“…However, this use in dogs is controversial, since clinical efficacy studies have produced conflicting results. Some studies indicate that tramadol is equally or more effective than other drugs used to treat pain in dogs (Mastrocinque and Fantoni, 2003;Almeida et al, 2010;Martins et al, 2010;Clark et al, 2011;KuKanich and Papich, 2011;Malek et al, 2012;Neves et al, 2012;Rialland et al, 2012;Kongara et al, 2013;Morgaz et al, 2013;Teixeira et al, 2013;Cardozo et al, 2014), whereas other studies have shown relatively poor analgesic efficacy in dogs (Davila et al, 2013;Delgado et al, 2014;Kögel et al, 2014). Tramadol is considered a prodrug with regard to opioid analgesic effects, requiring metabolic activation by cytochrome P450 (P450) enzymes.…”