Does tramadol cause constipation. How common is constipation as a side effect of tramadol. What are the other gastrointestinal side effects of tramadol. How can tramadol-induced constipation be managed effectively.

The Link Between Tramadol and Constipation

Tramadol, an opioid medication used to treat moderate to severe pain, is known to cause various side effects, with constipation being one of the most common. Understanding the relationship between tramadol and constipation is crucial for patients and healthcare providers alike.

Prevalence of Constipation in Tramadol Users

Studies have shown that constipation occurs in a significant percentage of patients taking tramadol. The reported incidence ranges from 9% to 46% of users. This wide range may be attributed to factors such as dosage, duration of use, and individual patient characteristics.

Is constipation a guaranteed side effect of tramadol? While not everyone who takes tramadol will experience constipation, it is considered one of the most common adverse effects. Patients should be aware of this potential side effect and discuss preventive measures with their healthcare provider.

Mechanism of Tramadol-Induced Constipation

Tramadol, like other opioids, affects the gastrointestinal tract in several ways that can lead to constipation:

• Decreased intestinal motility
• Increased absorption of water from the intestines
• Reduced secretion of digestive fluids
• Increased anal sphincter tone

These effects combine to slow down the movement of stool through the intestines, resulting in harder, drier stools that are difficult to pass.

Other Gastrointestinal Side Effects of Tramadol

While constipation is a significant concern, tramadol can cause various other gastrointestinal side effects. Understanding these potential issues can help patients and healthcare providers manage treatment more effectively.

Common Digestive System Effects

In addition to constipation, tramadol users may experience:

• Nausea (16% to 40% of users)
• Vomiting (5% to 17% of users)
• Dry mouth (5% to 13% of users)
• Heartburn (1% to 13% of users)

Can these side effects be mitigated? Many of these side effects can be managed with proper medication adjustments, lifestyle changes, or additional treatments. It’s essential for patients to communicate any persistent or severe side effects to their healthcare provider.

Impact on Quality of Life

Gastrointestinal side effects, particularly constipation, can significantly impact a patient’s quality of life. Chronic constipation may lead to:

• Abdominal pain and discomfort
• Bloating
• Decreased appetite
• Hemorrhoids
• Anal fissures

These complications can sometimes outweigh the pain relief benefits of tramadol, necessitating a reassessment of the treatment plan.

Managing Tramadol-Induced Constipation

Addressing constipation caused by tramadol is crucial for patient comfort and treatment adherence. Several strategies can be employed to manage this side effect effectively.

Preventive Measures

To reduce the risk of constipation when starting tramadol treatment, consider the following preventive measures:

1. Increase fiber intake through diet or supplements
2. Stay well-hydrated by drinking plenty of water
3. Engage in regular physical activity as tolerated
4. Establish a regular bathroom routine
5. Consider prophylactic use of stool softeners or mild laxatives

How effective are these preventive measures? While they may not eliminate the risk of constipation entirely, these strategies can significantly reduce its severity and frequency for many patients.

Treatment Options

If constipation develops despite preventive measures, several treatment options are available:

• Over-the-counter laxatives (osmotic or stimulant)
• Prescription medications specifically for opioid-induced constipation
• Increased fluid and fiber intake
• Enemas or suppositories for severe cases

It’s important to consult with a healthcare provider before starting any new treatments, as some may interact with tramadol or other medications.

Special Considerations for Older Adults

Older adults are particularly susceptible to the constipating effects of tramadol and require special attention when prescribed this medication.

Increased Risk and Monitoring

Studies have shown that constipation can be more severe and frequent in older patients taking tramadol. In fact, constipation resulted in discontinuation of treatment in 10% of patients over 75 years of age in clinical trials.

Why are older adults more vulnerable to tramadol-induced constipation? Several factors contribute to this increased risk:

• Age-related changes in gastrointestinal function
• Reduced physical activity
• Concurrent use of other medications that may cause constipation
• Decreased fluid intake

Healthcare providers should monitor older patients more closely for signs of constipation and adjust treatment plans accordingly.

Tailored Management Strategies

For older adults taking tramadol, consider the following management strategies:

1. Start with lower doses and titrate slowly
2. Implement a proactive bowel regimen from the start of treatment
3. Regularly assess for constipation and other side effects
4. Consider alternative pain management strategies when appropriate
5. Educate patients and caregivers about the importance of reporting constipation

These tailored approaches can help minimize the risk of severe constipation in older adults while maintaining effective pain management.

