Talk:Tramadol/Archive 1

Archive 1

Archive 2

Serotonin Syndrome from Mixing Tramadol with a Light Box

This simply isn't true. This is unfounded amateur pharmacology theorycrafting - and has been removed from the article. 69.179.3.217 (talk) 09:33, 20 February 2011 (UTC)

Controlled substance

Tramadol is a controlled substance now —Preceding unsigned comment added by 204.167.92.26 (talk) 13:55, 16 December 2008 (UTC) only in Arkansas and Oklahoma, not federally scheduled. As of 2011 Tennessee, Tramadol is a controled substance as well. — Preceding unsigned comment added by 12.139.105.203 (talk) 20:27, 29 September 2011 (UTC)

Who said tramadol is not addictive?

I've been addicted to tramadol for at least a year, maybe two or more (difficult to estimate). During this summer I've tried to get rid of them by phasing them out. I've had severe problems with abstinence.

I'm writing this because I think this matter is of importance, and it's in my interest to help people avoid what I experienced.

- Repabil 22:20, 5 Aug 2003 (UTC)

I replaced but is not addictive with therefore it's also addictive. - Repabil 13:16, 9 Aug 2003 (UTC)

- I added a reference to the Ortho-McNeil prescribing information which does discuss the potential for dependence and abuse. 66.166.22.146 18:04, 15 February 2006 (UTC)

That is original research... Is there evidence in the literature? —Preceding unsigned comment added by 77.251.51.253 (talk) 20:17, 6 May 2008 (UTC)

What?!? That's the exact opposite of original research. Did you maybe comment in the wrong place? --63.25.252.161 (talk) 06:25, 9 August 2008 (UTC)

you may want to elaborate on the addiction. remember, anything can be psychologically addicting, such as certain foods, entertainment, or hobbies. also remember, psychological withdrawls can also make you think your having physical withdrawls. —Preceding unsigned comment added by 68.188.201.146 (talk) 19:20, 15 December 2009 (UTC)

Certainly no doubt about the addictive nature of this drug. It is PRIMARILY physical in nature and not to be disputed as a physcological manifestation. Most abuse of this drug occurs from the need to not feel its physical withdrawl symptoms and has a minimal benefit otherwise. —Preceding unsigned comment added by 74.195.243.236 (talk) 05:13, 25 October 2010 (UTC)

Well, I have been on it for chronic back pain for several years and it manages my pain effectively. I have not had to increase my dosage either. When I miss a dose, my back just hurts as it did before...I don't freak out or go into withdrawal or anything. Sounds to me like you have some sort of personal problem with addiction. Whatever the case, you cannot make a blanket statement that it IS addictive. WarFighter (talk) 16:52, 12 March 2013 (UTC)

Tramadol is less addictive than Morphine

First  : it'is impossible to take large amount of tramadol otherwise you get convusion due to the action on serotonine recapture Second : by acting on serotonine receptors it has two ways of acting

This is not true. It is definitely possible to take a large amount of Tramadol. The more you take, the more you have to take for it to work. nut-meg 05:23, 23 January 2007 (UTC)

=> then you couldn't have a large morphinomimetics effect with tramadol

tramadol is not a very potent morphinomimetics, not like methadone, or very more potent : fentanyl and there analogues

Tramadol have a semi long timelife in your body : it'is good for pain medication, it make the comming on tollerence slower

But of corse if you use tramadol a long time ( and especially without pain ) you can get dependend .

You have right it is codeine structure related, but it'is 100% syntetic ( Its been found in Nature as of 09/2013 ) ( Nauclea latifolia has been found to be a natural source of the synthetic opioid tramadol. )

Tramadol belong on the class IIb of the analgesics, it'is not the most lightest of the opiates.

I think that the opiates that have acte on morphinomimetics receptors + the nmda receptors are better than thous that acte only on morphinomimetic receptors. Methadone do it, dextropropoxyphen, there is now a combinaison that is called Morphidex.

Hope that a day we got good medication against pain, that are not acting on morphinomimetics repectors

I realise you probably aren't well-versed in medical terminology, but I thought I might try to clarify a few things for you. Tramadol may be "morphinomimetic" in the sense that it mimics the action of morphine; however there is no such thing as a "morphinomimetic" receptor - you're probably referring to the μ-opioid receptor. And while it is a synthetic structure unrelated to the opiates, it is still an opioid with all the same problems associated with opioids (largely mediated by the aforementioned μ-opioid receptor). Tolerance does not depend on the rate-of-onset or the half-life of the drug, tolerance will occur to an agent regardless. You're probably confusing tolerance with psychological drug dependence where drugs with a rapid euphoric effect (e.g. intravenous heroin) are associated with a higher occurence of dependence. I was not aware that any of the opioids had any action at glutamatergic NMDA-receptors [methadone certainly does], but even so this would not have any significant effect of making them "better" in terms of the known pharmacology of glutamate and opioid receptor systems. Techelf 06:20, 10 Nov 2004 (UTC)

It's also good to note, except for opioid like withdrawal symptoms, a chronic user of tramadol, will also have to go through the depression similarly caused by the cessation of anti-depressants. Double whammy. Good news, its milder.--78.86.117.164 20:20, 28 September 2007 (UTC)

However, Tramadol doesn't increase tolerance much at all. The typical abuser gets to 400 to 800 mgs per day and stays in that area. It's one of the most widely abused drugs in the former Soviet Union, so that information should be easy to verify, although it may require some knowledge of one of the languages of CIS states. —Preceding unsigned comment added by 128.195.186.70 (talk) 12:53, 20 February 2008 (UTC)

Antidepressant effects (?) of Tramadol

Due to its purported inhibition of reuptate for norepinephrine and its potentiation of serotonin effects, I have heard it mentioned that Tramadol can exert an antidepressant effect. I have noticed no drowsiness, for example, as I might even get with codeine---no muddledness. Also, the notion that an upper limit exists for ingestion per day is an indication of its limited drowsiness potential. As for withdrawal, I did notice mild withdrawal for 2-3 days, but I think it would indeed be minor---consistent with anecdotal reports of its limited addictive potential. Apart from issues of seizure activity in susceptible individuals, it appears to be a safe and effective painkiller for lower back pain (in my experience).

Also - quite anecdotally, as well - I imagine antidepressant action. Mu receptor involvement might be the "third rail" of comtemporary psychiatric practice, with practitioners considering mu receptor involvent (bona fine neurotrammiters receptors like the other noncontroversial ones such as serotonin and norepinephrine) are off-limits in moderating depression. Tramadol offered this to me in my experience (concommitant to back pain relief), and I hope it might be given consideration in that capacity.

