Precautions and considerations for taking Tramadol 

Tramadol is not to be taken unless strictly recommended and prescribed by a medical doctor. Your doctor will have done a thorough assessment of your specific condition before determining treatment with Tramadol as an option. He or she will weigh up benefits against potential complications and likely side-effects before prescribing the use of this drug. If favourable, your doctor will recommend a prescription with strict instructions.

The nature of side-effects and possible complications will also prompt your doctor to inform you in detail as to what risks the medication may carry. Your doctor should advise you to take note of all necessary precautions, risk factors and possible side-effects. Before issuing a prescription, he or she will have assessed a variety of possible risk factors as well.

Assessment will include the following potential risk factors:

• Allergies: Inactive ingredients in Tramadol can cause various complications and allergic reactions. Your doctor will wish to know if you have any known allergies, or experienced adverse reactions in the past.
• Medical history and health conditions: Yours and that of close relatives may be required so that your doctor can assess potential risk factors. Certain medical conditions may prohibit the use of Tramadol altogether, or prompt your doctor to prescribe with caution. High on the list are a history of (or current) brain and nervous system disorders, such as seizures, epilepsy, Parkinson’s disease, head injuries or tumours, problems associated with breathing and respiratory function, such as chronic obstructive pulmonary disease (COPD), asthma, respiratory depression, slow breathing (hypoventilation) or sleep apnoea, organ diseases, such as those of the kidney or liver, mental or mood disorders, such as depression or bipolar disorder (including suicidal thoughts or attempts), addiction or substance abuse (drugs and alcohol), genetic conditions such as metabolic disorder and intestinal and digestive problems, such as diarrhoea, constipation and bladder control problems (urination), stomach upsets, gallbladder disease and pancreatitis. If you are treating migraine headaches, hormonal problems, or serious infections, these also need to be disclosed to your doctor. Tramadol may either worsen symptoms associated with these conditions or adversely interact with medication already being taken to treat them.
• Use of other medications and supplements: Your doctor will wish to list all over-the-counter and prescription medications, as well as any supplements and herbal products you are taking before prescribing this medication. If you are using any type of narcotic pain medication, antidepressants and / or other mental illness drugs (including antipsychotic medications and monoamine oxidase inhibitors / MAOIs), sedatives or tranquilisers, muscle relaxers, antihistamines, those used to prevent blood clots or seizures, antibiotics, antifungal medications, drugs treating heart and blood pressure problems or HIV/AIDS, or anti-nausea / vomiting drugs, you must disclose this to the doctor considering Tramadol for treatment (if they have not prescribed these for you or are not aware of your medical / treatment history).
• Age: Seniors (65 years of age and older) are known to be more sensitive to some side-effects of this medication and can experience adverse symptoms of drowsiness, dizziness, confusion, fainting, stomach upset, constipation, age-related liver and heart problems, as well as slow or shallow breathing. As a result, dosages for seniors (often recommended at lower strengths) will be handled with care and monitored throughout a treatment period. Absolute safety and efficacy in children younger than 16 has not been established, and as a result a doctor may prescribe Tramadol with caution.
• Pregnancy and breastfeeding (nursing mothers): A doctor will take into consideration all females of childbearing age before prescribing this medication. He or she will advise all risks and benefits during an initial consultation, especially if a woman intends to fall pregnant and bear a child of her own. It is strongly advised that if you are pregnant you disclose this to your doctor before accepting a prescription for this medication, especially during the first trimester. A doctor will only consider treatment with Tramadol during pregnancy if the benefits outweigh potential risk factors. There is a risk of birth defects which can affect a developing foetus during the first two months of pregnancy. High doses of this medication towards the end of gestation can also place an unborn baby at risk. A new-born baby can experience withdrawal-like symptoms following birth, which include irritability, unexplained or persistent crying, diarrhoea, vomiting, difficulty with feeding and slow or shallow breathing. If pregnant and a doctor assesses a need for this medication, doses will be strictly controlled (administering the lowest effective dose) for the shortest possible time period in order to avoid infant withdrawal symptoms. The medication will also be carefully considered before being prescribed when a patient is nursing (breastfeeding). Tramadol ingredients may pass through breast milk and thus affect a new-born baby, causing unexplained sleepiness, feeding difficulties and breathing problems. A baby that is born with habit-forming (withdrawal) symptoms may require treatment for several weeks. In severe instances, side-effects experienced by a baby can be life-threatening.

