approved for the management of moderate to severe pain in adults.[L9257,F4679]
Tramadol is also used off-label in the treatment of premature ejaculation.[A173986] |
| Marketing Status |
approved; investigational |
| ATC Code |
N02AX02 |
| DrugBank ID |
DB00193
|
| KEGG ID |
D08623
|
| MeSH ID |
D014147
|
| PubChem ID |
33741
|
| TTD Drug ID |
D05GKD
|
| NDC Product Code |
Not Available |
| UNII |
39J1LGJ30J
|
| Synonyms |
Tramadol | Tramundin | Biodalgic | Jutadol | K-315 | K 315 | K315 | MTW-Tramadol | MTW Tramadol | MTWTramadol | Nobligan | Prontofort | Zytram | Takadol | Theradol | Tiral | Tramadol Lindo | Topalgic | Tradol | Tradol-Puren | Tradol Puren | TradolPuren | Tradonal | Tralgiol | Trama AbZ | Trama KD | Trama-Dorsch | Trama Dorsch | TramaDorsch | Biokanol | Tramabeta | Tramadin | Tramadol-ratiopharm | Tramadolratiopharm | Tramadol Ratiopharm | Tramadoc | Tramadol PB | Tramadol acis | Tramadol AL | Tramadol Basics | Tramadol Bayvit | Tramadol Bexal | Tramadol 1A | Ranitidin 1A Pharma | Trama 1A Pharma | Tramadol Cinfa | Tramadol Edigen | Tramadol Hydrochloride | Trasedal | Ultram | Tramadol Heumann | Xymel 50 | Zamudol | Zumalgic | Zydol | Tramadol Kern | Tramadol Lichtenstein | Tramadol Mabo | Tramadol Normon | Tramadol Stada | Tramadol-Dolgit | Tramadol Dolgit | TramadolDolgit | Tramadol-Hameln | Tramadol Hameln | TramadolHameln | Tramadolor | Tramadura | Tramagetic | Tramagit | Tramake | Tramal | Tramex | Adolonta | Contramal | Amadol | Tramadol Asta Medica |
|
| Chemical Information |
| Molecular Formula |
C16H25NO2 |
| CAS Registry Number |
123154-38-1 |
| SMILES |
CN(C)CC1CCCCC1(C2=CC(=CC=C2)OC)O |
| Chemical Structure |
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| ADRs Induced by Drug |
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