I can understand, theoretically, how the adrenergic and serotonergic effects might lead to the conclusion that tramadol has antidepressant effects. And while I have seen several studies published, based on in vivo studies in rats, which show some efficacy; this is insufficient evidence to justify its use in humans for this indication. To the first poster in this thread, I find it quite surprising that you did not notice any drowsiness, given that sedation is a common effect of μ-opioid receptor activation and 5-HT reuptake inhibition. It may be that your body had already developed tolerance to the sedative effects of opioids from previous codeine use. To the second poster, μ-opioid receptors are indeed bona fide - and one of the known effects of μ-opioid receptor activation is to produce euphoria. This, however, is not the same as alleviating major depression. Using μ-opioid receptor agonists as a therapy for major depression is hardly rational - if they are effective in depression you would expect that more potent and selective opioid receptor agonists (e.g. morphine or fentanyl) would also be effective; however they are clearly NOT. This suggests that, if tramadol really is effective in depression, it may be an idiopathic effect - particularly since the mechanism of action of current antidepressants is also poorly understood. In the coming years the role of the endogenous opioids (dynorphins, endorphins, enkephalins) should be more substantially characterised and we shall see whether this hypothesis is correct. And even if tramadol or other opioids are shown to be clinically efficacious in humans, the risk of using opioids as antidepressants would be unjustified in light of their propensity to produce dependence/tolerance and risk of abuse compared with SSRIs. Techelf 06:20, 10 Nov 2004 (UTC)

Egad! Fentanyl is a serious CNS depressant, and would be as bad a candidate for an antidepressant as a bottle of vodka. Quite right that one would never treat major depression with opioids per se. However, tramadol has much more than mu activity. . . Look at its panoply of neurotransmmiter effects. A soupcon of mu activity (the lack of it) is of course a component in depression; if we had no natural opioids, we would terminate our lives in short order. Drowsiness or muddledness is, in fact, much reduced in tramadol, probably because of the comcomitant GABA, norepinephrine and serotonin effects. I am here to tell you---and since you are likely a medical professional you are aware of this---that SSRI's and others outside that class like Wellbutrin are only truly efficacious to 50-60%, so one should keep an open mind. My point is that simply because an opioid effect is present, many will rule it out as a possible treatment for depression. One last point: more exists in patient issues than major depression. Minor depression is widely dealt with by myriad Rx's; my implication was tramadol's possible consideration in minor depression.

What you are presenting here is original research. If you feel Tramadol should be used as an antidepressant you will need to back it up with literature references. While we need to keep an open mind, Wikipedia is not a forum for original research unless you can back this up (and a web page is insufficient, I'm talking peer-reviewed stuff here). There is a lot of amateur psychopharmacology on the web anyway. JFW | T@lk 12:35, 18 Nov 2004 (UTC)

Tramadol definitely has theoretical antidepressant potential as an SNRI (similar to venlafaxine). See http://opioids.com/tramadol/ultramantidep.html and http://opioids.com/tramadol/tramadol.html They both come from reputable publications, but mostly involve studies on mice, not humans.

The comment from a longtime contributor-editor of many Wikipedia pharmacology/drug articles opined [in the comment above from 18 Nov 2004] some 2-1/2 years ago that my musings on tramadol's consideration as an antidepressant drug candidate should be relegated out of even this discussion section . . . that I was proposing original research. Proposing original research is, I believe, entirely fitting as a Wiki discussion section comment. Now [in April of 2007] I find the article has been continually updated to currently include apparently substantiated information that the drug has SSRI qualities (I had heard before that it possessed reuptate inhibition for a different neurotransmitter). Does not SSRI activity fall under the aegis of antidepressant potential? If this is so, and if it is also so that tramadol potentiates dopamine presence, then this drug is looking more interesting as one to alleviate depression and fatigue. I am also hearing that the Mu receptor effect/involvement of tramadol is now thought to be relatively miniscule by comparison with traditional opioids: that much of its pain mitigating activity actually derives from the other potentiated neurotransmitters: GABAergic, noradrenergic, dopaminergic and serotonergic. Furthermore, the action of tramadol in achieving the sensation of fatigue lift (part and parcel of the lifting of depression)—along with its curious aspect of causing virtually no drowsiness at moderate dosages—is rather immediately achieved; any drug that can do this instead of entailing a wait-and-see of two to six weeks before onset of action seems worth a further look. --PLK

The terms 'epinephrine' and 'norepinephrine' should be replaced by 'adrenaline' and 'noradrenaline', which are more accepted worldwide. Nephro (talk) 19:40, 1 July 2008 (UTC)

To add to this discussion an anecdote, I have experienced depression as a result of serious chronic pain after an accident and daily use of strong opiates and opiods like morphine and oxycodone seemed to make me more depressed. When I switched to tramadol for relief of chronic pain, I found myself much less depressed. In addition to its serotonergic action, I believe that the depression was lifted both by tramadol' causing relatively less side effects than oxycodone and by its effect relief of my pain which made me depressed on its own. --Rotellam1 (talk) 20:21, 30 May 2011 (UTC)

Not meant for extended use

Tramadol has warning about quantity per day and "not for long term administration". Its unknown mechanism of action could produce changes in the synaptic gap similar to antidepressant effects but of no or of harmful value. Long term or overuse could produce personality change, anxiety symptoms and other disorders.

In practice many people are on long-term tramadol, most with no long-term repercussions. JFW | T@lk 05:09, 5 February 2006 (UTC)

Me included. I was prescribed it for long term usage, and that's with my stipulation to my doctor that I not be prescribed any medication with mood/personality affecting effects. ⇒ SWATJester ^Ready Aim _Fire! 05:30, 14 April 2006 (UTC)

I started using Tramadol about two weeks ago for severe burning and spiking sensation in my feet, hip pain, lower back pain and fatique. Tests have ruled out diabetes, hepatitus etc. While the tramadol is not really helping the pain it has dulled the burning sensations in my feet when I am at rest but not while working and it also has greatly alleviated my fatigue and depression. I was not expecting this as the precautions said it would cause drowsiness. I do not feel hyper, doped up or anything unusual suprisingly i feel normal like I am not even taking medicine. I do not feel addicted or have cravings for more of the pills. I take it as prescribed 2 every 4-6 hrs. While I would not keep taking tramadol for its non pain relieving effects I will keep taking it for its non narcotic uplifting effects.

Non-narcotic? Perhaps you should read through other's comments or the article itself. Tramadol clearly falls under the category of being a true narcotic. Of course, the word narcotic has come to be used as a generalization for almost any illicit drug (i.e. cocaine, marijuana) when in truth its strict definition is limited to drugs that cause sedation.) All tangents aside though, the poster should be aware that tramadol--while perhaps falling in the weaker, safer category--is still very much a narcotic. —Preceding unsigned comment added by 12.186.80.1 (talk) 16:17, 2 January 2009 (UTC)

I think the prior poster was using the term "narcotic" as a descriptor of a medication without sedating effects, as in this particular case, he found it to be non-sedating. Therefore "non-narcotic" would be an accurate description of the effects on this particular patient. Nightsmaiden (talk) 09:22, 30 July 2010 (UTC)

Length of use

I have been taking Tramadol for a year for pain associated with fibromyalgia. My doctor decided to change medications. I was on 100 to 300 mg per day.

