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Date: | Fri, 4 Aug 1995 12:17:23 -0500 |
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A new analgesic has just now been introduced and will probably be
encountered by most of you in the near future. I thought I'd provide a
little preliminary info to get you started.
It is called Ultram(tramadol)(Ortho-McNeil). Tramadol interacts with the
same mu receptors as the opiates, but it seems to lack the euphoric effect
of the other opioids and therefore has not been scheduled as a controlled
substance. Tramadol is probably closest in analgesia to codeine, a little
less than morphine, and will in some instances replace codeine preparations
such as Tylenol #3 or Empirin # 3, although it is easily at least 6 times
more expensive. I imagine it will show up in the OB wards soon. After
oral administration it attains a peak plasma level in about 2 hours. Its'
adult half-life is 5-9 hours, although the analgesia only lasts for 6 hrs.
Interestingly, the package insert contains significant breastfeeding data.
The usual dosage ranges from 50-300 mg per day. Protein binding is low = 20%.
Following a single dose of 100 mg IV, the total amount of tramadol excreted
in breastmilk after 16 hours was 100 micrograms ( approximately 0.1% of the
maternal dose). Although the manufacturer does not recommend this analgesic
in infants(as usual!!), it is apparent that the levels in milk are
extremely low.
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Tom Hale
Texas Tech University School of Medicine
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