Medication interactions – the importance of disclosing all medications and medical conditions

If during the doctor’s assessment it is determined that you have recently taken or are taking certain medications, your doctor will require specific information on these so that he or she can assess whether Tramadol can safely be prescribed.

The taking of multiple medications can cause adverse reactions and side-effects. This must be carefully considered so as to avoid potentially serious medical complications. Certain medications will never be allowed to be used at the same time for this reason. In other instances, your doctor will assess all that you are taking, and how necessary each is for the treatment of your overall condition. Dosages for each medication may be adjusted to ensure the least risk of side-effects. Alternatively, medications may be changed to achieve the least risk.

All necessary medication will be discussed with you in detail, ensuring that you are well aware of all benefits, and possible side-effects and complication risks.

One of the main concerns regarding multiple medication treatment is a potentially serious condition known as serotonin syndrome. This can happen when excess nerve cell activity occurs and there is too much (an accumulation of) serotonin production in the body. The condition is potentially fatal and can be triggered within a matter of hours after taking a new medication or an increased dosage.

Your doctor may also bring up other related interactions which can occur when taking Tramadol. If you are taking other medications at the same time, you may be advised to take some with food and others on an empty stomach. This is to alleviate potential discomfort (mild side-effects).

Your doctor may stress the importance of limiting or avoiding the use of alcohol or tobacco while taking medications. He or she will likely outline potential interaction the use of these substances will have at the time of taking your medications.

Tramadol should not be taken with the following medications as these may cause severe interactions:

• Monoamine oxidase inhibitors (MAOIS)
• Monoamine oxidase-B (MAO-B) inhibitors (Rasagiline – Azilect, Selegiline - l-deprenyl)
• Opioid Analgesics (Propoxyphene -Darvon)
• Opioid Antagonists (Naltrexone – Revia, Vivitrol)
• Serotoninergic Agents (Dapoxetine – Westoxetin and Priligy)

Other serious interactions may occur with:

• 5HT-1D Agonists (Triptans)
• Antibiotics (Linezolid – Zyvox, Zyvoxid)
• Anticonvulsants (Carbamazepine – Tegretol)
• Chronic opioids (Butorphanol, Buprenorphine, Nalbuphine)
• Opioid analgesics (Tapentadol – Tapal, Nucynta, Palexia, Codeine)
• Sodium Oxybate
• Tricylic compounds

Other risk factor precautions

Your doctor will also likely advise the following precautions to keep in mind once treatment commences:

• At the start of treatment, or when dosages are adjusted, you may experience drowsiness or dizziness. Your doctor will advise you to take precautions when it comes to activity that requires alertness, such as driving or performing certain activities or operating machinery.
• You may also be advised to limit or avoid alcohol consumption altogether. Consuming alcohol can worsen symptoms of your condition or aggravate those associated with side-effects. In severe instances, the combination of this medication with alcohol consumption can be life-threatening, especially if taking other medications as well.
• If at any stage during treatment you require surgery or dental procedures, you must advise your use of this medication to all attending professionals. If you are taking more than one medication (including supplements and herbal products), you will need to disclose this as well.

What else should I take into consideration regarding this medication?

• Refills: As Tramadol is a controlled substance (classified as a schedule 4 medication), by law, the medication can only be authorised by a licensed medical practitioner with a set number of refills per prescription. In most instances, one prescription can only be refilled up to 5 times within a 6-month period, before a new prescription can be authorised.
• Medical health insurance: Many medical health insurance providers may have policies which cover the cost of treatment with this medication. Prior authorisation may be necessary. It is advisable to check with your medical health insurance provider before commencing treatment.