I am most definitely experiencing physical symtoms as I am limiting the use of the drug. Within the last week I have gone from 300 mg to 50 per day. I am experiencing pretty severe anxiety and chills along with insomnia, and some physical discomfort. How long can I expect this to continue? When should I just stop the meds completely? I would have to agree that I have experienced physical dependence with the use of Tramadol. Is a year to long to have been on this medication? —This unsigned comment is by Jodygaff (talk • contribs) .

Hi Jodygaff,

I was on Tramadol for over two years, working my way up to over 1000mg a day for over 6 months. I stopped taking the drug cold-turkey, and the withdrawl was very bad; however, it was nowhere near as bad as withdrawl from hydrocodone, which I also took for 2 years, approaching 200mg a day near the end. I suffer from chronic jaw pain and was put on Tramadol as a substitute for hydrocodone -- because of its "non-addictive" status, but in large part because it is not considered a controlled substance and my doctor was more comfortable prescribing it. While tramadol doesn't produce the same, opiate-like high (as others have elaborated on in this article) its effects can certainly be considered addictive -- certainly with those predisposed to drug-abuse. —Preceding unsigned comment added by 72.224.112.40 (talk) 17:30, 21 June 2008 (UTC)

Wikipedia cannot give medical advice (nor can wikipedians), so I need to advise you to speak with your physician. Opioid withdrawl syndrome is quite variable and duration seems to depend on the individual as well as the substance. While typical heroin withdrawl is over within 48-72 hours, acute methadone withdrawl has been said (anecdotally) to last much longer, perhaps even weeks. Some experience little or no withdrawl symptoms at all. I don't know of any studies offhand regarding the duration (or even existance of) tramadol withdrawl. It's important that you speak with your physician about the symptoms you are experiencing regardless. --Bk0 (Talk) 00:16, 15 March 2006 (UTC)

--Rick53 09:56, 20 June 2006 (UTC) I too want to agree with Jodygaff,withdrawing gives me anxiety and chills,sneezing, runny nose,also bouts of crying and physical discomfort internally,i use 100mg Tramal per day. My main reason for going off Tramel is it makes my mouth stimulate so much saliva ,also the end of my tongue has a metalic taste,& lastly an irritation of air bubbles under the tongue & also on the top to the roof of my mouth,which is driving me to a point of despair

Tramadol VS Dihydrocodeine

I read in the DHC artical that the potency was 30% that of morphine

Tramadol is 10%

Is Dihydrocodine really 3 times more potent than Tramadol????

Somethings wrong; right?

Yes, the article on dihydrocodeine was incorrect. With respect to IM administration, approximately 130 mg codeine/dihydrocodeine or 100–120 mg tramadol is considered of similar analgesic potency to 10 mg morphine – not taking inter-individual variability of course. -Techelf 10:38, 26 May 2006 (UTC)

Codeine and dihydrocodeine are not of the same potency; the analgesic potency of DHC is some 170 - 200% that of codeine; while 130 mg codeine i.m. are equianalgesic to 10 mg MS i.m., 70 mg dihydrocodeine i.m. are equianalgesic to 10 mg MS i.m.--84.163.77.244 21:50, 4 September 2007 (UTC)

21:58, 9 May 2011 (UTC)ProfMad21:58, 9 May 2011 (UTC)

DHC is more potent than codeine, both w/w & objectively -fact.

It is more abusable, and thus most probably, more addictive.

DHC is poorly absorbed orally ( bioavailability ~25%.){Codeine ~85%}. Thus, as with morphine, with a similar oral bioavailability, it is considerably more potent on IM injection. Some Physicians compare it to a low dosage of morphine, in severe pain.

Note: Codeine or DHC must not be used IV. They both produce a histaminic & thus potentially lethal anaphyllactic reaction.

The above interpretation of tramadol/ DHC/ codeine comparison, has been misinterpreted. Tramadol is not as potent as DHC, more potent than codeine, and requires a lower dose by weight, to achieve analgesia.

It does have a ceiling of efficiency however, making it a relatively weak 'opiode analgesic', nonetheless.

21:58, 9 May 2011 (UTC)ProfMad21:58, 9 May 2011 (UTC)~ —Preceding unsigned comment added by Profmad (talk • contribs)

I'm Max, I had a vascular necrosis of the head of femur, which lead to me getting prescribed tramal six months before i had surgery (hip replacement). Now its been a year since i had the surgery and i'm still on the drug even though the pain stopped about 11 months ago. My problem is that my resistance level is increasing and i've walked my way upto 500mg a day and i fear that if i dont do something about it soon, it will continue to increase. I have sickle cell disease, which means whenever i'm in pain, the doctors have to give me very high doses of morphine to reduce the pain, and sometimes they inject me with the maximum dose allowed but the pain is still there which means i will have to suffer through it for hours as a result of my dependence on tramal. right now i trying my best cutting down on the dose as often as i can, even though i relapse sometimes i'm not ready to give up because i cant imagine what the future would be like if i dont end this addiction. —Preceding unsigned comment added by 41.206.12.12 (talk) 15:26, 16 January 2011 (UTC)

Opioid?

Tramadol is an opioid? News to me. A couple of years ago I was able to order 100 tablets of it from a Swiss mail-order pharmacy, without a prescription. AFAIK, no other opioids can be shipped internationally, at least on the consumer market. Does anyone have URLs for any whitepapers on the subject, which determine that it is, in fact, an opioid and not merely a strong non-opioid analgesic? Clearly, I need to be enlightened on this subject. Avalyn 14:48, 30 June 2006 (UTC)

Yes an opioid, and yes in UK most definitely is a Prescription only Medicine (meaning anyone supplying the drug without a prescription, in the UK, would be breaking the law). Likewise Ciailis & Viagra are POMs, yet as much spam email attests to often available without prescription from suppliers operating out of other countries. David Ruben ^Talk 21:09, 30 June 2006 (UTC)

Recreational Drug

Like yall said, it can be a recreational drug. Ive given it to many of my friends and taken high doeses myself. I added a recreation section (10/11/06) that includes the side effects and its possible dependence and tolerance. I dint use any sources, but yall above me (and the people ive given this drug to) will probrably agree with me that my added section is fact

—Preceding unsigned comment added by 71.71.71.43 (talk • contribs) (01:27, 12 October 2006)

