Does tramadol cause constipation. How common is constipation with tramadol use. What are the other gastrointestinal side effects of tramadol. How can tramadol-induced constipation be managed. Are there special precautions for older adults taking tramadol. What other medications can worsen tramadol-induced constipation.

The Relationship Between Tramadol and Constipation

Tramadol, a widely prescribed opioid pain medication, is known to cause various side effects, with constipation being one of the most common and troublesome. Understanding the relationship between tramadol and constipation is crucial for patients and healthcare providers alike.

Constipation is a well-documented side effect of opioid medications, including tramadol. Clinical studies have shown that constipation occurs in 9% to 46% of patients taking tramadol. This wide range suggests that individual responses to the medication can vary significantly.

How does tramadol cause constipation?

Tramadol, like other opioids, affects the gastrointestinal tract by:

• Slowing down intestinal motility
• Reducing fluid secretion in the bowels
• Increasing absorption of water from stool
• Decreasing the sensitivity to the urge to defecate

These mechanisms combined lead to harder, drier stools that are more difficult to pass, resulting in constipation.

Prevalence and Severity of Tramadol-Induced Constipation

The prevalence of constipation among tramadol users is significant. Studies have reported constipation rates ranging from 9% to 46%, making it one of the most common side effects of the medication. In some cases, the constipation can be severe enough to warrant discontinuation of treatment.

Is tramadol-induced constipation more common in certain populations?

Older adults are particularly susceptible to tramadol-induced constipation. In clinical studies, constipation resulted in discontinuation of treatment in 10% of patients over 75 years of age. This higher risk in the elderly population necessitates closer monitoring and proactive management of constipation in this age group.

Other Gastrointestinal Side Effects of Tramadol

While constipation is a significant concern, tramadol is associated with various other gastrointestinal side effects. These include:

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

These side effects can significantly impact a patient’s quality of life and may lead to discontinuation of the medication in some cases.

Managing Tramadol-Induced Constipation

Addressing tramadol-induced constipation promptly is crucial to prevent complications and ensure patient comfort. Several strategies can be employed to manage this side effect:

What are effective ways to manage tramadol-induced constipation?

1. Increase fluid intake: Drinking more water and other fluids can help soften stools.
2. Dietary modifications: Consuming more fiber-rich foods can promote regular bowel movements.
3. Regular exercise: Physical activity can stimulate bowel function.
4. Over-the-counter laxatives: Osmotic laxatives or stool softeners may be recommended.
5. Prescription medications: Peripherally acting mu-opioid receptor antagonists (PAMORAs) can be prescribed for opioid-induced constipation.

It’s essential to consult with a healthcare provider before starting any new treatment for constipation, especially when taking tramadol or other opioid medications.

Special Considerations for Older Adults

Older adults are at a higher risk of experiencing severe constipation with tramadol use. This increased susceptibility is due to several factors:

• Age-related changes in gastrointestinal function
• Reduced mobility
• Concurrent use of other medications that may contribute to constipation
• Decreased fluid intake

How should tramadol use be approached in older adults?

When prescribing tramadol to older adults, healthcare providers should:

• Start with lower doses and titrate slowly
• Monitor closely for signs of constipation
• Implement preventive measures early
• Consider alternative pain management strategies if constipation becomes severe

These precautions can help minimize the risk of severe constipation and improve treatment outcomes in the elderly population.

Interactions with Other Medications

The constipating effect of tramadol can be exacerbated by concurrent use of other medications. Certain drug classes are known to increase the risk of constipation when combined with tramadol:

Which medications can worsen tramadol-induced constipation?

• Anticholinergic drugs
• Calcium channel blockers
• Iron supplements
• Antidepressants (particularly tricyclic antidepressants)
• Antipsychotics
• Antihistamines

Patients taking tramadol should inform their healthcare provider about all medications they are using, including over-the-counter drugs and supplements. This information allows for better management of potential drug interactions and side effects.

Monitoring and Reporting Side Effects

Vigilant monitoring of side effects is crucial when taking tramadol. Patients should be educated about potential side effects and encouraged to report any symptoms promptly to their healthcare provider.

When should patients seek medical attention for tramadol-related side effects?

Patients should contact their healthcare provider if they experience:

• Severe constipation that does not respond to initial management strategies
• Abdominal pain or distension
• Nausea or vomiting that persists or worsens
• Signs of an allergic reaction
• Any new or worsening symptoms while taking tramadol

Early intervention can prevent complications and improve treatment outcomes.