Drug Interactions and Constipation Risk

The constipating effect of tramadol can be exacerbated by concurrent use of certain medications. Understanding these interactions is crucial for effective management of constipation risk.

Medications That May Worsen Constipation

Several classes of drugs can increase the likelihood or severity of constipation when taken alongside tramadol:

• Anticholinergic medications
• Other opioid pain relievers
• Certain antidepressants
• Iron supplements
• Calcium channel blockers

How can patients determine if their medications may interact? It’s essential to provide a complete list of all medications, including over-the-counter drugs and supplements, to healthcare providers and pharmacists. They can identify potential interactions and suggest alternatives or management strategies.

Mitigating Interaction-Related Constipation

To reduce the risk of constipation due to drug interactions:

1. Review all medications with a healthcare provider or pharmacist
2. Consider alternative medications with lower constipation risk when possible
3. Implement more aggressive preventive measures if multiple constipating drugs are necessary
4. Monitor bowel movements closely and report changes promptly

By addressing potential drug interactions proactively, patients and healthcare providers can minimize the risk of severe constipation while maintaining effective pain management.

Long-Term Effects and Complications

While constipation is often viewed as a temporary side effect, prolonged tramadol use can lead to chronic constipation and associated complications. Understanding these long-term effects is crucial for patients on extended tramadol therapy.

Chronic Constipation and Its Consequences

Persistent constipation over an extended period can result in various health issues:

• Fecal impaction
• Bowel obstruction
• Rectal prolapse
• Chronic abdominal pain
• Urinary retention or incontinence

These complications can significantly impact a patient’s quality of life and may require medical intervention. How can patients prevent these long-term complications? Regular monitoring, proactive management, and open communication with healthcare providers are key to preventing severe, chronic constipation.

Balancing Pain Management and Side Effect Prevention

For patients requiring long-term tramadol therapy, finding the right balance between pain relief and side effect management is crucial. Strategies to consider include:

1. Regular reassessment of pain management needs
2. Exploring multimodal pain management approaches
3. Implementing a consistent bowel management routine
4. Considering opioid rotation if constipation remains problematic
5. Evaluating the potential benefits of newer, gut-selective opioid antagonists

By addressing constipation as an ongoing concern rather than a temporary issue, patients and healthcare providers can work together to maintain effective pain control while minimizing gastrointestinal side effects.

Alternative Pain Management Strategies

For patients experiencing severe or persistent constipation with tramadol, exploring alternative pain management strategies may be necessary. A multimodal approach to pain relief can often provide effective management while reducing opioid-related side effects.

Non-Opioid Medications

Several non-opioid medications can be effective for pain management, either alone or in combination with lower doses of tramadol:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Acetaminophen
• Gabapentinoids (e.g., gabapentin, pregabalin)
• Certain antidepressants with pain-modulating properties
• Topical analgesics

Can these alternatives provide comparable pain relief? While individual responses vary, many patients find that a combination of non-opioid medications can provide effective pain control with fewer side effects.

Non-Pharmacological Approaches

Incorporating non-pharmacological pain management techniques can help reduce reliance on opioids like tramadol:

1. Physical therapy and exercise programs
2. Cognitive-behavioral therapy
3. Acupuncture
4. Mindfulness and meditation practices
5. Heat or cold therapy

These approaches can be particularly beneficial when combined with appropriate medication management, often allowing for lower doses of pain medications and reduced side effects.

By exploring a range of pain management strategies, patients and healthcare providers can work together to find an optimal balance between pain relief and side effect management. This approach not only addresses the immediate concern of constipation but also promotes overall health and well-being in the long term.

Does tramadol cause constipation?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Nov 7, 2022.

Yes, tramadol can cause constipation and is one of the most common side effects with this drug. In studies, constipation was reported in 9% to 46% of patients. In some cases it may be severe. Call your healthcare provider if you have any tramadol symptoms and they are severe.

• Constipation is a well-known and expected side effect of opioid use. It should be addressed quickly to prevent further complications.
• Use extra caution in older patients and monitor more closely. In studies, constipation resulted in discontinuation of treatment in 10% of those over 75 years of age.
• The use of other drug therapies that lead to constipation, such as anticholinergic drugs, can worsen the constipating effect of tramadol. If you are not sure if you are taking other medicines that may worsen constipation, ask your doctor or pharmacist.

