Tramadol

What it is used for

• Starting dose
• Current dosing recommendations
• Chronic pain
• Analgesia
• Analgesia
• Analgesia
• Chronic laminitis pain
• General/Non-responsive pain
• Analgesic
• Chronic pain
• Mild acute and chronic soft tissue and musculoskeletal pain
• Perioperative acute pain

How it is given

Possible side effects

• Dogs: Excessive sedation, agitation, anxiety, tremor, dizziness
• Dogs: Inappetence, vomiting, constipation, diarrhea
• Cats: Dysphoria, mydriasis, dose avoidance (unpalatability)
• Humans: Pruritus (approx. 10%)
• Injectable form: Respiratory and cardiac depression
• Sedation (especially at high doses in dogs)
• Dysphoria (more likely in cats)
• Nausea
• Behavioral changes
• Increased risk of seizures

Cautions & contraindications

• Hypersensitivity to tramadol or other opioids
• Combination products containing acetaminophen (e.g., Ultracet) are STRICTLY CONTRAINDICATED in cats
• Concurrent use with MAOIs (e.g., selegiline, amitraz) due to risk of serotonin syndrome
• Patients with a history of epilepsy or seizure disorders
• Concurrent use with MAOIs
• > **Important Warnings:** * **Seizure Risk:** Use with caution in animals with preexisting seizure disorders or those receiving drugs that lower the seizure threshold. Tramadol has caused seizures in humans. * **CNS/Respiratory Depression:** Use cautiously with other CNS or respiratory depressants. * **Geriatric/Debilitated Patients:** Use with caution; dosage adjustments may be needed for patients with impaired renal or hepatic function. * **Dependence & Withdrawal:** Physical dependence can occur; withdraw gradually after chronic use. * **Formulation Warning:** Extended-release tablets must **not** be broken, crushed, or chewed, as this can lead to rapid absorption and toxicity. Dogs do not absorb ER tablets well.

Drug interactions

• Digoxin: Rarely linked to digoxin toxicity in humans.
• MAO Inhibitors (amitraz, selegiline): Potential for fatal serotonin syndrome; concurrent use should be avoided.
• Ondansetron: May reduce the effectiveness of both drugs.
• Quinidine: May increase tramadol concentrations and decrease M1 (active metabolite) concentrations.
• SAMe (S-adenosylmethionine): Theoretically could cause additive serotonergic effects.
• Sevoflurane: Pretreatment with tramadol reduced MAC values by approximately 30% in dogs and 40% in cats.
• SSRI Antidepressants (fluoxetine, sertraline, paroxetine): Can inhibit the metabolism of tramadol to its active metabolites, decreasing efficacy and increasing the risk of toxicity (serotonin syndrome, seizures).
• Tricyclic Antidepressants (clomipramine, amitriptyline): Increased risk for seizures; amitriptyline may inhibit tramadol metabolism.
• Warfarin: Increased PT and INR reported in humans (relatively rare).
• Amitriptyline: Increased risk of serotonin syndrome
• Selegiline: Increased risk of serotonin syndrome
• SSRIs (e.g., Fluoxetine): Increased risk of serotonin syndrome
• Fentanyl: Increased risk of serotonin syndrome
• Pethidine: Increased risk of serotonin syndrome
• Buprenorphine: Increased risk of serotonin syndrome
• NSAIDs: Safe and synergistic multimodal analgesia
• Gabapentin: Safe and synergistic multimodal analgesia
• Amantadine: Safe and synergistic multimodal analgesia

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