Does tramadol cause constipation. How common is constipation with tramadol use. What other gastrointestinal side effects can tramadol cause. How can tramadol-induced constipation be managed. Are certain groups at higher risk for constipation from tramadol.

The Link Between Tramadol and Constipation

Tramadol, an opioid medication used to treat moderate to severe pain, is known to cause constipation as one of its most common side effects. Studies have shown that constipation occurs in 9% to 46% of patients taking tramadol. This wide range likely reflects differences in dosage, duration of use, and individual patient factors.

Constipation is a well-recognized side effect of opioid medications in general. With tramadol specifically, the constipating effect is due to how it acts on opioid receptors in the gastrointestinal tract, slowing down intestinal motility and reducing fluid secretion into the bowels.

Prevalence of Tramadol-Induced Constipation

While estimates vary, research indicates that a significant portion of tramadol users experience constipation:

• 9-46% of patients report constipation as a side effect
• Higher rates tend to occur with higher doses and longer duration of use
• Up to 10% of patients over 75 years old discontinued treatment due to constipation

Given how common this side effect is, patients starting tramadol should be counseled about the risk and potential need for preventive measures.

Other Gastrointestinal Side Effects of Tramadol

In addition to constipation, tramadol can cause several other gastrointestinal side effects:

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

These effects are largely due to tramadol’s action on opioid receptors throughout the digestive system. The medication can slow gastric emptying, reduce intestinal secretions, and affect the nerves controlling digestive processes.

Why do opioids like tramadol cause gastrointestinal side effects?

Opioids like tramadol bind to mu-opioid receptors in the gastrointestinal tract. This leads to:

1. Decreased propulsive contractions in the intestines
2. Increased absorption of fluids from intestinal contents
3. Reduced secretion of digestive fluids
4. Increased anal sphincter tone

These effects combine to slow the passage of stool through the intestines, leading to harder stools and less frequent bowel movements – the hallmarks of constipation.

Risk Factors for Tramadol-Induced Constipation

While constipation can affect any tramadol user, certain factors increase the risk:

Age

Older adults are at higher risk for opioid-induced constipation, including from tramadol. This is due to:

• Slower metabolism of medications
• Decreased intestinal motility
• Reduced physical activity
• Dietary changes common in older adults

Studies have shown that up to 10% of tramadol users over 75 years old discontinued treatment due to constipation, highlighting the increased risk in this population.

Concurrent Medications

Taking other medications that can cause constipation may increase the risk when combined with tramadol. These include:

• Anticholinergic drugs
• Calcium channel blockers
• Iron supplements
• Other opioids

Patients should inform their healthcare provider of all medications they are taking to assess the combined risk of constipation.

Underlying Health Conditions

Certain health conditions can predispose patients to constipation, which may be exacerbated by tramadol use:

• Hypothyroidism
• Diabetes
• Neurological disorders
• Inflammatory bowel disease

Healthcare providers should consider these factors when prescribing tramadol and develop appropriate management strategies.

Managing Tramadol-Induced Constipation

Addressing constipation caused by tramadol is crucial to prevent complications and ensure patient comfort. Several strategies can be employed:

Lifestyle Modifications

Simple changes in daily habits can help mitigate constipation:

• Increasing fluid intake
• Adding more fiber to the diet
• Engaging in regular physical activity
• Establishing a regular toileting routine

These modifications should be the first line of defense against mild constipation.

Over-the-Counter Remedies

Various OTC products can help relieve constipation:

• Stool softeners (e.g., docusate sodium)
• Osmotic laxatives (e.g., polyethylene glycol)
• Stimulant laxatives (e.g., bisacodyl)

Patients should consult their healthcare provider before starting any new medication, even OTC products.

Prescription Medications

In cases of severe or persistent constipation, prescription medications may be necessary:

• Lubiprostone
• Naloxegol
• Methylnaltrexone

These medications are specifically designed to target opioid-induced constipation without affecting pain relief.

