 |
Legendary
|
|
Join Date: Sep 2006
Posts: 18,914
|
|
|
Legendary
Join Date: Sep 2006
Posts: 18,914
|
Hi, Waves,
I am not familiar with tramadol.
I found four things that might be helpful:
http://psycnet.apa.org/psycinfo/1997-43523-020
Quote:
Case Study: Tramadol induced mania
Reports a case of tramadol-induced mania in a 27-yr-old female with a 2-yr history of bipolar disorder. The S was prescribed tramadol (100 mg, tid) after a motor vehicle accident. By the 4th day of tramadol treatment, she had marked insomnia, felt "hyper," demonstrated rapid speech, euphoric mood, grandiose delusions, and greater psychomotor activity. The S discontinued tramadol treatment and restarted a regimen of carbamazepine. Within 2 wks, the S was completely euthymic. It is possible the S experienced a natural recurrence of her mania. However, it is noted that tramadol is a serotonin reuptake inhibitor, and it is possible that it induced mania similarly to that of antidepressants. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
|
http://neuro.psychiatryonline.org/ar...me=19&page=449
Quote:
Mood-Elevating Effects of Opioid Analgesics in Patients With Bipolar Disorder
Charles B. Schaffer; Thomas
Moreover, patients with a known bipolar disorder should be alerted to the risk of an exacerbation of hypomanic/manic symptoms when they take opioids. Bipolar patients taking maintenance opioids for chronic pain should be periodically assessed to determine whether they are misusing the opioid to self-medicate their depressive symptoms. Four of the nine bipolar subjects who had a hypomanic/manic reaction to opioid analgesics reported that they were faithfully taking prescribed antimanic medication at the time, indicating that antimanic agents might not be protective against this opioid-induced reaction.
As indicated in the table, three of the nine patients who experienced a hypomanic/manic reaction were on a maintenance schedule of antidepressant medications at the time of the activation. The occurrence of this reaction was associated with the introduction of opioids and not the initiation of an antidepressant.
As noted earlier, investigators have found that opioid receptor agonists may have antidepressant properties. Therapeutic medications can affect multiple neurotransmitter systems. One theory proposed for the mood-elevating effects of opioids involves interactions between opioid and dopamine systems. Relevant literature links dopaminergic function with depression and motoric/cognitive hyperactivity.13,14 Further, some opioids, such as meperidine15 and tramadol,16 have serotonin reuptake properties which might account for mood-altering effects.
|
http://onlinelibrary.wiley.com/doi/1...omisedMessage=
Quote:
Slowing the titration rate of tramadol HCl reduces the incidence of discontinuation due to nausea and/or vomiting: a double-blind randomized trial
Results:Significantly fewer patients (22%) discontinued because of nausea and/or vomiting in the 13- and 16-day titration groups compared to the 10-day group (P=0·008 and P=0·006, respectively). The time to discontinuation was also significantly delayed in the 13- and 16-day groups compared to the 10-day group (P=0·006 and P=0·007, respectively). The outcome of the 13-day titration to 150 mg/day was essentially the same as that of the 16-day titration to 200 mg/day, suggesting that this is a true rate effect rather than being dose related.
Conclusion:This study demonstrated that a slower titration rate of tramadol HCl improves tolerability in patients who previously discontinued therapy due to nausea and/or vomiting. This study also demonstrates that the rate of titration of tramadol HCl rather than the target dose is the major determinant of tolerability.
|
http://www.ncbi.nlm.nih.gov/pubmed/19180260
Abstract
Quote:
Tramadol: basic pharmacology and emerging concepts.
Tramadol hydrochloride is a widely prescribed, centrally acting analgesic marketed in over 90 countries. Before being released in the U.S. in 1995, the drug had been available in Europe for almost two decades. Thus, the pharmacokinetic and pharmacodynamic properties of tramadol have been extensively investigated. However, additional information about the drug continues to be discovered. Tramadol exists as a racemic mixture with the (+)-enantiomer and the (-)-enantiomer, and at least some of their metabolites, having different effects.
Tramadol has dual mechanisms of action by which analgesia may be achieved: micro-opioid receptor activation and enhancement of serotonin and norepinephrine transmission. Serotonin syndrome may occur in patients taking combinations of tramadol and other agents that increase serotonin activity. The relative degree of contribution of each mechanism toward pain control is not fully understood. By increasing serotonin and norepinephrine neurotransmission, tramadol may conceivably also exert a degree of antidepressant effect. Therefore, tramadol may be of particular value in patients with chronic pain who also suffer from depression. This drug has been shown to be beneficial in the treatment of a wide range of acute and chronic pain syndromes, including neuropathic pain. While abuse of tramadol may occur, several large studies have demonstrated that the incidence of abuse is rather low, about one case per 100,000 patients.
|
M
|