Tramadol
 

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?

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

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.

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

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

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.

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.

Generally not recommended. See: http://www.drugs.com/drug-interactio...73-2221-0.html

:confused: Not sure I understand; Tramadol is an opiate. Or did you mean something else?

Doc

I'm going to see the neurologist on Tuesday... so, I'll let everyone know what he says about that...

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.

Sorry to post 2 times in a row, but, I am also one of those 'rare' cases who had a hideous reaction to Zofran (an SSRI type drug to stop nausea) and boy was this a doozy....movement disorder for days....and to make matters worse, the usual treatment is Benadryl, which does the same thing to me.

When I see some one not getting the prescribed effect from a drug, I wonder if they are not metabolizing or metabolizing too fast. That is when I look at what else they are one, to see if there is any one enzymatic pathway 'plugged' up, ala 'drug interaction'. More often than not, when it comes to pain treatment, an SSRI is involved.

There has been talk of how much tramadol is to much and the effects on the liver. My average is 150-200mg per day and really helps with the burning.

My thoughts are no point spending years in Pain and checking out with a pink super healthy liver, you cant use it when your gone!

As a matter of interest check out this tramadol abuse forum. keep in mind a vast number abusers are middle class . some of the doses are scary

http://www.medhelp.org/user_journals...y-Room-Part-14

I've been taking Tramadol for over 10 years, along with Lyrica
(previously with neurontin).
I take 100-150 per dose for a max of 300-400mg/day.
It sure helps me & I haven't seen a tolerance issue.

I would eat raw yak liver if it would cure this.:(

When researching Tramadol I found evidence that it also has anti depressant properties. This is a side effect as tramadol is not prescribed for depression that I am aware of

This may explain why its so abused, simply pop a few and get the lift you need. also explains why its so difficult to wean off.

Great for us that are genuine as it effectively gives 2 for the price 1.

Certainly I dont think about much when Im taking it and Im usually a big thinker.

It binds to opiate receptors, much like hydrocodone and all opiates. Tolerance to the drug occurs the same as with opiates. Abrupt withdrawal of tramadol causes flu like symptoms. This can be found on the PDR site and other reliable sources. Although not classified as a controlled substance, do not be surprised if it goes on the list.

If it walks like a duck, and quacks like a duck....
 

I'm not a chemist, and there are definitions, and there are definitions.

Using the Medical dictionary above, "opiate" is defined as:
As a derivative of codeine, tramadol fits that definition, and has many/most of the same characteristics: an opioid analgesic that can produce euphoria, dependency, tolerance, (opiate-like) withdrawal, and the potential for abuse/addiction.

Not trying to start a debate - just explaining my statement.

Doc

Not a debate, but important info to share. It is frightening for one to think their condition is deteriorating because more pain med is needed to control symptoms. In most cases also, esp in high dose control, stopping this med without another opioid on board will induce withdrawal symptoms similar to the heavier controlled pain meds. If one understands tolerance, it helps relieve some of the concern about worsening of PN. The use of any of this class of drugs causes the body's own endorphin production to slow down, thus less of nature's protective system is working, and over time more breakthrough pain. It only takes 3 days use to start reducing endorphins.

In addition to my critical care and ED work, I spent 6 year working in a medical detox, mostly teens and mostly opioids. Sorry to say, tramadol was a frequent flyer.:(

Some other opiates have a serotonin stimulating component too. Oxycodone is one. The itching some people get from synthetic opiates is thought to be serotonin triggered.

The mu receptor does cross react with stimulating serotonin receptors. Some drugs like tramadol have this mixed action more than other opiates.

If you google oxycodone serotonin you can read about it in more detail.

Tramadol mixed with Flexeril increases seizure risk as well as both have mixed serotonin weak agonism.

Tramadol in high doses can trigger seizures in some patients.

This accounts for the "cocktail" effect.

Initially, when Tramadol was marketed, it was said to not have the potential for 'dependence'.

As far as using it, it if works, I see no problem. Very little of what they offer us doesn't cause some kind of dependence issue, or major side effects.

The only issue I see is the original poster is on 2 serotonergic drugs.

I'm on the 2 serotonergic drugs (Cymbalta and Pamelor) so that I can either drop back on the dosage of Neurontin or get off of the Cymbalta.

Tramadol is serotonergic as well.

Ultimately, I think a lot of us have tried a significant number of these medications, and really, none of them work totally. It's a personal journey to find what works 'somewhat' and doesn't cause you a lot of side effects. Some are luckier than others. The best I get to is feeling is, like I was run over by a truck....and the worst, wishing that truck had done me in.

Neuropathy is vast in scope and on a continuum. It is a component of hundreds of diseases, and also a disease on it's own. The only issue I see, is the potential for more drugs to interact....versus using one or two that don't. My personal opinion is that serotonin is a bit over-rated. If some is good, more is not always better. It's pretty much like that with all drugs.

It's not a judgment issue, it's no value attached. If serotonin works, great, if opiates work, fine. Like I said, I would eat raw yak liver, if it worked. I would hold my nose tho.

I think that raw Yak liver would smell like........... liver.:eek:
Most liver, smells just like .....liver.:rolleyes:

There's excellent reason for that.

It's because it's.... :vomit: liver.

that cmybalta is wild stuff be careful . and the tramado er doesn't work as well as the reg tramadol ... I take reg tramadol 100 mg 4 times a day

Hi Raz,

Any idea why that might be?

Doc

I agree! It does give some a big happy boost and that's is hard to not want all the time.

I have idiopathic pnp. I suspect it came about after I received a spinal while giving birth.The nurse had to jab me a couple of times to find the correct injection site.I have suffered from break through pain from over sensitive genital area touch. Please have any female members on this thread ever encountered this type of pain? Please don,t think I am pranking the thread; this is very real.Oh I was on tramadol and neurontin for a long while but my doctor took me off of the tramadol.I didnt have any bad experience with the tramadol, I believe my doctor was afraid I'd become addicted.

In my research i did come across some information pertaining to oxalates and vulva pain. I'm not well versed in this but you may want to check it out. And no i can't imagine anyone with idiopathic pnp pranking any thread.

Hi I got tolerance withdrawal so,
 

Hi
I took Tramadol for almost 10 years. Sometimes needed extra if I did too much, sometimes I gotta do stuff.
I stayed at same dose of first 50-75-100 daily yet went to 75 with back up 25 bc not wanting to go up.
Pain got worse, moods rapid changes, exhausted and irritable.

It is Tolerance Withdrawals and can cause increases in pain.
I learned more so now am in withdrawal on a taper to quit.
It ruined my stomach and impacted my mental health.

I got it compound at pharmacy into a liquid. Doing okay down to last 22 mg, started taper in April.

I use alternative pain management.

Love to connect with others going through or went through a Tramadol taper!

I personally don’t want to be on meds. I still take lots of Neurotin, yet one thing at a time!

Wellness,

Tramadol has...
 

Hi
Tramadol has synthetic opioid & narcotic plus a serotonin component!
I know I am 3/4 way through my withdrawal taper!

I did not want more. I had tolerance withdrawals bc of same does for 8 years.
If you need 300 or more few times a Day imo you need a new pain med!

Plus Tramadol is supposed to be a short term drug! Found that out as well.

Wellness