Thread by @Drug_Evidence

THREAD: Trama-DO or Trama-DON'T?
What to know about #tramadol

1/7 Tramadol has multiple mechanisms of action:
- via serotonin & norepinephrine reuptake inhibition
- after metabolism to M1 metabolite, via opioid agonism

bit.ly/3t5o7jC #chronicpain #arthritis #MedEd

2/7 People metabolize #tramadol variably 🤔💊

- Some who are ‘ultra rapid’ produce more M1 (opioid);
- Some ‘poor’ metabolizers (~20% with inactive CYP2D6) may have more SSRI/SNRI-like effect

Thus, analgesic & adverse effects are unpredictable
ncbi.nlm.nih.gov/books/NBK315950 #MedEd

3/7 Tramadol, once called a ‘safer’ opioid, causes tolerance and withdrawal, and is associated with addiction, overdose, and death

Observational studies show people treated with #tramadol, vs other opioids, are ↗️ likely to engage in prolonged opiate use #chronicpain #arthritis

4/7 For meaningful improvement of osteoarthritic pain, #tramadol 💊 is no better than placebo and likely not as effective as NSAIDs

Cochrane review: bit.ly/3owivLz

#chronicpain #arthritis #MedEd

5/7 A @cochranecollab review found low quality evidence that for cancer pain, #tramadol is not as effective as morphine bit.ly/3r1BeR6

Tramadol is NOT on BC Pharmacare formularies and is NOT covered by the Palliative Benefits Plan (“plan P”)

#chronicpain #arthritis

6/7 Each 💊 of tramadol-acetaminophen costs about $0.67-1.69 compared with $0.12-0.20 for 5mg Morphine Sulphate-IR 💰 😯

In 2019, 132 220 British Columbians received at least 1 dispensed Rx of tramadol at total cost of💲9.452 million

#chronicpain #arthritis #drugcosts

7/7 WHY prescribe #tramadol?

👉 it's NOT predictable in effect
👉@cochranecollab found it has MORE ADEs that cause people to stop taking it vs. other analgesics, incl. opioids
👉 it's ↘️ effective than comparators for OA, cancer pain
👉it costs more💰 than morphine

#medsafety

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