Tramadol hydrocholoride is the generic name of branded pain relievers Tramal, Ultram, Ultracet, Ryzolt, Rybix, Conzip, Ralivia, Adolonta, and Zytram, among many others.
Below is a guideline to availability and prices.
Note that Tramadol purchasing online is illegal in some states and countries.
It has now become illegal in the UK but still available in most EU countries.
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Tramadol is a synthetic chemical compound that is used to treat pain and discomfort. It is normally an ingested medication that works centrally instead of locally. While it is used as a pain reliever, it is often not prescribed to handle very severe pain. Ideally, it is given for mid-level to mid-level severe pain. Given the wide range of pain thresholds it can handle, it is prescribed for quite a lengthy list of painful or uncomfortable conditions such as fibromyalgia, motor neurone disease, restless legs syndrome, rheumatoid arthritis, among many other conditions. In this respect, Tramadol is prescribed similar to pain reliever drug classes like codein.
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Tramadol, in of itself, is quite a relatively weak receptor agonist of µ-opioid. However, the body metabolizes Tramadol to O-desmethyltramadol which is a much more powerful receptor agonist of µ-opioid. Among users of the IV version of Tramadol, this more powerful metabolized version is very similar to the metabolized form of codeine-morphine. Still, there are many other compounds on the market that feature a higher level of potency in terms of µ-opioid receptor agonist activity. Interestingly enough, Tramadol also impacts the body's norepinephrine and serotonin levels. It inhibits the reuptake of these compounds. Since inhibiting the reuptake of these brain neurotransmitters has been used to treat conditions like phobias, anxiety, and depression, the idea of using Tramadol as an anti-phobia, antidepressant, or antianxiety medication has been floated. Physicians have not been entirely warm to this idea and this indication for Tramadol has not been approved. Instead, health professionals suggest that Tramadol's serotonin and norepinephrine reuptake inhibition qualities be utilized only in unique or very limited circumstances. These professionals suggest that this limited use of Tramadol should only be considered if other treatments don't produce desired results in treating phobias, depression, or anxiety. In such a circumstance, Tramadol's usage as a serotonin and norepinephrine reuptake inhibitor should only be done under the strict supervision of a qualified psychiatrist.
In terms of structure, Tramadol looks similar to codeine albeit a stripped-down variant. How are they alike? Both codeine and tramadol have a shared 3-methyl ether structure. Both compounds are metabolized in the same pathway in the liver. Both are metabolized by the liver to produce stronger compounds. In the case of codeine, the final form is morphine while in tramadol, the final metabolized form is O-desmethyltramadol In terms of observed effect, patients don't feel any subjective difference in potency in the IV form of morphine and tramadol.
Tramadol is off-patent in the US and is available in generic form under a number of brands. Many different manufacturers produce Tramadol under their own brands. Some of the bigger generic manufacturers of Tramadol are: Teva, APO, Pur-Pak, Mallinckrodt, Cor Pharma, Mylan, Caraco, Amneal, and many others. The most common generic dosage size and form are tablets in 50mg doses. Tramadol also has brand name versions on the market. These are Ultram and Ultram ER.
Tramadol can be taken in quite a number of forms. In the form of oral tablets and capsules, it is commonly available in the following dosages: 37.5mg, 50mg, 100mg, 200mg, and 300mg. In tablet form, Tramadol can be taken as both uncoated or low residue tablets under the tongue (sublingual). It also comes in chewable or regular tablet form. There are also extended and regular release versions of this pain medication.
Tramadol is also available in injectable, intramuscular and/or intravenous. It is available in a 100mg dosage.
Tramadol is also available in suppository, effervescent tablets, phial, and powder form.
If used as an ingredient, Tramadol can be added to other ingredients for topical creams and gels. These topical formulations are used to relieve nerve pain on the skin and joints. Some rectal foams also include Tramadol. There is even a product line that includes Tramadol as an ingredient for a skin patch. Tramadol is quite versatile in its applications and forms. Perhaps a large part of this versatility is due to market demand arising from the perception that Tramadol is less susceptible to abuse.
Although users need a prescription to buy Tramadol, this drug is currently not controlled by the US federal government. Still, several US states have decided to control Tramadol as a Schedule IV drug. The drug is more tightly controlled in the following state jurisdictions: US Military bases, Oklahoma, North Dakota, Mississippi, Wyoming, Kentucky, West Virginia, Ohio, New York, New Mexico, Illinois, Tennessee, and Arkansas. The list of states controlling Tramadol as a Schedule IV medication might possibly grow since there are some states with pending bills regarding the scheduling of Tramadol. In other countries, Tramadol is facing stronger controls. For example, in Sweden, drug regulators have moved to classify Tramadol in the same class as highly restricted drugs like dextropropoxyphene and codeine. However, unlike those other drug types, patients can still gain access to Tramadol with a prescription. Other countries have a more relaxed view towards Tramadol. In Asia, Tramadol is used mainly to address labor pains. In Mexico, Tramadol is freely available in a form where it is mixed with paracetamol. In this form, no prescription is needed.
Schedule IV drugs, under the Controlled Substances Act of the United States, are drugs that have a lower potential for abuse compared to drugs listed as Schedule III drugs. Schedule IV drugs have an accepted medical treatment use in the US and abuse of these drugs might lead to limited dependence or lower dependence compared to drugs listed in Schedule III. Schedule IV drugs are controlled and monitored and have limits on how many times their prescriptions can be refilled within a six-month period Currently, drugs under this schedule can be refilled a maximum of five times every six-month period.