Unfortunately neither your personal claim (which counts as WP:No original research or those of yoyr friends will count as WP:Reliable sources as far as adding material to an encyclopaedia. And yes material in wikipedia must be sourced. Many drugs could be used "recreationally", but that does not automatically mean that they are, or that so used by a trivial number of people (large number, if can WP:VERIFY woul dneed mentioning of course under WP:NPOV).David Ruben ^Talk 01:14, 12 October 2006 (UTC)

Tell that to any of the DEA-type agencies anywhere in the former Soviet Union. It's one of the most widely abused drugs there, on the same level only with codeine and marijuana. —Preceding unsigned comment added by 128.195.186.70 (talk) 12:55, 20 February 2008 (UTC)

Here is an article mentioning widespread recreational usage of Tramadol: Hooked on chill pills in war-torn Gaza. If that's not a reliable source, just use Google to search "Tramadol Gaza" and you'll easily find another article. Fdskjs (talk) 23:44, 13 July 2009 (UTC)

If this is going to be in the article, and appropriate section must be created for it, such as "Tramadol and Society" — Preceding unsigned comment added by 66.31.40.97 (talk) 00:57, 31 October 2012 (UTC)

My doctor prescribed me tramadol about 2 years ago, and when i researched it i found that it is "not" an opiate. My doctor also told me that it was not. Now a couple years later i read that it is? —Preceding unsigned comment added by 99.9.61.133 (talk) 14:42, 17 November 2010 (UTC)

Illegal/Recreational Use

Rephrased the "recreational use" section, as it appeared to advocate illegal use and abuse of the drug. Removed uncited "study" claim of being less addictive than other drugs. Editors with more knowledge should fact check this section. nut-meg 05:11, 23 January 2007 (UTC)

Tramadol Withdrawl

Currently in the main article, the only mention of withdrawal is:

In addition, there are widespread reports by consumers of extremely difficult withdrawal experiences.

For people going through withdrawal, WP will be one of the many sources that people will look at. I have just gone through this experience myself after being on only 150mg/day for about 6 weeks for back pain. I personally found it to be a totally horrible week, that started not too bad before 4 days I'd rather forget, but now a week later I'm out the other side.

WP however needs to have not personal experiences, like mine, but well researched information and in areas like this, preferably from a medical expert. I spent a lot of time looking for medical reference material around this area and found little material that would meet the quality standards for WP, although I found a huge amount of posts denoting personal experiences.

So this is a request for expert help to extend this article to benefit WP readers, especially people who have been on this drug and medical professionals (my own GP had a look at this page checking for info). I am more than willing to help in this task, with guidance. --Mendors 02:34, 4 March 2007 (UTC)

It is addictive, and so are virtually all antidepressants, as well as such things as caffeine. If one must cease the drug, then one must taper off; don't be foolish and stop abruptly. Natually, unpleasantness will be the result. I once had a terrible headache from coffee (caffeine) withdrawal: I had undergone surgery and hadn't had any coffee that a.m. After surgery, my dull headache got progressively worse. I had thought that the norphine I was being given (they gave me MORE after I asked for it) would obviate the caffeine withdrawal headache, but it only went away when I got some coffee! The moral is . . . there is a moral (see above). --PLK

Contradict marker

I placed the contradiction marker on the page, the introduction states it's for "mild to moderate pain", the first section claims "moderate to severe". A citation for one or the other would help. 85.216.229.175 19:10, 15 September 2007 (UTC)

Pain assessment is notoriously impossible to objectively quantify. In medicine, pain scores are always self-reported. There is no contradiction here, although there exists imprecision. But that is intrinsic to descriptions of pain and, ipso facto, pain palliatives.Lesotho 01:27, 16 September 2007 (UTC)

Yes, pain is difficult to quantify. The documented recommendations of when the medication is meant to be used are not. The request for a citation and consistency throughout this article is not inappropriate. If different sources give different information, a sentence or two indicating that there are conflicting sources would be relevant information, I think. Nightsmaiden (talk) 09:27, 30 July 2010 (UTC)

Serious citation gaps

Can someone fill them, in Dependence? Tony 08:16, 17 September 2007 (UTC)

And a general note:

DO NOT SEEK MEDICAL ADVICE ON THIS PAGE: here, we discuss how to improve the article only. Tony 08:19, 17 September 2007 (UTC)

Indeed - {{talkheader}} tag insert at top of this talk page and some blogging (& unsigned) personal experiences removed. David Ruben ^Talk 12:26, 17 September 2007 (UTC)

Why were the country specific brand names removed?

Why were the country specific brand names removed? --Law Lord 22:28, 29 September 2007 (UTC)

That section is too long and I can't see any value to it. This is the English-language Wikipedia and most of them aren't even in English-language countries. Besides, we don't have a WP:RS for that information, which is an absolute requirement to be included on WP. Unless somebody can come up with a good reason, I'm going to delete it again. --Nbauman (talk) 01:11, 19 October 2011 (UTC)

What happened to anxiety? Panic attacks?!?

I took tramadol for a few weeks two years ago, and it caused me anxiety and severe panic attacks. I was only able to figure this out because the prescribing information stated that these were potential side effects. I seem to think the Wikipedia article mentioned this back then, but maybe I'm wrong. Point is, anxiety is a well-known potential side effect of tramadol, and I'm wondering why it isn't in the article to begin with. --63.25.116.33 (talk) 01:53, 13 December 2007 (UTC)

That could be serotonin syndrome, since tramadol tends to prevent uptake of serotonin. If there are other substances (not necessarily SSRIs) that are inhibiting uptake or contributing to high serotonergic activity, then perhaps that would trigger the symptoms. Wellbutrin, for instance, is not an SSRI but does have SSRI-like properties, so that could be a questionable cocktail that a lot of doctors might miss. -Rolypolyman (talk) 00:42, 26 December 2007 (UTC)

I'm not convinced that anxiety and severe panic attacks have a proven association with tramadol; it seems to have been observed only very rarely. Rolypoly, do you mean reuptake? Tony (talk) 13:25, 26 December 2007 (UTC)

I need more proof please...

I have been researching this medication for years upon years, trying to decipher all of the available information. I'm trying to understand HOW IN THE WORLD Ultram (tramadol) is an "opiate". I see "proof" on both sides of the isle, some information proving that it is an opiate and some proving that it isn't. Personally, I do not believe that Ultram/Tramadol is an opiate, or derived from any form of opiate.

Now, from personal experience, as a chronic pain sufferer, and also having spoken with countless friends in my chronic pain online support group, NONE of us see, or rather feel (effects on the body, that is) that this medication is an opiate. The one and only time that I took it, I did not feel relief from pain at all, and having been on hydrocodone for years prior to starting the Ultram/Tramadol, could feel nothing from it (even at triple doses).

