Comparative pharmacology and toxicology of tramadol and tapentadol

Faria, Juliana; Barbosa, Joana; Moreira, Roxana; Queirós, Odília; Carvalho, Félix; Dinis-Oliveira, Ricardo Jorge

doi:10.1002/ejp.1196

Cited by 72 publications

(115 citation statements)

References 125 publications

(263 reference statements)

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“…Tramadol, with both opioid and antidepressant-like effects, 11 has long been thought to be safer than other short-acting opioids. 11,[15][16][17] Until 2014, tramadol was not a controlled substance and thus was Note. Hazard ratios (HRs) are adjusted for the variables listed in Table 3 of Appendix S1.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike other opioids, tramadol is both a μ‐opioid agonist and a norepinephrine and serotonin reuptake inhibitor . Its unique pharmacology was thought to provide analgesia equivalent to other opioids at a lower effective opioid dose, thus reducing the risk of overdose or dependence . However, tramadol's multiple mechanisms of action also could affect its safety …”

Section: Introductionmentioning

confidence: 99%

“…11 Its unique pharmacology was thought to provide analgesia equivalent to other opioids at a lower effective opioid dose, thus reducing the risk of overdose or dependence. 11,[15][16][17] However, tramadol's multiple mechanisms of action also could affect its safety. 18,19 Oxycodone prescribing has been controversial because it is one of the most frequently abused prescription opioids.…”

Section: Introductionmentioning

confidence: 99%

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Individual short‐acting opioids and the risk of opioid‐related adverse events in adolescents

Chung

Callahan

Dupont

et al. 2019

Pharmacoepidemiology and Drug

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Purpose Hydrocodone, codeine, oxycodone, and tramadol are frequently prescribed to adolescents for moderate pain related to minor trauma or dental, surgical, or medical procedures. Pharmacokinetic and pharmacodynamic differences between these opioids could affect their relative safety. We aimed to compare occurrence of opioid‐related adverse events in adolescents without cancer or other severe conditions taking hydrocodone, codeine, oxycodone, and tramadol. Methods Retrospective cohort study of 201 940 Tennessee Medicaid enrollees 12 to 17 years of age without cancer, other severe conditions, or evidence of substance abuse with 529 731 filled prescriptions for study opioids. Adverse events were defined as an emergency department visit, hospital admission, or death related to opioid use, confirmed by medical record review. Serious events had opioid‐related escalation of care, hospitalization, or death. Propensity‐score adjusted hazard ratios (HRs) were calculated with hydrocodone as the reference category. Results The incidence of opioid‐related adverse events per 10 000 person‐years of opioid exposure was 97.5 for hydrocodone (127 events/13 026 person‐years), 91.2 for codeine (58/6,359), 229.7 for oxycodone (43/1,872), and 317.7 for tramadol (47/1479). The HRs for tramadol in comparison with hydrocodone for all and serious events were 2.98 (2.03‐4.39) and 2.94 (1.81‐4.75), respectively. Increased risk for tramadol was consistently present when the adverse events were restricted to those with neurologic‐respiratory depression/other symptoms of possible overdose. Conclusion In adolescents without cancer or other severe conditions prescribed short‐acting opioids, the incidence of both all opioid‐related adverse events and more serious events with opioid‐related escalation of care, hospitalization, or death was consistently greater for tramadol than for hydrocodone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Individual short‐acting opioids and the risk of opioid‐related adverse events in adolescents

Chung

Callahan

Dupont

et al. 2019

Pharmacoepidemiology and Drug

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“…Gerçekten de alprazolamın yarı ömrü 10-20 saattir (24). Tramadol ve aktif metabolitinin (M1) yarı ömürleri ise sırasıyla 5-6 ve 8-9 saattir (25).…”