Considering the fact that Tramadol has demonstrated serotonin and norepinephrine reuptake inhibiting qualities, patients who are taking selective serotonin reuptake inhibitors like Zoloft, Prozac, and other compounds, selective norepinephrine reuptake inhibitors like Effexor, monoamine oxidase inhibitors like isocarboxazid, phenelzine, selegiline and other compounds, tricyclic antidepressants like amitriptyline, amitriptylinoxide, butriptyline, and others must consult with their physician about the dosage of tramadol to take. In some of these situations, Tramadol might be ruled out completely due to strong drug interactions . Similarly, if the patient is taking strong opioid-based based compounds like morphine, fentanyl, methadone, and oxycodone, the patient's doctor needs to be advised to see if Tramadol is a feasible treatment option. Finally, if a patient is over 75 years of age or is a minor or is suffering from reduced liver or kidney functions, the patient's physician must be advised.
For the majority of patients taking Tramadol, there are no adverse effects. However, in small percentages of Tramadol users, the following side effects have been observed. The following list is in the order of severity with the most common side effects listed first. The most common side effects of Tramadol are drowsiness, nausea, dizziness, constipation, headache, vomiting, diarrhea, dry mouth, fatigue, indigestion, and, in a very small number of patients, seizures. In addition to the side effects above, there is also a body of observed side effects for people taken off Tramadol too quickly. These range from nervous 'thrashing' in the patient's bed and uncontrolled tremors and muscle contractions.
Other fairly rare side effects include electrical shock-like sensations, a 'buzzing' effect, and anxiety. Some observers note that these effects are somewhat similar to those of patients experiencing withdrawal from Effexor. In terms of sexual performance, Tramadol has been observed to delay ejaculation in some instances as well as produce other sexual dysfunctions.
Patients who are taking SSRI medications require extra scrutiny since these medications might interact with Tramadol in such a way as to trigger potentially fatal serotonin toxicity.
The most severe side effect of Tramadol are seizures. Thankfully, this occurs only in very rare instances. Seizures have been reported in the cases of individuals who take very large doses (700mg oral or 300mg intravenous) of Tramadol. In very rare cases, persons who take much lower doses experience seizures. There is a growing body of research that indicates that Tramadol should not be prescribed for patients who have uncontrolled epilepsy.
Who are most at risk of seizures? Tramadol takers who are between the gages of 25 and 54 years old, patients who exceed four tramadol prescriptions, and individuals who have a record of head trauma injury, stroke, or alcohol abuse.
All in all, it is harder to become physically depend or addicted to Tramadol compared to other opiate-based medications. In fact, this drug's habit-forming potential is low enough for the US Drug Enforcement Agency to leave it off its list of controlled substances. With that said, addiction to Tramadol is still possible. Patients who take low dosages for Tramadol on a short-term basis are less likely to develop physical dependence than those who take the medication over a long period of time at high dosages. These latter patients can exhibit withdrawal symptoms when taken off Tramadol. These withdrawal symptoms are like those of withdrawal symptoms for opiate-like or opioid-based pain relievers. However, in a small percentage of cases, patients can experience withdrawal symptoms which are atypical-these involve seizures or other symptoms similar to those exhibited by patients who have gone off SSRI medications. These atypical withdrawal symptoms are more severe because they might be related to tramadol's norepinephrine and/or serotonin reuptake features. Some of the more common symptoms of SSRI medication withdrawal that a minority of long-term Tramadol users might experience include: headaches, palpitations, sweating, electric shock sensations in many parts of the patient's body, brain zapping, brain zaps, pronounced mood swings, increased aggressiveness, higher levels of anguish and anxiety, and depression.
Still, patients should consider the 2010 version of the Physicians' Desk Reference which contains
some warnings from Tramadol's main manufacturer. These warnings were not included in previous versions of the Desk Reference. Interestingly enough, the warnings use more forceful language regarding Tramadol's possible habit-forming potential. Other warnings include the possibility that patients might develop difficulty breathing when using the medication. The Desk Reference also had a new list which featured side effects which were more serious in nature. Finally, the reference also included a notice urging Tramadol not be prescribed to replace opiate drugs for addicts. Accordingly, Tramadol should also not be used to treat long-term addiction to opiates or be used to help addicts wean themselves off opiate-based medications.
In the majority of tramadol withdrawal cases, withdrawal symptoms start appearing with 12 to 20 hours from the time of the patient's last dose. However, this time frame can vary. How long are the withdrawals? Compared to other opioid-based pain relievers, withdrawal symptoms for tramadol take much longer. Instead of the normal three to four days or more of codeine-based compound withdrawal, people suffering from acute Tramadol withdrawal can expect to experience these symptoms for seven days or even longer.
Due to Tramadol's SSRI and SNRI qualities, individuals who want to get off this medication are advised to take a gradual approach. Instead of abruptly quitting Tramadol, patients who have been taking this pain medication for an extended period of time and exhibit physical dependence should continue taking Tramadol but gradually get weaned off it. This course of action is recommended to prevent withdrawal symptoms tied to Tramadol's SSRI and SNRI qualities. The tapering off process should be tailored to each individual patient and his or her circumstances. Some factors to consider are the particular situation of the patient, the dosage of Tramadol the patient was taking, and how long the patient has been using this pain reliever.