I understand that most internet information reports that Ultram/Tramadol "acts" as an opiate, but isn't actually an opiate. That in and of itself makes NO sense to me.

1. Can someone, provide me relative proof that this drug either is/is not an opiate? And I don't mean telling me "it's an opiate, because "so-and-so" says it is. (i.e. In the chemical breakdown; opium, or a derivative of it, is there.)

2. IF Ultram/Tramadol is an opiate, how can it be sold w/o a prescription over the internet? (And before you go there, I know it is being/can be done for a fact.)

3. IF it is an opiate, I understand that it is a synthetic form. How does this affect the medication?

4. What are the benefits/drawbacks with using synthetic opiates? Do synthetics not work as well, or do "naturally" derived chemical compounds work better? For Example: I was on hydrocodone for 6 yrs. and could feel when it hit my system. With the current medication that I am on, it is similar to Ultram, in that it is synthetic, and I never feel it hit my system. Why is that? (Note: This medication is for my chronic pain, NOT recreational/illicit drug use!)

I know these are a lot of questions, but I've been doing research for a long time on this medication, and I do have a good source with which to provide information to update the article with a qualified resource, but before I do, I'd like to just know a few things. I haven't ever added to any article in WP before, and am a bit nervous/uninformed about how to do it. Any info on that would be much appreciated as well.

Many thanks for anyone that is willing to tackle my questions.

Mom2-4Kids (talk) 19:23, 24 January 2008 (UTC)

I can certainly understand your questions and I'm sure someone (if no one else maybe even me) would be happy to take a stab at answering them. This is not the place to do so, however, as this is a page for discussing changes to the Tramadol article and not answering questions about the drug. May I suggest you post your questions over at the Science Reference Desk? Those folks specialize in just this sort of thing. --George (talk) 13:53, 25 January 2008 (UTC)

Tramadol should not be bought over the Internet; such a practice is illegal in many jurisdictions, and medically questionable everywhere, for a number of reasons.

As I understand it, as a layperson, T is an opiate analogue, synthesised in the lab. Its properties differ from those of other opiates, but there is a degree of commonality. For example, it, too, can cause constipation; but its bioavailability and pharmacokinetics are specific (of course, T is typically "slow release", too); and it's serotonergic, too, of course, which natural opiates are not.

Some of your points may relate to the improvement of the article, but some appear to be seeking medical advice. Please restrict your postings to the former. Tony (talk) 02:58, 25 January 2008 (UTC)

It would be more correct to call Tramadol a synthetic selective opioid receptor agonist. It only affects some of the receptors that opiates affect (2 out of 3, I believe?). Therefore, it lacks the sedative effect typical for natural opiates. It is widely abused as an opiate replacement by addicts all over the world. —Preceding unsigned comment added by 128.195.186.70 (talk) 13:01, 20 February 2008 (UTC)

FROM A LAYPERSON: — Preceding unsigned comment added by 98.213.26.69 (talk) 07:59, 23 March 2013 (UTC)

Firstly, I must make it clear that I am not a doctor or psychiatrist. I have three years in psychology and a stepfather as a surgeon. I DO have PTSD due to a life you could basically term as a nightmare. My life began with beatings at the age of 6 weeks, sexual abuse, torture and other forms of extreme abuse.

I was given Tramadol due to the fact I could not sleep properly. My sleep studies showed that even with 100mgsXR of Tramadol that PAIN kept waking me up.

However, I made another interesting discovery. Tramadol treatment ALLEVIATED the remaining side effects of PTSD. SSRI drugs have ALWAYS caused extreme psychosis in me. Due to some of the training I have had, this means I am not only a danger to myself, but to others as well. So no SSRI's for me. I have had to live with depression and the hands shaking for many years along with the pain from two broken vertebra and cervical compression due to being thrown head first into walls repeatedly.

Dangerous? I don't think so. I have noted NO side effects using this drug at all. There are also NO withdrawals I have noted either. I tried overdosing on it not long after I first started taking the drug. 6000mg down the hatch, each pill cut in half. Result: 8 hours of sleep and then nothing. So dangerous? No. Not even to a person such as myself who has a low seizure threshold.

Continued use of Tramadol however was worth it. For the first time in my life, I don't wish to die to join my dead children. There is NO euphoria in using this drug. If anything, my ability to think clearly and reason has improved a great deal.

I experiment with drugs I am prescribed albeit carefully. My metabolism is somewhat outside of normal when it comes to processing chemical compounds. I repeat: if given SSRI's, you can guarantee that I will become extremely psychotic. My will prevents me from killing other people, so then it turns inwards and I turn suicidal. This has been a pattern for over 20 years as I have been given drug after drug after drug to try and alleviate the extremity of the PTSD and extreme depression I suffered from.

I do not like drugs such as Morphine, Hydrocodone and Oxycodone for pain relief. They interfere with my thinking. I do not like anything that interferes with the functioning of my mind. I got so tired of morphine that I flushed the whole lot down the toilet and went cold turkey. I waited for withdrawal effects and didn't get any.

Theoretically, I could say that there are individuals who are more inclined towards dependency upon drugs of any kind - whether the reason be metabolic or a deep psychological need to escape reality.

As a person who takes Tramadol along with a number of other drugs - Depakote, Valium and a heavy anti-inflammatory, all I can say is, is that it is the best thing that has happened for me and my quality of life.

What I feel is that the bigger pharmaceutical companies do NOT want a drug being available that is non-addictive for the most part, and does not require other drugs to mitigate its' effects.

There is no profit to be made in cures. There is no profit to be made in happy people.

From my personal experience after a very hard life from which I escaped, Tramadol has been the only thing that has ever been both a successful pain reliever, and even touched or affected the PTSD from which I suffer.

This drug should be investigated more thoroughly WITHOUT BIAS in clinical conditions. The death rate of those prescribed SSRI's is higher than it should be. The action of SSRI's is NOT fully understood. So why is there a huge bias against a medication who's actions ARE understood? Not everyone will benefit from it, but many do not benefit from drinking milk, taking aspirin or SSRI's. — Preceding unsigned comment added by 98.213.26.69 (talk) 07:57, 23 March 2013 (UTC)

Tramadol and GABA

Looking for a source for tramadol's effect on GABA systems. And a source for seizures being due to the non-metabolized tramadol (M). If anyone has one, please share. Thanks. --Jmcclare (talk) 00:30, 29 April 2008 (UTC)

• I am also looking for a reliable source regarding tramadol and GABA. The term "GABAergic" implies that it is a GABA agonist (e.g., benzodiazepine drugs), and it seems misleading if it is worded this way. I see plenty of other sources regarding the definite statement of tramadol having effects on the noradrenergic and serotonergic systems, but nothing about it being a GABAergic drug. If anything, tramadol could be a GABA antagonist. Introducing this concept should make it clear if that is the case. I'm removing the term GABAergic, for now, due to this confusion.

