DESCRIPTION
Tramadol is an analgesic that is related to the opioids. While its mode of action resembles that of narcotics and it is as effective as many narcotics in relieving pain, it is not a narcotic and does not depress breathing, a side effect of most narcotics. Tramadol is also not a nonsteroidal anti-inflammatory drug (NSAID) and does not have the increased risk of stomach ulceration and internal bleeding that can occur with the use of NSAIDs. It does affect serotonin neurotransmitters — chemical messengers — in the brain that may help change the perception of pain in diabetic neuropathy.

ORIGINAL USES (ON-LABEL)
Relief of moderate to moderately severe general and dental pain.

NEWLY DISCOVERED USES (OFF-LABEL)
Fibromyalgia, diabetic neuropathy, neuropathy, restless legs syndrome.

POTENTIAL SIDE EFFECTS
Dizziness, headache, sedation, constipation, nausea, agitation, anxiety, confusion, coordination impaired, itching, rash, menopausal symptoms, abdominal pain, anorexia, diarrhea, dry mouth, urinary frequency, urinary retention, spasticity, weakness, visual disturbances, sweating.

CAUTIONS
  • Central nervous system (CNS) depression and respiratory depression may occur; risk increases with the coadministration of other CNS depressants. Consult with your doctor or pharmacist before starting new therapy with any prescription, non-prescription or herbal product.
  • Increased risk of seizures may occur if taken with selective serotonin reuptake inhibitors (SSRIs — fluoxetine, sertraline, paroxetine, etc.), tricyclic antidepressants (such as amitriptyline, nortriptyline, etc.), neuroleptics, or monoamine oxidase inhibitors (MAOIs — phenelzine, etc.). See recommendation above regarding consultation with doctor or pharmacist.
  • Inform your doctor if you currently experience seizures or have a history of seizures.
  • Elderly patients with chronic respiratory disorders are at increased risk for adverse reactions.
  • May impair alertness required for certain tasks (such as operation of machinery, driving, etc.).
  • Caution in patients with increased intracranial pressure or head injury.
  • Use caution and reduce dose in patients with liver disease, kidney, thyroid, or adrenal dysfunction.
  • Tolerance or drug dependence may occur.
  • Abrupt discontinuation should be avoided.
DRUG INTERACTIONS
Amphetamines, cimetidine, tricyclic antidepressants, SSRIs, linezolid, MAOIs, naloxone, neuroleptics, opioids, quinidine, carbamazepine, warfarin, digoxin.

FOOD INTERACTIONS
Alcohol

HERBAL INTERACTIONS
Valerian, St. John's wort, kava kava, gotu kola.

PREGNANCY AND BREAST-FEEDING CAUTIONS
FDA Pregnancy Risk Category C. Excreted in breast milk. Consult your doctor.

SPECIAL INFORMATION
Withdrawal symptoms may occur if tramadol is discontinued abruptly. Do not take products which contain alcohol.

Two key studies have demonstrated the efficacy and safety of tramadol in diabetic neuropathy. A clinical study in 131 diabetes patients showed a significant reduction in pain intensity compared to placebo, according to Neurology. A second study compared tramadol to placebo for the treatment of pain, paresthesia, and touch-evoked pain associated with polyneuropathies. The drug again proved to be more effective than placebo, although the improvement was modest, according to Pain.

An article in the American Journal of Health System Pharmacists concluded that tramadol is safe and effective for diabetic neuropathy, although the dose required for benefits is relatively high.

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