Section: Discussionunclassified

Pain Management After Laparoscopic Cholecystectomy

Yaprak¹,

Doğru²,

Mescı³

et al. 2019

Akd Med J

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ÖZAmaç: Ağrı algısı sadece duyusal bir uyarıcı değil, aynı zamanda motivasyonel durum ve duygu durumu ile yakından ilgilidir ve kültürel öğrenme, geçmiş deneyimler, kaygı ve depresyon ile şekillenir. Çalışmada laparoskopik kolesistektomi için uygulanan postoperatif analjezi protokollerindeki opioid tüketimini azaltabilecek yardımcı ajanları belirlemek amaçlanmıştır. Gereç ve Yöntemler:Nonsteroidal antienflamatuar bir ilaç olan Dexketoprofen ve zayıf bir opioid olan Tramadol'u içeren standart bir postoperatif yatan hasta ağrı yönetimi protokolü alan hastalarımız içinde bir anksiyolitik olan Alprazolam'ın preoperatif uygulanmasının (n=12) opioid ihtiyacı üzerine etkisi istatistiksel analizlerle incelendi . Kontrol grubu (n=81), sadece standart protokole bağlı kalanları içermekteydi. Lokal anestezik Bupivakainʼin adjuvan kullanımı, kesi yerine infiltrasyonu (n=23) ile opioid ihtiyacı arasındaki ilişki ayrıca analiz edildi.Bulgular: Ameliyat öncesi Alprazolam verilen ve kesi yerlerine Bupivakain Hidroklorür enjeksiyonu yapılan grupların ilk 24 saatlik opioid gereksinimi kontrol grubuna göre anlamlı derecede düşüktü (sırasıyla p=0,019 ve p=0,033). Toplam opioid tüketimi, sadece lokal anestezi grubunda kontrol grubuna göre anlamlı derecede düşüktü (p=0,045). Alprazolam grubunda, kontrol grubuna göre ilk 24 saatten sonra opioid talep etme riskinin önemli ölçüde arttığı gözlendi. Odds ratio 4,0 (%95 Cl, 1,00 ila 15,99; p=0,038) idi.Sonuç: Bupivakain, Alprazolam ve Tramadol, P450 sisteminin aynı alt birimi ile metabolize edilir; CYP3A4 enzimi. Bu nedenle, bu ilaçların eliminasyonu sırasında enzim için yarışma gerçekleşip vücutta bu duruma bağlı ilaç toksisiteleri gelişebilir. Öyle ki, çalışmada preoperatif Alprazolam alan hastalarda ameliyat sonrası ilk günden sonra Tramadol HCl için artmış ilaç arama davranışı gözlemlenmiştir. Bu durum opioid toksisitesi riski için anlamlı bir ipucu olarak değerlendirilebilir. ABSTRACTObjective: The perception of pain is not only a sensorial stimulus, but it is closely related with motivational state and affect and it is shaped with cultural learning, past experiences, anxiety and depression. Common postoperative analgesia protocols for laparoscopic cholecystectomy are scrutinized to identify adjunctive agents reducing weak opioid consumption. Material and Methods:Preoperative administration of an anxiolytic, Alprazolam (n=12), was analyzed among patients who received a standardized postoperative inpatient pain management protocol including a nonsteroidal anti-inflammatory drug, Dexketoprofen, and a weak opioid, Tramadol. The control group (n=81) included those who adhered to the standardized protocol only. Adjunctive use of the local anesthetic Bupivacaine, by means of wound infiltration (n=23) was analyzed separately to compare the analgesic outcome.

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“…Opioids are mainly used as analgesics and antitussives [13][14][15][16][17]. Physical work and high psychosocial work demands, excessive repetition of tasks, awkward postures, and heavy lifting are all known workplace risk factors for musculoskeletal pain and consequently lead to administration of opioids, according to prospective studies [18,19].…”

Section: Psychoactive Substances and Occupational Risksmentioning

confidence: 99%

Abuse of Licit and Illicit Psychoactive Substances in the Workplace: Medical, Toxicological, and Forensic Aspects

Dinis-Oliveira

Magalhães

2020

JCM

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About one-third of adult life is spent in the workplace. The use of psychoactive substances is a major preventable cause of morbidity and mortality. The consumption of psychoactive substances during or outside working hours greatly increases the frequency and severity of labor accidents, as well as the workers’ poor general state of health and productivity, implying higher costs for enterprises. It is the responsibility of organizations to ensure the safety and health of their workers. These cannot be limited to traditional routine clinical exams, as other aspects also have an impact on health. Thus, prevention and intervention in the consumption of psychoactive substances (e.g., ethanol, opioids, central nervous system stimulants or depressants, hallucinogens, Cannabis derivatives, dissociative substances, and inhalants) in labor activity should be considered as an investment of organizations and not as a cost, in view of the professional, personal, and family advantages for workers and employers, with a potential impact on productivity, security, health, and quality of life at work. Despite the extensive literature on the subject, each article generally focuses on one or another aspect of a very specific nature, not tackling the problem in a holistic way by confronting clinical, safety, and legal issues. This article presents a reflection on the legal, laboratorial, clinical, ethical, forensic, and safety concerns related to the consumption of psychoactive substances in the workplace, and can be a cross-cutting contribution to occupational medicine, forensic medicine, and insurance medicine, as well as for entrepreneurs, lawyers, judges, workers, and technicians from the public and private sectors that develop projects in this area. This discussion is based on general principles established internationally and highlights the role of the occupational healthcare system and other decision-making actors in the prevention and supervision of workplace psychoactive consumption.

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Comparative pharmacology and toxicology of tramadol and tapentadol

Cited by 72 publications

References 125 publications

Individual short‐acting opioids and the risk of opioid‐related adverse events in adolescents

Individual short‐acting opioids and the risk of opioid‐related adverse events in adolescents

Pain Management After Laparoscopic Cholecystectomy

Abuse of Licit and Illicit Psychoactive Substances in the Workplace: Medical, Toxicological, and Forensic Aspects

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