APatcher (talk) 20:49, 24 June 2008 (UTC)

tramadol as a way to alleviate withdrawal symptoms from mthadone-is it an opiate or not?

As a cancer patient, I have been on probably just about every opiate known to man and as such have had to take myself "off of" thesr drugs for mere survival. I began taking methadone about two years ago and as anyone knows that has taken opiates, your body becomes immune to the dosage and therefore it takes more to ease pain. I took it upon myself to increase the dosage of my methadone causing me to run out way too early for refills. After the 4th or 5th day I had severe withdrawal symptoms including depression that was debilitating to me. A friend of mine offered me tramadol to alleviate the withdrawal symptoms and to my amazement the symptoms all bit disappeared! Now my question is this-is tramadol an opiate or is it not? A plain and simple answer would so please me. If it is an opiate why does it not show up in drugs tests?

My daughter takes tramadol on a regular basis for back pain and it causes very unpleasant mood swings in her and at times absolutely horrible behavior. She claims to suffer withdrawal symptoms if she runs out yet it completwly alleviated mine. I am very confused on the subject and finally if tramadol is an opiate why are there not stricter guidelines by the DEA on it?

209.86.226.11 (talk) 22:02, 23 May 2008 (UTC)05/23/08 Teresa Smith

Tramadol

It is ironic, how this article plays down tramadol addiction and withdrawal symptoms despite numerous studies carried out to show that not only does tramadol carry withdrawal symptoms similar or worse than that of high dosage codeine, as well as showing how tramadol induces pronounced withdrawal symptoms similar to that of Prozac and similar anti-depressants. What a piece of propaganda this article is when it comes to it's habitual and side effect related correctness. If anyone reads this: Tramadol is just as addictive as any other opiate related substance. It is known to carry opioid/opiate side effects similar to that of a low strength morphine dose or high strength codeine, but is also known to produce stimulant effects not chemically the same but likened to amphetamines. Tramadol is also known of inducing switched depressive mood episodes (e.g. your happy, suddenly you feel sad, suddenly you feel happy again for no reason at all) after a short time of use. There are loads of studies done to support the nasty side effects of tramadol which all are available on academic sites; You need an Athens membership to login which I'm sure the medical staff and academics around here have;. It seems that either some pro-tramadol user or that Grunenthal representatives are roaming around here filtering out damaging facts from this article in order to fulfill their interests (as many companies have been known of doing on Wikipedia) or perhaps an uninformed editor/user has failed to consider or look at studies done on tramadol other than the pharmaceutical companies themselves. Looking at the history of this article, many factual writings in regards to the side effects of this article have been reversed or taken out with no real basis or reason. I hope someone with more time on their hand and an Athens membership can help me update this article to show the dangers and addiction potential of Tramadol on this article fairly as well as its positive pain killing effects. The myth regarding Tramadol's safety, or non-addictive properties alone have only resulted in increased number of seizures, addicts and chronic-tramadol users worldwide. Online Tramadol sales are booming, with most orders being repeats without prescriptions and there are also reports of Tramadol being used by young thrill seekers on Erowid. There are also reports of Tramadol gaining street slangs, such as Tremz, Trammies etc. In the UK, approx. 1 out of 7 patients given tramadol when hospitalized have had seizures as a result. Tramadol is also more damaging to the liver than thought before, and also when cross compared to traditional opioids/opiates with equal pain killing properties. Tramadol mimics Dextropropoxyphene when considering the publicity and claims made at the introduction and initial usage of the medicine by the pharmaceutical companies following against its real dangers discovered and documented in the future by practice and independent studies. All the best. --78.86.159.199 (talk) 02:16, 13 June 2008 (UTC)

Thanks, but all that effort is wasted because you provided no references. Tony (talk) 06:40, 9 August 2008 (UTC)

Maybe if you read carefully, you would login to Athens database's and type "tramadol addiction" in the medical related ones such as BMJ. You need an academic login, only accessible by universities and doctors. There is loads of sources, too many to mention here. So next time, read thoroughly. --78.86.159.199 (talk) 17:54, 13 September 2008 (UTC)

Start citing them and adding data to this tramadol article then. I recently added some information on the addictiveness physical and psychological to the article as well as pointing out that tramadol has additive withdrawal effects probably related to its additional effects on serotonin and noradrenalin.--Literaturegeek | T@1k? 14:50, 14 September 2008 (UTC)

Lack of access to online journal databases is not an excuse for not providing references. If you can't get ahold of the info, what makes you believe anyone else coudl so they could look it up themselves? The truth is, www.pubmed.gov will show you at least the abstract, title, and citation of articles in all biomedical journals, including the pharma ones. Many of them are also available in fulltext of some form. If you don't have university access (which is available for free from public university libraries if you go in person, and from many public city libraries) to journal databases, google scholar can help connect you to at least the citations you want... so, never say you can't give at least a citation of the article you want. —Preceding unsigned comment added by 24.85.47.53 (talk) 08:49, 26 November 2009 (UTC)

Tramadol

Can someone taking tramadol for pain fail a drug screen? Jimiealtonhayes (talk) 20:22, 21 November 2008 (UTC)

You may get a faster answer if you post at Wikipedia:Reference desk/Science. --GraemeL ^(talk) 20:33, 21 November 2008 (UTC)

Vision Changes

I have been on Tramadol for two plus years. I started having problem with my vision. I just reread the side effect and noted that vision changes is expected. I would like for someone to explain what happen to the vision occurs.

(JEHB) —Preceding unsigned comment added by Foxybrowndog (talk • contribs) 12:58, 14 April 2009 (UTC)

Tramadol not scheduled

No. It isn't scheduled. A few states have scheduled it as C-IV. Kentucky being one of them. I don't see tramadol being scheduled nationally in the near future. —Preceding unsigned comment added by 98.80.21.68 (talk) 14:33, 10 June 2009 (UTC)

Stereoisomers

Tramadol is a molecule with two different stereocenters. Thus, four different stereoisomers may exist:

• (1R,2R)-form
• (1S,2S)-form
• (1R,2S)-form
• (1S,2R)-form

The drug is used as a racemic mixture of two stereoisomers:

• (1R,2R)-form (50%)
• (1S,2S)-form (50%)

The IUPAC name [(1R,2R)-....] is not correct. According to "The Merck Index" (14. Edition, 2006, page 1644) the correct IUPAC name is (1R,2R)-rel-...., in other words (1RS,2RS)-.... The 2D- and the 3D-formulae only show one out of two stereoisomers as mentioned above. This should be changed. --Jü (talk) 18:10, 10 June 2009 (UTC)