To learn more: Treatment of Opioid-Induced Constipation: The Hard Facts

Tramadol (Ultram) is commonly associated with other stomach (gastrointestinal) side effects such as:

• nausea (16% to 40%)
• vomiting (5% to 17%)
• dry mouth (5% to 13%)
• heartburn (1% to 13%)

Tramadol side effects (in more detail)

Bottom Line

• Tramadol can cause constipation in 9% to 46% of patients. Stomach side effects in general are common with tramadol.
• Constipation is a well-known side effect of opioid pain treatment, and it should be addressed quickly to prevent further complications. Call your doctor if you have constipation with opioid treatment.

This is not all the information you need to know about tramadol for safe and effective use. Review the full tramadol information here, and discuss this information and any questions with your doctor or other health care provider.

References

• Tramadol monograph. Drugs.com. Accessed Nov. 16, 2020 at https://www.drugs.com/ppa/tramadol.html
• Ultram [product information]. Janssen Pharmaceuticals, Inc. Updated July 16, 2020. Accessed Nov. 16, 2020 at https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=45f59e6f-1794-40a4-8f8b-3a9415924468

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Drug information

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Medical Disclaimer

Tramadol Side Effects: Nausea, Constipation, and More

Tramadol is an opioid painkiller used to treat chronic pain. When taken as prescribed, this medication is ingested every 4-6 hours; however, people who struggle with tramadol addiction may take it more often and at higher doses. Doctors adjust prescription doses so their patients do not consume more than 400 mg of tramadol per day.

More than this amount can cause severe side effects, including addiction, tolerance, and dependence.

While a person who takes tramadol as prescribed may develop some side effects, they are more likely to develop in people who struggle with addiction. General side effects from tramadol include:

• Flushing
• Dizziness
• Fatigue or sleepiness
• Sore throat
• Congestion
• Headache
• Itching
• Constipation
• Appetite changes or stomach upset
• Nausea or vomiting
• Physical weakness

Per the National Library of Medicine, in a double-blind study regarding the general side effects from tramadol, about 26 percent of people taking the medicine as directed developed diarrhea; 24 percent experienced nausea and vomiting; 18 percent had headaches; and 16 percent experienced excessive fatigue. Other side effects, like vomiting, itching, and sweating, occurred in less than 10 percent of study participants; dry mouth, indigestion, and diarrhea occurred in about 5 percent of study participants.

Tramadol can cause changes in the central nervous system, which could be disturbing or detrimental. These include:

• Anxiety
• Physical tremors
• Muscle spasms
• Emotional changes
• Hallucinations

These are very rare when tramadol is taken as directed; however, people who struggle with addiction to this narcotic may experience these side effects.

Some people may develop an allergy to tramadol, and this can cause symptoms like hives, difficulty breathing, mouth sores, rash, itchy eyes, and even convulsions. While this is rare, symptoms should be reported to doctors for emergency treatment immediately.

Other rare side effects include:

• Excess gas
• Urinary retention
• Frequent urination
• Bloating
• Blurry vision
• Trouble performing routine tasks
• Numbness or tingling, especially in the hands or feet
• Changes to physical sensations, especially decreased sensation
• Chest pain or discomfort
• Loss of balance
• Fainting
• Pain in the arms, jaw, legs, or back
• Trembling or shaking in the hands and feet
• Severe cramping
• Hallucinations, typically auditory
• Lack of oxygen to the extremities, leading to blue or clammy hands, feet, or nose
• Menstrual irregularities
• Vasodilation

If too much vasodilation occurs, blood pressure will drop, and the person may faint, suffer damage to the heart and blood vessels, and potentially experience organ damage, including brain damage from lack of oxygen.

People who abuse tramadol are at risk of suffering an opioid overdose. If a person survives opioid overdose, they may suffer liver failure, although this could be associated with taking acetaminophen at the same time as the narcotic. It is rare for opioid painkillers like tramadol to cause liver damage, but it has occurred in a small percent of cases.

Tramadol may also increase the risk of serotonin syndrome in people who take antidepressants, including SSRIs. It is unclear how this occurs, but it appears that tramadol enhances the effects of the antidepressant on releasing serotonin and preventing it from being reabsorbed. This causes serotonin to remain in the brain for too long. Many cases of serotonin syndrome clear up on their own, but very serious instances can cause high fever, irregular heartbeat, unconsciousness, or seizures.

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Last Updated on Jul 10, 2023

TRAMOL is an effective centrally acting analgesic

TRAMOL

is a tramadol preparation manufactured by Brahma Drug (India), which has been used in clinical practice for a long time to relieve moderate to severe pain.

Tramadol is an opioid receptor agonist, interacting mainly with the m-subtype, and also inhibits the reuptake of certain monoamines (norepinephrine, serotonin), which contributes to the development of an analgesic effect. The active metabolite of tramadol, o-demethyltramadol, significantly exceeds the parent substance in affinity for m-opioid receptors, and 2–4 times in analgesic activity. The antinociceptive effect of tramadol is partially eliminated by the opiate receptor antagonist naloxone.