Alternative Pain Management Strategies

For patients experiencing severe constipation or other intolerable side effects from tramadol, exploring alternative pain management strategies may be necessary. These alternatives can include:

What are potential alternatives to tramadol for pain management?

• Non-opioid analgesics (e.g., acetaminophen, NSAIDs)
• Topical pain relievers
• Physical therapy
• Cognitive-behavioral therapy for pain management
• Acupuncture or other complementary therapies
• Different classes of pain medications with lower risk of constipation

The choice of alternative treatment should be individualized based on the patient’s specific condition, overall health status, and preferences. A comprehensive pain management plan often involves a combination of pharmacological and non-pharmacological approaches.

Long-Term Considerations for Tramadol Use

While tramadol can be an effective pain management tool, long-term use requires careful consideration and monitoring. Chronic use of tramadol may lead to:

• Tolerance, requiring higher doses for the same pain relief
• Physical dependence
• Risk of addiction in some individuals
• Persistent constipation and other gastrointestinal issues

Healthcare providers should regularly assess the need for continued tramadol therapy and explore options for dose reduction or discontinuation when appropriate.

How can the risks of long-term tramadol use be mitigated?

To minimize risks associated with long-term tramadol use:

1. Implement regular follow-up appointments to assess pain control and side effects
2. Use the lowest effective dose for the shortest duration necessary
3. Incorporate non-pharmacological pain management strategies
4. Monitor for signs of tolerance or dependence
5. Provide patient education on proper use and potential risks
6. Develop a plan for gradual dose reduction when appropriate

These strategies can help balance the benefits of pain relief with the potential risks of long-term opioid use.

Understanding the relationship between tramadol and constipation is crucial for effective pain management. While constipation is a common side effect, it can be managed through various strategies. Patients and healthcare providers should work together to find the right balance between pain relief and side effect management. Regular monitoring, prompt reporting of symptoms, and individualized treatment plans are key to optimizing tramadol therapy while minimizing gastrointestinal complications.

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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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 Sep 9, 2022

Tramadol side effects.

– a question for doctors

How to deal with the side effects of tramadol, such as urinary retention and constipation?

Vladimir, 20 May 2014 16:54

Hello, Vladimir! Why are you taking Tramadol? He needs to stop taking it. After discontinuation of this drug, everything is restored.

Klimik Nelya Nikolaevna, 20 May 2014 17:32 | #2

Prescribed to my father after the usual analgesics stopped working. He has cancer, aged 65.

Vladimir, 21 May 2014 13:58 | #3

Hello Vladimir! In case of constipation, symptomatic treatment should be given: enzymes – panzinorm for better digestion of food (promotes intestinal motility) 1 tablet 3 times a day; Duphalac is a modern remedy for constipation. This drug forms fecal masses (regulates the physiological emptying of the large intestine, softens the stool, has a laxative effect and, most importantly, has a prebiotic effect. It is given to the patient in the morning with meals diluted in juice or water. It is sold in tablets and in liquid. In your case, it is better in liquid “I understand that the patient is severe. In order to have a stool, you need to eat in small fractional portions and move. Therefore, you need to monitor the stool and if it is not there for 3 days, you need to do an enema. Clean the intestines regularly so that there is no intoxication for counting feces. As for urination, the patient most likely has a prostate adenoma, which contributes to urinary retention. Do you have an ultrasound of the prostate gland? You need to consult a urologist. In such cases, a catheter is inserted. PATIENCE is great for you.

Klimik Nelya Nikolaevna, 23 May 2014 08:49 | #4

Hello, my mom has uterine cancer. As an analgesic therapy, tramadol was prescribed, first 50 mg 3 times a day, then 100 mg each. However, the drug from the very beginning, for some reason, practically did not help to relieve pain. On the contrary, mother often complains that after using it, the pain in the lower abdomen even intensifies. Even a simple Trigan-D relieves pain better, though not for long. To my question to the attending physician at the oncology dispensary, I received an answer that it is simply not possible that tramadol cannot increase pain. Tell me, please, what could be the matter here?

Tereshchenko Natalya Nikolaevna, 20 Apr 2017 14:24 | #5

Dear Natalia Nikolaevna! Tramadol is an analgesic with proven clinical efficacy. It cannot lead to an increase in pain, at the same time, abdominal pain is one of the side effects of the drug. Most likely, there is an individual reduced sensitivity of the body’s opiate receptors to the effects of Tramadol, so your mother does not feel the expected effect. Trigan contains an antispasmodic. Apparently, the pain syndrome in this case is mostly associated with spasm of smooth muscles, which is why it helps your mother.