Important notice

(This should be added to the main page.) Unlike Opiates, Tramadol does not act right away when injected. The active ingredients that make Tramadol work, are metabolized in the liver. So, Tramadol is not suited for immediate pain relief. It will only act, relieve pain after about 10 to 15 minutes in IV form, about 30 minutes in other forms. Many doctors are not aware of this! I know of cases were Tramadol IV was used as a pain reliever, assuming that it would work like an opiate or benzodiazepine derivate, where the patients suffered lots of pain until it would in fact start to act. Also because of the fact that Tramadol, only acts once it has been metabolized in the liver, it can not be smoked, or abused in other ways like what can be done with opiates or benzodiazepines. Another detail for IV use... the dose should be around 1mg per Kg of body weight, any dose that exceeds this dosage by more then 10%, is very likely to cause rapid side effects in the patient. As such, Tramadol, administered in IV form, about 15 minutes before, ie. a Colonoscopy, is a very good substitute to the benzodiazepin Dormicum, it allows the patient to fully follow the procedure, suffering little to tolerable pain, enough feeling to reduce the risks of accidental injury during the procedure, which is a major problem when using Dormicum IV. Tramadol is also of much use, for patients that have problems with opiates or benzodiazepin derivates; often people that have a history, or past history of substance abuse, ie. smoking hash, opium etc. develop a resistance or intolerance towards many opiates or benzodiazepin derivates. As to side effects, sweating and a serious headache, about 6 hours after a single IV dose of Tramadol for ie. doing a Colonoscopy, are near always the case. I believe this information, examples should be added, as Tramadol is a potent alternative to opiates and benzodiapezin derivatives, probably underused and not well understood by too many doctors. —Preceding unsigned comment added by 212.77.42.158 (talk) 12:27, 17 June 2009 (UTC)

Sounds as though it comes from professional experience. To add such information to the article would require citations. Tony (talk) 13:10, 17 June 2009 (UTC)

Thank you to the authors of this page

I am in Santiago, Chile, and dealing with an eye injury due to a dried contact lens. Very painful. They prescribed Zafin for the pain, and so of course I wondered what it was and went to google to find the wikipedia entry. I read the entire page and found it quite informative. There wasn't anything that I really needed to know because, as a short-term user of a prescribed pain killer, my job is just to take it as the doctor instructed. But I'm an information addict and I like to know things, particularly when I'm putting something into my body.

I expect that literally millions of people every week turn to Wikipedia for just this sort of help. And I really want to thank you as one of those millions of people for having written an excellent and informative article. Information like this really does help make people's lives better.--Jimbo Wales (talk) 15:17, 30 August 2009 (UTC)

Tramadol is addictive.

I have been taking tramadol for about a year now, but I have taken it previously after breaking my left hip and finding that I have Osteoporosis. I have since been suffering with severe pain constantly and started to use Zamadol 200mg every 12hours (slow release) as prescribed by my Doctor.

Yesterday I ran out of tramadol and was not able to get any prescribed until this afternoon. As a result, all day (until taking it) I have suffered with side effects, because of withdrawal. I have had mood swings,sweating and hot flushes,shivers and chills,feeling sick,dizziness, confusion and generally feeling pretty awful.

I know that these are common side effects of tramadol through my own experience and because of my situation I must keep taking it. Nevertheless,it has proven to me that it most certainly is addictive and yet has also proven in my circumstance to aleviate pain and discomfort when used in conjunction with paracetamol. I was taking it with codeine previously, but found that the codeine caused severe itching in my case. I do believe that, as with any medication, it always depends on the person as to whether they may suffer side effects and that it is up to the individual to decide whether the side effects of taking or withdrawal from it is worth it in the long run.--Sydney Goodwin (talk) 20:02, 7 October 2009 (UTC)

Serious inconsistency in discussion of structurally-related drugs

In the Characteristics and Comparison with related substances sections, we have the mutually contradictory statements:

• The closest chemical relative of tramadol in clinical use is Venlafaxine (Effexor), the SNRI.

• Structurally, Tapentadol is the closest chemical relative of tramadol in clinical use.

and

• In reality, the closest structural chemical entity (to tapentadol) in clinical use, is the OTC active, phenylephrine.

Which (if any) of these three statements are true? --Kay Dekker (talk) 02:09, 6 November 2009 (UTC)

Dosage

The article states under 'availbility' that "The maximum dosage for tramadol in any form is 400 mg/day." This does not have a citation and is incorrect. Whilst many Patient Information Leaflets' for Tramadol, for example, that for Zamadol SR Capsules, state that "normally you should take no more than 400mg of tramadol a day." this is not a hard-fast rule, and as many people on the discussion section have mentioned, people are frequently prescribed more, I for example have been on 600mg a day for the past four years.

It would be more accurate to state that the 'usual' or 'normal' or 'average' maximum prescribed dosage is 400mg. From my understanding and having spoken to my GP concerning this, 400mg is the advised maximum if the drug is being used to treat moderate pain. However, when used to treat 'severe' pain higher doses are frequently used. However, doctors are (apparently) increasingly trying to reduce higher doses due to the withdrawal symptoms becoming more serious if the person is used to having far high amounts of the drug in their system. —Preceding unsigned comment added by 163.1.89.62 (talk) 16:14, 24 November 2009 (UTC)

Severe Leg Knee Pain

Tramadol has been a life saver for 8 months. No narcotic type side effects, and it does what it should, remove the pain only. 100mg 3xaday. If dose is delayed the pain does return. When given this medication I was told it would either work or do nothing. What's the basis of the statement, work or do nothing? —Preceding unsigned comment added by Words444 (talk • contribs) 17:40, 27 November 2009 (UTC)

Tramadol length in system

How long does Tramadol stay in the blood stream? If I were to get tested at work, would this medication show up as a narcotic? 137.99.93.120 (talk) 19:58, 2 December 2009 (UTC)

---

Tramadol will not show up in a screening unless it is tested for specifically. It is not tested for frequently and you should be fine. —Preceding unsigned comment added by 76.18.166.101 (talk) 20:18, 7 December 2009 (UTC)

stopping tramadol

how to stop tramadol if i took it for a long time? mom with 3 kids —Preceding unsigned comment added by 79.173.212.153 (talk) 21:24, 23 January 2010 (UTC)

References to diabetic neuropathy

As a person with peripheral neuropathy which is essentially diabetic neuropathy without the diabetes, I think it unwise and unfortunate that diabetic neuropathy is generally listed even though most peripheral neuropathy patients have different etiologies than diabetes. Idiopathic peripheral neuropathy is the most common form. I could cite it, but I just think that it would make no sense to argue changing diabetic neuropathy to peripheral neuropathy as it includes more patients and more people will be affected (potentially) by this information. Diabetic neuropathy IS peripheral neuropathy. —Preceding unsigned comment added by 72.131.83.97 (talk) 09:15, 24 January 2010 (UTC)

Delayed recovery after use of Tramadol in General Anaesthesia

My wife is in a coma after a general anaesthetic using Tramadol for a minor operation. I am being told she may be hypersensitive to it. Is this a known problem and is there a solution help please Pjdoubleu (talk) 18:35, 6 February 2010 (UTC) 6/2/2010

Adictive? Yes. Withdrawal? Yes. Loose weight? Come On?