Monitoring and Adjusting Tramadol Treatment

Proper management of tramadol therapy involves ongoing assessment and adjustment:

Regular Follow-ups

Healthcare providers should schedule regular check-ins with patients on tramadol to:

• Assess the effectiveness of pain relief
• Monitor for side effects, including constipation
• Adjust dosage if necessary
• Evaluate the need for continued treatment

Dose Optimization

Finding the lowest effective dose of tramadol can help minimize side effects while maintaining pain control. This may involve:

• Starting with a low dose and titrating up slowly
• Using extended-release formulations to reduce dosing frequency
• Combining tramadol with non-opioid pain relievers to allow for lower opioid doses

Considering Alternative Pain Management Strategies

In some cases, exploring alternative pain management options may be beneficial:

• Non-opioid medications (e.g., NSAIDs, acetaminophen)
• Physical therapy
• Cognitive behavioral therapy
• Acupuncture or other complementary therapies

These approaches may allow for reduced tramadol use and subsequently less constipation.

Potential Complications of Untreated Constipation

If left unaddressed, tramadol-induced constipation can lead to more serious health issues:

Fecal Impaction

Severe constipation can result in hardened stool becoming stuck in the rectum, requiring medical intervention for removal.

Hemorrhoids

Straining to pass hard stools can lead to the development or worsening of hemorrhoids.

Anal Fissures

Passing large, hard stools can cause small tears in the anal tissue, leading to pain and bleeding.

Bowel Obstruction

In rare cases, severe constipation can lead to a partial or complete blockage of the intestines, which may require surgical intervention.

Given these potential complications, it’s crucial for patients and healthcare providers to address constipation promptly and effectively.

Patient Education and Self-Management

Empowering patients with knowledge and tools for self-management is key to preventing and managing tramadol-induced constipation:

Understanding the Risk

Patients should be informed about the likelihood of constipation when starting tramadol treatment. This awareness can help them be proactive in prevention and early management.

Recognizing Symptoms

Educating patients on the signs of constipation can ensure timely intervention. Symptoms to watch for include:

• Infrequent bowel movements (less than three per week)
• Hard, dry stools
• Straining during bowel movements
• Feeling of incomplete evacuation

Implementing Preventive Measures

Patients should be encouraged to adopt preventive strategies from the start of tramadol treatment:

• Maintaining a high-fiber diet
• Staying well-hydrated
• Engaging in regular physical activity
• Using stool softeners or mild laxatives as recommended by their healthcare provider

Keeping a Symptom Diary

Tracking bowel movements and associated symptoms can help patients and healthcare providers monitor the effectiveness of management strategies and identify any worsening trends.

The Role of Healthcare Providers in Managing Tramadol-Induced Constipation

Healthcare providers play a crucial role in preventing and managing constipation in patients taking tramadol:

Risk Assessment

Before prescribing tramadol, providers should assess each patient’s risk for constipation, considering factors such as:

• Age
• Concurrent medications
• Existing gastrointestinal conditions
• Dietary and lifestyle habits

Proactive Management

Providers should consider prescribing preventive measures alongside tramadol, especially for high-risk patients. This may include:

• Recommending or prescribing stool softeners or laxatives
• Providing dietary and lifestyle advice
• Scheduling follow-up appointments to monitor for constipation

Individualized Treatment Plans

Recognizing that each patient may respond differently to tramadol and constipation management strategies, providers should develop personalized treatment plans. This may involve:

• Adjusting tramadol dosage
• Trying different laxative regimens
• Considering alternative pain management strategies

Interdisciplinary Collaboration

In complex cases, collaboration with gastroenterologists or pain specialists may be beneficial to optimize both pain management and bowel function.

By taking a proactive and comprehensive approach to managing tramadol-induced constipation, healthcare providers can help ensure that patients receive effective pain relief while minimizing uncomfortable and potentially serious side effects.

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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opioid

side effects

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.