Tramal® drops
Active ingredient
Tramadol
introduction
Tramal® is a drug from the group of opioids. Opioids are among the strongest pain relievers, with the opioids between low potency and highly potent Active ingredients are differentiated. Low-potency drugs such as tramadol can be used to treat moderate to severe pain, while high-potency drugs such as fentanyl are reserved for the treatment of very severe pain. The World Health Organization (WHO) has launched a step-by-step scheme that deals with pain therapy. At level 2, low-potency opioids, possibly in combination with painkillers of level 1, i.e. non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac or indomethacin as well as paracetamol and metamizole (Novalgin®) are administered, while at level 3, highly potent opioids are administered. Tramal® is one of the low-potency opioids, compared to morphine it is 0.1 times more potent. Almost all opioids are subject to the Narcotics Act (BtM), tramadol offers an exception. It is available in the form of tablets, hard capsules, suppositories, drops, and solution for injection.
Side effects
Unlike drugs from the widespread group of nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen or diclofenac, opioids have relatively few serious side effects on the organism. However, they can cause numerous side effects that can be distressing for the person concerned. Often it happens to nausea and Vomit, Sweat, a headache, Dry mouth and dizziness. Less often, drowsiness may occur, which in some of the patients means that they are unable to drive. Furthermore, skin symptoms such as rash (Exanthem) or reddening of the skin occur, are also common Constipation (Constipation). On the one hand, these are agonizing for the patient, but on the other hand they are also dangerous because Intestinal obstruction being able to lead. This is why patients who are treated with opioids for a long time are often also given a drug that stimulates the bowel movement (Laxative). Less common side effects of opioids are changes in mood in the sense of euphoria or dysphoria (increased irritability), difficulty urinating (micturition disorders), hallucinations and states of confusion, muscle weakness, respiratory depression, seizures, slowing of the heartbeat (Bradycardia), Increase in blood pressure (hypertension) such as allergic reactions.
Interactions
Before prescribing Tramal ®, the doctor should be informed about all medication taken, including those without a prescription, which may have been purchased in the drugstore and which are regarded as purely herbal and "harmless", because interactions can also occur here. The depressant effect of Tramal ® can be significantly increased if you take sleeping pills, antidepressants of the sedating type (e.g. mirtazapine) and other opioids and if you are under the influence of alcohol. Methadone and similar preparations for the treatment of withdrawal syndrome in drug addiction and cough drops containing codeine can also increase the sedative effect of opioids. In addition, the combination of the above drugs with Tramal ® increases the risk of respiratory depression and even respiratory arrest. Tramal ® itself can lead to a lowering of the seizure threshold and thus increase the risk of a seizure especially in previously ill patients. If Tramal ® is combined with other drugs that lower the seizure threshold, this risk increases significantly. These include antipsychotics such as haloperidol and antidepressants such as amitriptyline.
Another risk with the combination therapy of antidepressants and Tramal ® is the triggering of a potentially life-threatening serotonin syndrome. This can lead to muscle twitching (myoclonus), tremors (tremor), fever, sweating, an increase in pulse (tachycardia) and blood pressure (hypertension) and impaired consciousness. In particular, antidepressants from the group of selective serotonin reuptake inhibitors (SSRI) such as citalopram and those from the group of MAO inhibitors such as moclobemid in combination with Tramal ® significantly increase the risk of such a serotonin syndrome.
You can find much more information under our topic: Serotonin Syndrome
In patients who take blood thinners from the group of vitamin K antagonists (coumarins) such as Marcumar ® (Phenprocoumon), a dose adjustment in the sense of a lowering may be necessary, since therapy with Tramal ® can lead to an even higher bleeding tendency; this shows up in the laboratory as a further decrease in the Quick value or an increase in the INR value. The drug ondansetron from the group of serotonin receptor antagonists used against nausea can inhibit the analgesic effect of tilidine, as can carbamazepine, which is used to treat epilepsy, mania and neuropathic pain.
dosage
The single dose of Tramal® drops can be 20-40 drops, the doctor often prescribes 30 drops as a single dose. 20 drops of Tramal® contain 50 mg of tramadol. As with the tablets and hard capsules, the maximum daily dose is 400 mg, corresponding to 160 drops. Accordingly, a maximum of 40 drops can be taken in the morning, at noon, in the evening and at night.
Application / indication
Tramal® drops, like tablets, are used to treat moderate to severe pain. They are therefore used in stage 2 of the 3-stage WHO pain therapy scheme and can be combined with painkillers of WHO stage 1 such as indomethacin, ibuprofen, paracetamol or metamizol (Novalgin®). A combination of low-potency opioids such as Tramal® with high-potency opioids such as fentanyl should be avoided, as their analgesic effects mutually inhibit each other.
Contraindications
In the event of acute intoxication with sleeping pills, alcohol, antidepressants or other drugs from the group of opioids, as well as in the event of intoxication with heroin (one of the opioids), Tramal® must not be taken, as the depressive and respiratory depressive effect is significantly increased and up to the breath - and can lead to cardiac arrest.
Furthermore, Tramal® must not be taken if therapy with MAO inhibitors is being carried out to treat depression, as the risk of serotonin syndrome is significantly increased here. MAO inhibitors must be discontinued for at least 14 days before treatment with Tramal®.
Simultaneous therapy with Tramal® and antidepressants from the group of selective serotonin reuptake inhibitors (SSRI), such as citalopram or fluoxetine, carries just as much risk, the combination therapy should therefore be carried out with the strictest indication and the greatest caution and regular controls. Tramal ® should not be used in patients with epilepsy that is not well controlled with medication, as the risk of seizures is increased.
Other relative contraindications (taking Tramal® not absolutely contraindicated but with great caution) are impaired consciousness, breathing disorders, conditions with increased intracranial pressure and significant renal or hepatic insufficiency. The use of Tramal® during pregnancy and breastfeeding is not absolutely contraindicated; single doses can be given relatively safely. Nevertheless, the indication should be carefully considered. Long-term therapy with Tramal® during pregnancy and breastfeeding should be avoided, as the child can get used to the active ingredient, which can result in withdrawal symptoms after birth or during the breastfeeding period. In seniors (over 75 years of age), the elimination of Tramal® can be prolonged, so that the dose has to be adjusted to lower it.
costs
Tramal® drops with a dose of 100 mg / ml (about 50 mg for 20 drops) are available in 10 ml, 20 ml, 50 ml and 100 ml packs. 10 ml on a private prescription cost 12.21 euros, 20 ml 13.53 euros, 50 ml 18.04 euros and 100 ml 26.30 euros. If you present a prescription at the till, you only have to pay a prescription fee of 5 euros.