Tramadol is not an opium derivative or a semi-synthetic derivative of morphine or thebaine, although its analgesic effect is due to opiate receptor agonism.

Dependence and withdrawal symptoms are possible with tramadol, but are less severe than with other opiate agonists, as well as adverse effects such as nausea, lethargy, constipation, dry mouth, excessive sweating, and pruritus. Respiratory depression compared to morphine is usually not pronounced, but may occur when the drug is used in high doses. In this regard, tramadol is prescribed with caution to patients with a threat of developing respiratory depression. Side effects are usually rare; from the side of the cardiovascular system, the development of arterial hypotension, syncope and sinus tachycardia is possible.

TRAMOL

is widely used to relieve acute and chronic pain syndrome of moderate to severe intensity of various etiologies in patients after various surgical interventions, including orthopedic, gynecological operations, caesarean section, dental surgical procedures (for example, extraction of molars).

When administered parenterally at a daily dose of 100–250 mg (lumbago, neuropathy, diseases of the musculoskeletal system, as well as when used in maxillofacial surgery), the drug is not inferior in effectiveness to repeated use of combined oral analgesics, including those containing codeine.

The use of TRAMOLA is indicated for pain in patients with cancer with insufficient effectiveness of non-narcotic analgesics. The drug is inferior in effectiveness to morphine derivatives, however, it causes the development of serious side effects much less frequently.

TRAMOL

is also used to eliminate severe myalgia in leptospirosis, pain syndrome in enterovirus infections, colitis of infectious etiology.

TRAMOL

is administered at a dose of 50-100 mg subcutaneously, intramuscularly or intravenously (slowly). The maximum analgesic effect develops approximately within 1 hour after the administration of the drug, its duration is 3-6 hours. If necessary, it is administered again at a dose of 50 mg after 30-60 minutes.

The most common side effects that develop during treatment with tramadol are dose-dependent: dizziness or nausea, headache, lethargy; from the digestive tract – constipation. Vomiting is less common, especially after rapid intravenous administration, as well as a feeling of dry mouth, dyspepsia, very rarely – skin rash, decreased blood pressure, syncope, tachycardia, urination disorders.

With caution, the drug should be used simultaneously with carbamazepine, opiate analgesics – it is possible to potentiate the side effects characteristic of these drugs.

The drug may have an adverse effect on the ability to drive vehicles and potentially dangerous machinery. Alcohol should be avoided while using the drug.

Use during pregnancy only if the expected benefit to the expectant mother outweighs the potential risk to the fetus.

Tramadol is excreted in breast milk. Data on the safety of its use during breastfeeding are not available.

Clinical manifestations of tramadol overdose are similar to those of opiate poisoning – miosis, vomiting, respiratory depression, convulsions, collapse.

In such cases, supportive treatment is carried out, aimed primarily at ensuring adequate respiratory function (ALV). Naloxone (an opiate antagonist) reverses some of the effects of tramadol. The effectiveness of hemodialysis is low.

Subject to the recommendations for the use of , TRAMOL is an effective and safe analgesic in the treatment of pain syndrome of various origins.

Publication prepared
based on materials provided
by Jenom Biotek

Medznat

Tramadol – pain reliever
centrally acting drug with a unique dual mechanism of action,
implemented in the central nervous system (CNS).

INTRODUCTION

Tramadol is a centrally acting analgesic
with a unique dual mechanism of action implemented in the central nervous
system (CNS). It has an agonistic effect on opiate receptors
and prevents the reuptake of neurotransmitters. Tramadol is also weak
binds to µ-opiate receptors, blocking the transmission of pain signals in
brain. Tramadol effectively controls postoperative pain, however
not suitable for use as an adjuvant to anesthesia in
associated with weak sedative properties.

Pharmacological
class: Opioid
analgesic

Indications for use

• Moderate or severe pain
• Pain
• Acute musculoskeletal pain

PHARMACOLOGICAL ACTION

Tramadol is a centrally acting opioid analgesic. Although its mechanism of action is not fully understood, based on animal studies, at least two complementary mechanisms are possible: binding of the parent substance and the M1 metabolite to μ-opioid receptors and weak inhibition of norepinephrine and serotonin reuptake. The opioid activity is due to the low affinity of the parent compound and the high affinity of the O-demethylated metabolite M1 for μ-opioid receptors. The relative role of tramadol and M1 in human pain relief is determined by the plasma concentration of each substance. Tramadol inhibits the reuptake of norepinephrine and serotonin in vitro , similar to other opioid analgesics. These mechanisms may play an independent role in the overall analgesic effect of tramadol.