Kumalagova Natalya Mitrofanovna, 20 Apr 2017 23:13 | #6

Tramadol tablets for oncology – instructions for use, reviews, reaction in cancer patients to the drug

Tramadol is an effective pain reliever that belongs to soft drugs. It is difficult to get a prescription for it, but it is often impossible for cancer patients to do without this drug.

Oncology and pain syndrome

Drug therapy of pain syndrome in oncology is carried out in accordance with some fundamental principles:

• step-by-step prescription – from simple to complex, from non-steroidal anti-inflammatory drugs to weak and then strong narcotic analgesics, which reduces pain in 90% of patients;
• each patient requires their own dose of pain medication;
• strict adherence to the regimen of admission – at the appointed time, without waiting for the onset of symptoms;
• Oral: Oral (swallowed) dosage forms are preferred, as are other non-injectable forms.

Description and pharmacological effects of Tramadol

Tramadol is a weak opioid analgesic similar to morphine, only weaker. This compound is a derivative of cyclohexanol. Once in the body, it binds to opioid prescriptions and blocks the transmission of pain impulses to the spinal cord. In addition, this drug has a sedative (sedative) and antitussive effect. Thus, after the introduction of Tramadol, the patient not only ceases to experience pain, but also calms down, can sleep normally.

Indications for the use of Tramadol

Tramadol is prescribed for various conditions that are accompanied by very severe pain, with the ineffectiveness of drugs from the NSAID group:

• injuries;
• oncological diseases;
• myocardial infarction;
• postoperative period;
• neuralgia.

Tramadol in oncological practice

Tramadol according to the rules of the “anaesthesia ladder” recommended by WHO, is prescribed in the second line – after the use of nonsteroidal drugs (NSAIDs).

Long-term use of opiates is addictive. But cancer patients should not be afraid of this side effect – provided that they are used strictly according to indications, adequate dosage and regimen.

Pharmacokinetics

Tramadol enters the body in an inactive form and only in the liver is converted into ten inactive metabolites and one active, which reduces pain intensity and disrupts the transmission of pain impulses in the spinal cord.

Of the tablets and drops taken, 68% of the medicine reaches the “sore spot”, all 100% are delivered by blood when injected. The disintegrated drug is excreted by 90% by the kidneys and 10% through the intestines, therefore, with renal failure, it can linger in the blood and tissues for a long time.

After taking a tablet or drops, the analgesic effect will appear after a quarter of an hour, after a maximum of half an hour, and will last almost 6 hours, Tramadol-retard acts up to 12 hours. The drug is highly effective, but over time the body decomposes it more actively, which requires an increase in the dose. If tramadol does not help at all, then a transition to stronger narcotic analgesics is required.

How to use the medicine?

Unlike most narcotic analgesics, Tramadol has several dosage forms. You can swallow capsules and tablets, and two types of solutions are also available: in drops for oral administration and in ampoules for injection.

In all cases, oral forms are preferred: injections are painful and, in patients weakened by a long illness, are associated with the possibility of developing an abscess even if complete sterility is observed – immunity works at half strength.

Tramadol drops begin to work very quickly, but they are easy to overdose. It is necessary to drip 20 drops onto a piece of sugar or into water – this is a dose for one dose. The second 20 drops are taken in the absence of pain relief within an hour after the first dose.

Capsule and tablet contains a full single dose. They are taken regardless of food. With unbearable pain syndrome, it is allowed to swallow two at once.

Long-acting tablet – Tramadol retard contains a double, triple dose, and the largest one contains 4 single doses at once, which last up to 12 hours, but in especially difficult situations it can be taken after 6 hours.

Ampoules contain 1 or 2 ml of solution, i.e. 50 mg or 100 mg of the drug. How often can you inject tramadol? Injections under the skin, into a muscle or vein are repeated no earlier than 4 hours later.

Contraindications

Tramadol should not be used:

• if allergic to it;
• in case of alcohol and drug intoxication, overdose of psychotropic drugs;
• is incompatible with antidepressants from the group of MAO inhibitors due to the possibility of developing a severe serotonin syndrome;
• in severe renal failure, when the drug is retained in the blood for a long time at a high concentration and an overdose may occur;
• in liver failure, the formation of the active metabolite is impaired.

