The analgesic tramadol has minimal effect on gastrointestinal motor function

Abstract

Aims The analgesic tramadol, an opioid agonist and monoaminergic reuptake blocker, has been assumed to interfere less with gastrointestinal motor function than other opioid analgesics, but this has not been specifically investigated. In this study we examined the effect of tramadol on variables of gastrointestinal motor fimction. Methods Ten healthy volunteers participated in a two-arm, placebo-controlled, double-blind, randomized, cross-over study comparing tramadol 50 mg and placebo solutions given four times a day for 10 days. Oro-caecal (lactulose H,-breath test) and colonic (solid markers) transit times and anal sphincter pressures were measured after 10 days dosing. ResultsMehan oro-caecal transit time was 90 min (interquartile range: 75-105) with placebo and 90 min (60-105) with tramadol (not signlficant). The mehan total colonic transit time increased from 45.6 h (25.2-64.8) with placebo to 58.8 h (50.4-78.0) with tramadol (not significant), which is still withm the normal range ( < 60 h). Anal sphincter resting pressures were not significantly changed by tramadol compared with placebo.Concfrrsions Tramadol has a minor delaying effect on colonic transit, but no effect on upper gastrointestinal transit or gut smooth muscle tone. Tramadol may be a useful analgesic where interference with gut motor function is undesirable.

The enantiomers of tramadol and its major metabolite inhibit peristalsis in the guinea pig small intestine via differential mechanisms

“…In one study tramadol was found to slow colonic transit time to a small extent in healthy volunteers, but had no effect on upper gastrointestinal motility [21]. Another study found tramadol to have a measurable but smaller inhibitory effect on gastric emptying than morphine and codeine [22].…”

Pharmacokinetics of tramadol and its major metabolites in alpacas following intravenous and oral administration

“…Tramadol is considered to have a low abuse potential, and unlike opiates, is not a controlled substance (Desmeules, 2000). In other species, tramadol has little effect on GI motility, no clinically relevant cardiovascular or respiratory effects, and lacks pharmacodynamic tolerance (Wilder Smith & Bettiga, 1997; Scott & Perry, 2000; Klotz, 2003; Grond & Sablotzki, 2004). Therefore, tramadol is a first‐choice drug for moderate to severe pain, especially in patients with compromised cardiovascular and pulmonary function (Scott & Perry, 2000).…”

Safety, Tolerability, and Pharmacokinetics of Therapeutic and Supratherapeutic Doses of Tramadol Hydrochloride in Healthy Adults: A Randomized, Double‐Blind, Placebo‐Controlled Multiple‐Ascending‐Dose Study

“…Although research suggests that tramadol exhibits a measurable but smaller effect on gastrointestinal motility than that of conventional opioids such as codeine and morphine, care should be taken while administering higher doses. 14,23,24…”

“…The most common adverse events associated with the use of tramadol are dizziness, nausea, vomiting, headache, constipation, and somnolence . Tramadol has been reported as less likely to lead to respiratory depression and has less effect on the gastrointestinal motor function than pure opioid agonists at equianalgesic doses …”

“…12,13 Tramadol has been reported as less likely to lead to respiratory depression and has less effect on the gastrointestinal motor function than pure opioid agonists at equianalgesic doses. 14,15 Regulatory authorities are increasingly focusing on the cardiac effects of noncardiac drugs and especially on their potential impact on cardiac repolarization, as measured by the duration of the QT interval on a standard 12-lead resting electrocardiogram (ECG). Delay of cardiac repolarization could lead to cardiac arrhythmias and sudden death by ventricular fibrillation.…”