I have taken tramadol for about a year and a half now, off and on average of 300 mg per day but never missing a day. My reason is interesting and really stupid as you will presumably find for yourself. I heard through an acquaintance that this miracle drug can, yes, allow the user to lose weight! "Ok I have conquered many things and now the end of all ends the cure for being fat? This is worth looking into." I have read, prior to dedicated use, all the warnings for not taking the drug. I also have plenty of years clean and sober. Alcohol addiction is something not even closely related to my run in with tramadol, in my opinion. Ok good background story now some advice don’t make the calculated mistake I made. I have 3 children and haven’t slept for 2 days now. The first run in w/ quitting almost led to suicide. (I love life!) Sound CRAZY well I'm here to tell you. Tramadol allowed me to lose 38 lbs. When I tried to get off of it I lost one day of sleep then suffered from hallucinations and muscle spasms. To the laymen this always sounded kind of cool. "If you’re crazy, hallucinating how can it be so bad?" When I got to the point that I could no longer tell real from imaginary, I gave up and was contemplating suicide. Taking sleep pills were wearing on me too. I know from experience I can’t do this on my own, so I got help. If I hadn’t of known this I really don’t know what I would have done that terrible night. I got up and was getting ready to tell my children good by when a voice told me to wake my spouse up. I did we talked for 15 minutes before she even knew what I was talking about. Well we decided to medicate 100 mgs of tram. 2 hrs later I was sleeping like a baby. That was about 5 months ago. Three days ago I was able to quit taking tram with no physical cramping or spasms, although, I did experience some nasal sensitivity. I was able to “taper off” as suggested in this Wikipedia-discussion page. The insomnia now is haunting me. I waited for this long weekend to get off of this drug. As I've read in "Tramadol Withdrawal" on this discussion page I only need another 2-3 days of mental torture and insomnia to hopefully "come out the other side".

You won’t listen though so if you get anything out of this please get life! It is only the material part of our spiritual being. I have every bit of faith on that "but now a week later I'm out the other side." quote. In fact if I get through this that may be my new mantra...For life. Take Tylenol not this stuff! —Preceding unsigned comment added by 71.210.214.224 (talk) 11:45, 16 February 2010 (UTC)

According to the DEA's Schedule of Controlled Substances, Tramadol is not among the drugs listed. It is available by prescription only in the United States, but does not fall under the definition of a "controlled substance" in the U.S. The Wikipedia article "Tramadol" states that it"... is a controlled substance in the U.S. and Canada and requires a prescription." (see "Legal status"). Wikipedia's article "Controlled substance" appears to be erroneous as well, at least in regard to the United States definition. Cuddybear130 (talk) 07:34, 21 February 2010 (UTC)cuddybear130

Is there any link between Tinnitus and not taking tramadal

I get a ringing in my ears that sometimes increases and decreases very quickly after I stop taking it for 4 to 6 hours

Ive been taking it for restless Legs....Has anyone had this problem? —Preceding unsigned comment added by 70.120.162.152 (talk) 01:47, 11 March 2010 (UTC)

Scientific evidence of inability to orgasm?

I have found reports online of people experiencing an inability to reach orgasm after having taken this drug: here and here and here are some examples. (My Google search terms were tramadol inhibit orgasm, but it seems to me as though most of the results there were patients' discussions -- probably not a reliable source.) Does anyone know of a scientific and/or reliable article which points this out so that it can be cited as a reference here? —Preceding unsigned comment added by 207.65.109.10 (talk) 06:57, 13 May 2010 (UTC) Speaking as a 37 year old woman who came off morphine (was on it for 4 years every day) onto Tramadol (400mg a day via twice daily SR caplets) for severe back pain, I have found that my libido and ability to have (multiple)orgasms has increased ten-fold. —Preceding unsigned comment added by 121.221.14.178 (talk) 10:45, 18 July 2010 (UTC)

Subject matter contradicted by learned veterinarians.

Under the subject "Veterinary" there is the text "the fact that its characteristic taste is not very bitter and can be masked in food ". Through administration to my Golden Retriever and confirmation by more than one practicing veterinary surgeon including Assistant Professors of small animal medicine (oncology & radiology) at Purdue University, that Tramadol has a very bitter taste which cannot easily be masked. There is no readily available liquid solution for Tramadol. Pteronaut (talk) 01:18, 13 June 2010 (UTC)

This is absolutely 100% true. I saw "mildly bitter" in the article and about fell out of my chair. This is some of the most horridly tasting stuff I've ever had. It is extremely bitter and disgusting. I accidentally bit one in half while taking it (with water with crushed ice) and will never forget how awful it is. I think they have a very light coating on them, but if they've rattled around my pill vial for a while, I can taste it when I take them, so I try to take it with soda or something very sweet to try to mask the horrible taste. It is 2013 -- they really ought to be able to do something about this awful, foul-tasting stuff. It is NASTY. WarFighter (talk) 17:04, 12 March 2013 (UTC)

Try mixing it with Vegemite or Marmite. Dogs can't resist the stuff, even if most Americans can! Sorry, I'm Australian and all Australian vets know this little trick works with any medicine and on every dog. Avagooday.

Euphoria

This needs sources if euphoria is going to be in the abuse section. Pubmed has one study saying there is almost no risk of euphoria, so please find some sources for this Persephone12 (talk) 13:59, 20 July 2010 (UTC)

I'm bipolar, and I am one of those people who naturally have a very high level of CYP2D6, and a chemically induced high level (strong inducer) of CYP2B6, because I take Oxcarbazebine. These are two of the three P450 liver enzymes that metabolize Tramadol. I can take a 50 mg tablet and end up with euphoria for 12+ hours! Every time. I know all of this because I had a very unintelligent doctor prescribe this combination, that landed me in the ER with a Severe case of Serotonin Syndrome. If a person metabolizes the pro-drug Tramadol into O-desmethyltramadol via the isoenzyme CYP2B6 very quickly and also has that plus CYP2D6 inhibit the removal of it from your body, you better believe it causes Euphoria, weather you want it or not. — Preceding unsigned comment added by Happily Bi-P (talk • contribs) 16:18, 27 October 2011 (UTC)