Oncology and pain syndrome

90% of cancer patients experience pain of varying intensity, but not necessarily unbearable. Intolerable excruciating pain usually accompanies metastatic cancer, again, not in everyone, but with severe complications.

Duration of use

How long tramadol can be taken depends on the purpose for which it is prescribed. For example, after injuries and operations, it is used in a short course for several days, a maximum of weeks. In oncological diseases, the drug is used for a long time. It is important to strictly follow the instructions of the attending physician and immediately report all side effects.

Special instructions

During pregnancy Tramadol is prescribed only in short courses. Otherwise, the fetus may become addictive, and then the newborn child may experience a withdrawal syndrome. During breastfeeding, it is also necessary to take into account that a certain amount of the drug passes into breast milk.

Tramadol should be used with caution in case of impaired liver and kidney function .

Do not use the drug in children under 1 year of age. At the age of 1-14 years, dosages of 1 to 2 mg/kg are used. At the same time, prolonged forms of Tramadol should not be used in children under 14 years of age.

Tramadol should be used with caution in case of hypersensitivity to other opioid analgesics, confusion, drug dependence, convulsions.

The drug is incompatible with alcohol, drugs from the group of MAO inhibitors.

Tramadol reduces attention and reaction speed, therefore, during the course of treatment, you can not drive a car and engage in certain activities.

Side effects

Tramadol at therapeutic doses is well tolerated but may cause nausea , which is usually treated with conventional antiemetics – antiemetics.

In long-term treatment, especially in bedridden patients, constipation is possible , which are fought with enemas and laxatives.

Drowsiness and drowsiness are not always unfavorable for severe patients, they even help to some extent, however, this is a side effect.

The drug is characterized by excitation due to changes in the metabolism of serotonin – the “hormone of joy”.

Some patients find over time that this medicine no longer helps them effectively relieve pain and ask the doctor: “why doesn’t tramadol work?”. First, it is one of the weakest opioids. Secondly, as we mentioned above, with prolonged use, the body “gets used” to it and does not respond as well. If the pain syndrome can no longer be effectively controlled, this is an occasion to reconsider the treatment regimen, to include more powerful drugs in it.

Overdose

The maximum dose of Tramadol per day is not more than 400 mg, that is, four times 40 drops, or 8 capsules and regular tablets, 4 suppositories or 4 painkillers injections of tramadol, 2 ml each.

Exceeding the dose is accompanied by a change in consciousness – workload and even coma, convulsions, respiratory depression against the background of a strong heartbeat and a decrease in blood pressure are not excluded. To stop the condition, naloxone is used, convulsions are relieved by an injection of diazepam. Serotonin syndrome is treated with cyproheptadine.

Tramadol analogues

Tramadol and Tramal are the same drug from different manufacturers.

The combination of Tramadol with paracetamol from the group of NSAIDs is available under the names zaldiar, ramleps, tramaceta and forsodol.

How to replace tramadol in oncology? This question is best answered by the attending physician, who knows how the disease proceeds in a particular individual patient.

Only a doctor knows what needs to be done to make the painkiller Tramadol work in full force and with minimal risk to the patient’s health. But it is also important for the patient himself to have information about the drug in order to better understand the goals of treatment, follow the doctor’s prescriptions correctly, and notice side effects in time. Euroonco clinics use only original drugs with proven efficacy, and they are always in stock. Our doctors prescribe treatment in accordance with modern international recommendations.

Appointment for consultation around the clock

+7 (495) 668-82-28

References:

1. Abuzarova G.R. /The role of tramadol in oncology and surgery// Abstracts X Ross. National congress “Man and medicine”; M.; 2003.
2. Abuzarova G.R., Gallinger E.Yu. Pchelintsev M.V. / Algorithm for pharmacotherapy of chronic pain syndrome in an oncological clinic // Vrach; 2011.-№ 6.
3. Pain ed. Yakhno N.N. / Guide for doctors / / Ed. Medpress info; 2009
4. Kogonia L.M., Voloshin A.G., Novikov G.A., Sidorov A.V. /Practical recommendations for the treatment of chronic pain syndrome in cancer patients // Malignant tumors: Practical recommendations RUSSCO #3s2, 2018 (vol. 8 ).
5. Osipova N.A., Abuzarova G.R. /Treatment of chronic pain in incurable patients at home// Doctor; 2002.-№ 4.
6. Novikov G.A., Osipova N.A. /Treatment of chronic pain of oncological genesis//Ed.