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Sarah Fennick provides a guide to the pain medication tramadol, discussing its use and describing some precautions that patients should take when using the medication.

Tramadol is the generic name for a type of pain relief medication that is generally used to treat moderate to severe pain. Chemically, tramadol is closely related to codeine and is considered a synthetic opioid, but it is generally thought to have lower abuse and dependency potential than opioids like morphine and hydrocodone. As a result, it is not as heavily regulated as those related substances and can be purchased without a prescription in some parts of the world.

Dosage and Methods of Ingestion

There are several options for tramadol buying. The medication is available as a traditional tablet that is taken by mouth every four to six hours, with or without meals. In that form, patients typically take 100 milligrams per day divided into doses of 25 milligrams when starting treatment. Depending on the patient's response, the dosage may be increased to 200 milligrams per day, divided into doses of 50 milligrams. For symptoms that do not respond at that level, daily dosage can be gradually increased as needed, but should not exceed 400 milligrams per day.

Tramadol is also supplied as a quick-release tablet that dissolves when placed in the mouth and should not be swallowed whole. This is a fast-acting form of the medication for patients in need of more immediate pain relief. Dosage is generally higher than that of the standard tablet, with individual doses of 50 or 100 milligrams taken up to four times per day.

A third option for tramadol buying is an extended-release tablet that need only be taken once a day. An initial dose of 100 milligrams is typical, but this can be increased as needed to 300 milligrams daily. This method of delivery is particularly appropriate for patients suffering from chronic pain.

In addition to its generic form, tramadol is marketed under several brand names, including Rybix, Ryzolt and Ultram in the United States, and as Ultracet, a preparation that combines tramadol with acetaminophen. In other parts of the world, tramadol is produced under a variety of trade names licensed by the German pharmaceutical company Grunenthal GmbH, which holds the worldwide patent on tramadol. In addition to tablets and capsules meant for oral ingestion, tramadol is produced in liquid, suppository and injectable forms.

The chemical action of tramadol is not completely understood, but seems to involve both its ability to bind to a particular opioid agonist in the brain and its effect upon the release of the release of the neurotransmitters serotonin and norepinephrine, both of which play roles in regulating mood and attention.

Side Effects and Precautions

The most common side effects of tramadol use are drowsiness, nausea and dizziness. Indigestion, constipation and dry mouth are also somewhat common, although none are considered serious unless they persist and interfere with daily living. More serious side effects can include seizures, skin conditions like rashes, blisters or hives, swelling of the hands, feet or parts of the face, difficulty breathing and fever.

Patients who are allergic to other opioids should generally avoid tramadol and patients who have experienced seizures in the past should exercise caution, as there is some evidence that tramadol can lower the seizure threshold in some individuals. Since part of the drug's mechanism of action involves regulation of serotonin and norepinephrine, tramadol can interact adversely with some antidepressants and MAO inhibitors, increasing the likelihood of seizures in susceptible patients. Patients should be sure to alert their doctors before combining those medicines.

Patients are also cautioned to avoid drinking alcohol while taking tramadol. Since both substances act as respiratory depressants, their use in combination may cause a patient's breathing to slow to a dangerous level.

When initially prescribing tramadol, physicians will often begin treatment at a low dose and increase the dose gradually until symptom relief is achieved. Since patients can develop a tolerance to the medication and become habituated, tramadol use should be reduced gradually. This approach can help patients avoid uncomfortable side effects that can accompany sudden discontinuance of an established tramadol regimen.

Availability

Government regulation of tramadol buying varies from country to country. It is considered a controlled substance in the United States and Canada, but it is available by ordinary prescription and is less restricted than "scheduled" drugs. Other countries generally follow the prescription model, but tramadol is available over-the-counter in Mexico and in some Asian, African and South American countries.

Tramadol buying can also be accomplished through Internet pharmacies. Since the drug is not heavily restricted, purchases can be made without the patient having to present an original paper prescription to the pharmacy. As a result, patients have options that are not available for most other opioid medications. For patients with prescriptions in hand, many pharmacies will fill those prescriptions on delivery via fax or mail. For those without prescriptions, prescribing services are sometimes available.