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Old 08-17-2011, 10:26 AM   #1
Ed A
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I'm on Tramadol ER (200 mg) and have a script of Tramadol (for the break thru pains). It (regular Tramadol)says every 6 hours. Most days, I only use 1-2 during the afternoon. Some days, however, I take 4-5. is there anything else that can be prescribed? It does work, but, if I'm in a lot of pain, I have to take 1 more. Anyone else have this problem?

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Old 08-17-2011, 12:47 PM   #2
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Hi Ed,

Sure, there are a lot of other analgesics that can be prescribed. Which ones depend on your condition(s), medical history, and other factors. Analgesics are not generally the firstline medications prescribed for peripheral neuropathy (usually gabapentin, Lyrica, Cymbalta, or Topamax, but others as well) but often are in conjuction with non-analgesics.
http://www.mayoclinic.com/health/per...ents-and-drugs

I'm not sure, but it sounds to me like you're describing an increasing tolerance for tramadol. Tolerance can occur with any kind of analgesic; how fast depends on your metabolism. This should not be confused with addiction.
http://drugs.about.com/od/mdrugandme...erance_def.htm

These are matters to discuss with your doctor(s) to make some kind of change if warranted.

HTH,

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Old 08-17-2011, 01:17 PM   #3
Ed A
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Originally Posted by Dr. Smith View Post
Hi Ed,

Sure, there are a lot of other analgesics that can be prescribed. Which ones depend on your condition(s), medical history, and other factors. Analgesics are not generally the firstline medications prescribed for peripheral neuropathy (usually gabapentin, Lyrica, Cymbalta, or Topamax, but others as well) but often are in conjuction with non-analgesics.
http://www.mayoclinic.com/health/per...ents-and-drugs

I'm not sure, but it sounds to me like you're describing an increasing tolerance for tramadol. Tolerance can occur with any kind of analgesic; how fast depends on your metabolism. This should not be confused with addiction.
http://drugs.about.com/od/mdrugandme...erance_def.htm

These are matters to discuss with your doctor(s) to make some kind of change if warranted.

HTH,

Doc
Dr. Smith,
Glad you replied back. I guess I should have posted this with my original message. I'm also currently on Gabapentin (1200mg x3/day), Cymbalta (60mg/day), and Nortriptyline (20mg/day). Guess I just wanted to see if an others are taking Tramadol and if they have/are taking more on some days, less on others. I was also wondering if there's a replacement for Tramadol. Thanks for your reply!!!

Ed
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Old 08-17-2011, 02:18 PM   #4
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Guess I just wanted to see if an others are taking Tramadol and if they have/are taking more on some days, less on others.
I have no doubts. That's usually why they prescribe a maintainance med plus one for breakthrough pain. Sometimes the breakthrough med (as in your case) is the same as the maintainance (or longer-lasting) med, and sometimes they're different meds. Every case is different.

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I was also wondering if there's a replacement for Tramadol.
Sure. Any other analgesic. It's a fairly large pharmacopoeia. People can tell you what works for them, but because everyone is different, that doesn't really help with what may work for you. Doctors often start with what they know works with the greatest number of their patients similar to you, and then make changes/adjustments depending on the patients' feedback. Some trial & error may be involved.

Doc
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Old 08-18-2011, 04:32 AM   #5
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Ed I started on 50 mg of tramadol and it was very strong at the time.
I just took 300mg in the last 24 hours after my feet really swelled up on a plane trip.
Can barley notice the 3OOmg although it has helped with the pain.

Im on around 200 mg a day average and have built up a tolerance
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Old 08-19-2011, 08:48 AM   #6
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Quote:
Originally Posted by Ed A View Post
I'm on Tramadol ER (200 mg) and have a script of Tramadol (for the break thru pains). It (regular Tramadol)says every 6 hours. Most days, I only use 1-2 during the afternoon. Some days, however, I take 4-5. is there anything else that can be prescribed? It does work, but, if I'm in a lot of pain, I have to take 1 more. Anyone else have this problem?
I think 4 or 5 tramadol 200mg? a day is too much. When you get in that range you run the risk to side effects...some people may have seizures or other neuro effects. So I would discuss this dosing with your doctor ASAP.

I am still on vacation and have to be brief today. Will be back next weekend for more thorough postings.
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Old 08-19-2011, 09:58 AM   #7
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Tramadol contains an SSRI like component. How does this all interact with Cymbalta?

I sometimes wonder why not just give some one a low dose opiate? I have managed on mine for many years.
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Old 08-19-2011, 12:08 PM   #8
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Tramadol contains an SSRI like component. How does this all interact with Cymbalta?
Generally not recommended. See: http://www.drugs.com/drug-interactio...73-2221-0.html

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I sometimes wonder why not just give some one a low dose opiate? I have managed on mine for many years.
Not sure I understand; Tramadol is an opiate. Or did you mean something else?

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Old 08-19-2011, 01:28 PM   #9
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Originally Posted by mrsD View Post
I think 4 or 5 tramadol 200mg? a day is too much. When you get in that range you run the risk to side effects...some people may have seizures or other neuro effects. So I would discuss this dosing with your doctor ASAP.

I am still on vacation and have to be brief today. Will be back next weekend for more thorough postings.
I'm going to see the neurologist on Tuesday... so, I'll let everyone know what he says about that...
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Old 08-19-2011, 01:33 PM   #10
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I was thinking something more along the lines of hydrocodone. When Tramadol first came out, the thought was this new synthetic compound was NON-addictive. It isn't. It is called an opoid agonist, but I think there are some differences in terms of metabolism. I believe Tramadol could be classified as an SSRI, as much as an opiate. From what I have read, structurally it isn't an opiate.

I had a huge reaction to Tramadol that landed me in the ER, due to the serotonin agonistic effect.

Why risk liver toxicity due to some of these serotonergic drugs they have on the market? That SSRI clearance is an issue for some people, altho the orignal post wasn't about clearance, it was about an ineffective dose....which, I suppose could be a metabolism problem if all the enzyme pathways were already used, the tramdol wouldn't be broken down to the morphine metabolite?

I think there needs to be more testing of folks in terms of what their liver can metabolize.

I am sure MRSD will put in her 2 cents, and she knows more about this than I do. I just know if one is on an SSRI, that adding additional SSRI could be an issue. Polypharmacy is a big problem these days, not that opiates solve the problem, there are additional problems with opiates as well. But Tramadol is not the panacea that the pharmaceutical industry was hoping for. Unfortunately recreational users of these meds have made a mess for a lot of people. A lower dose of an opiate, can take the edge off for some folks....then again, one can't keep upping the dose hoping for complete relief. It's a quandry.
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