DOSAGE
needed for pain relief

Children: 1-2.5 mg/kg orally every 8 hours when
necessary for pain relief

PHARMACOKINETICS

Absorption of tramadol is 34%±34. Volume of distribution
is 2.71 l / kg, binding to plasma proteins – 20%. With urine
30% of the drug is excreted (in unchanged form), 60% (in the form of metabolites),
the plasma half-life is 6.3 hours.

CONTRAINDICATIONS

• Hypersensitivity to opioids
• Situations where opioids are contraindicated, including acute
  intoxication with the following substances: alcohol, sleeping pills,
  centrally acting painkillers, opioids or psychotropic
  drugs. In such patients, the drug may exacerbate CNS depression and
  breathing.
• Combination of tramadol and MAO inhibitors (either in
  within 14 days after discontinuation of such therapy) is contraindicated

OTHER DRUG INTERACTIONS

• Concomitant use of CYP2D6 and/or CYP3A4 inhibitors,
  e.g. quinidine, fluoxetine, paroxetine and amitriptyline (inhibitors
  CYP2D6), ketoconazole and erythromycin (CYP3A4 inhibitors) may reduce
  metabolic clearance of tramadol, increasing the risk of serious
  adverse events, including seizures and serotonin syndrome
• Patients taking carbamazepine may experience
  significantly weaker analgesic effect of tramadol hydrochloride

SIDE EFFECTS

Common (> 1/10, < 1/100):

• Abdominal disorders (diarrhea, constipation,
  nausea or abdominal pain)
• Depression
• Skin disorders (itching, rash or sweating)
• Generalized pain or pain in the muscles and joints

Uncommon (> 1/100, < 1/100 0):

• Joint swelling
• Change in body weight
• Severe headache
• Fall
• Confusion
• Severe cough

Very rare (< 1/10000):

9 0088 Blistering under the skin
• Blood in the urine
• Chest pain
• Convulsions Precaution0077
  • Pre-existing diseases of the kidneys, liver, epilepsy,
    history of lung disease, drug dependence or allergy
  • Pregnancy and breastfeeding
  • Use of drugs such as
    tranquilizers, sleeping pills or other pain medications containing
    opiates
  • Acute diseases of the abdominal organs
    cavities subject to clinical evaluation

  Clinical data

  • Tramadol is a centrally acting analgesic,
    which is similar in structure to codeine and morphine. Its effect in
    relief of the postoperative share is comparable to that
    pethidine. The analgesic effect of tramadol is increased in combination with
    non-opioid analgesics. Tramadol is effective and well tolerated
    patients when used to relieve pain after trauma, renal or
    hepatic colic or during childbirth. The drug is also used to treat
    chronic pain of malignant or non-malignant origin, in
    features in neuropathic pain. Tramadol is less likely to cause constipation and
    dependence compared to powerful opioids in similar analgesics
    doses.
  • The effectiveness of tramadol in the treatment
    moderate or severe postoperative pain has been shown in outpatient and
    surgical conditions. Unlike other opioids, tramadol does not
    has clinically significant effects on respiratory and cardiovascular
    indicators. This drug may be particularly suitable for patients with
    impaired cardiopulmonary function, including elderly patients, patients with
    obese and smokers, for patients with impaired liver or kidney function, and
    also for patients who are receiving non-steroidal anti-inflammatory drugs
    (NSAIDs) are not recommended or should be used with caution. Tramadol
    for parenteral or oral administration has proven to be effective and
    tolerance for anesthesia during operations.
  • Tramadol is effective for the treatment
    various types of moderate to severe acute and chronic pain, including neuropathic
    pain, back pain, osteoarthritis and uncontrolled pain. The
    the drug also causes fewer side effects that are characteristic of opioids,
    including nausea, drowsiness, vomiting, dry mouth and constipation. Although the study
    literature data showed the presence of an immunostimulating effect
    tramadol, some studies also suggest that
    that the immunosuppressive effect of tramadol is less pronounced compared with
    morphine. Due to pharmacological properties, tramadol is more
    more suitable for patients with gastrointestinal and renal disorders than NSAIDs. Apart from
    proven clinical efficacy, tramadol is a safe drug,
    because it causes respiratory depression to a lesser extent, cardiovascular
    side effects, abuse and dependence compared to others
    opioids.