Tramadol blood thinning. Tramadol and Blood Pressure: Understanding the Effects and Interactions

14.08.202318.07.2023 by alexxlab

Does tramadol affect blood pressure. How does tramadol interact with other medications. What are the potential side effects of tramadol. Who should avoid taking tramadol. How does tramadol impact blood thinning.

Содержание

The Effects of Tramadol on Blood Pressure

Tramadol, a synthetic opioid pain reliever, has been associated with both increases and decreases in blood pressure, though these effects are not common when the medication is taken as prescribed. Research indicates that between 1% and 5% of individuals taking the extended-release version of tramadol experienced high blood pressure (hypertension). For those taking the fast-acting version, the incidence of hypertension was even lower.

On the other hand, less than 1% of people taking tramadol developed low blood pressure (hypotension) in clinical studies. Some individuals experienced postural or orthostatic hypotension, which occurs when blood pressure drops upon standing from a sitting or lying position. However, it remains unclear whether tramadol was the direct cause of this effect.

Can tramadol cause significant changes in blood pressure?

While blood pressure changes are not a common side effect of tramadol, certain medication interactions can lead to extreme fluctuations in blood pressure. It’s crucial for patients to discuss all current medications with their healthcare provider before starting tramadol treatment to avoid potential complications.

Tramadol and Blood Thinning: Potential Interactions

Although tramadol is not classified as a blood thinner, there have been reports of potential interactions with anticoagulant medications such as warfarin. This interaction could potentially affect blood clotting and increase the risk of bleeding.

How does tramadol interact with blood thinners?

The exact mechanism of interaction between tramadol and blood thinners is not fully understood. However, case reports suggest that tramadol may enhance the anticoagulant effect of warfarin, leading to an elevated International Normalised Ratio (INR) and, in some cases, bruising or hemorrhage. This interaction typically occurs 3-4 days after starting tramadol treatment in patients already taking warfarin.

Common Drug Interactions with Tramadol

Tramadol has the potential to interact with various medications, which can affect its efficacy or increase the risk of side effects. Some of the drugs that may interact with tramadol include:

Certain antidepressants
Appetite suppressants
Specific antifungal medications
Certain antibiotics
Other opioids
Seizure medications
Some migraine medications
Malaria drugs
Certain heart medications
Blood thinners

Are there any safe medications to take with tramadol?

While tramadol doesn’t appear to interact significantly with high blood pressure medications, it’s essential to consult with a healthcare provider before combining tramadol with any other drugs. They can provide personalized advice based on your specific medical history and current medication regimen.

Contraindications and Precautions for Tramadol Use

Certain individuals should avoid taking tramadol due to increased risk of adverse effects. These include:

People with known allergies to the drug
Individuals with respiratory depression or slowed breathing
Those with acute or severe asthma

Additionally, patients taking tramadol should avoid consuming alcohol or using additional opioid medications, as these combinations can increase the risk of severe side effects.

Who is most at risk for adverse effects from tramadol?

Individuals with a history of substance abuse, respiratory conditions, or certain mental health disorders may be at higher risk for adverse effects from tramadol. Elderly patients and those with kidney or liver impairment may also require closer monitoring when using this medication.

Brand Names and Formulations of Tramadol

Tramadol is available under various brand names and formulations, including:

ConZip
Qdolo
Ultracet
Ultram
Ultram ER

These different formulations may have varying onset times and durations of action, which can affect their use in managing different types of pain.

How do extended-release and immediate-release tramadol differ?

Extended-release formulations of tramadol, such as Ultram ER, are designed to provide long-lasting pain relief over an extended period. They are typically taken once daily. Immediate-release formulations, on the other hand, act more quickly but have a shorter duration of effect, often requiring multiple doses throughout the day for adequate pain control.

Monitoring and Managing Tramadol Use

Regular monitoring is essential for patients taking tramadol, especially those with pre-existing health conditions or those taking other medications. Healthcare providers may recommend periodic blood tests to check liver and kidney function, as well as to monitor for potential drug interactions.

How often should blood pressure be checked while taking tramadol?

For patients with a history of hypertension or those experiencing blood pressure changes after starting tramadol, more frequent blood pressure monitoring may be necessary. Your healthcare provider can recommend an appropriate monitoring schedule based on your individual health status and response to the medication.

Alternatives to Tramadol for Pain Management

For individuals who cannot take tramadol due to contraindications or severe side effects, several alternative pain management options are available. These may include:

Non-opioid analgesics (e.g., acetaminophen, ibuprofen)
Other opioid medications (under strict medical supervision)
Topical pain relievers
Physical therapy and exercise
Cognitive-behavioral therapy for chronic pain
Alternative therapies such as acupuncture or massage

What factors should be considered when choosing an alternative to tramadol?

When selecting an alternative pain management strategy, healthcare providers consider various factors, including the type and severity of pain, the patient’s medical history, potential drug interactions, and the risk of side effects or dependency. A personalized approach is crucial to ensure optimal pain relief while minimizing risks.

Recognizing and Managing Tramadol Side Effects

While changes in blood pressure are not among the most common side effects of tramadol, patients should be aware of other potential adverse reactions. Common side effects may include:

Nausea and vomiting
Constipation
Dizziness
Headache
Drowsiness
Dry mouth

More severe side effects, although rare, can include seizures, serotonin syndrome, and respiratory depression. Patients should seek immediate medical attention if they experience any severe or unusual symptoms while taking tramadol.

How can patients minimize the risk of tramadol side effects?

To reduce the risk of side effects, patients should:

Take tramadol exactly as prescribed
Inform their healthcare provider of all other medications and supplements they are taking
Avoid alcohol and other central nervous system depressants
Stay hydrated and maintain a balanced diet to help manage constipation
Report any unusual symptoms or side effects to their healthcare provider promptly

By following these guidelines and maintaining open communication with their healthcare team, patients can help ensure the safe and effective use of tramadol for pain management while minimizing potential risks and side effects.

Does tramadol raise or lower blood pressure?

Medically reviewed by Sally Chao, MD. Last updated on Oct 24, 2022.

Tramadol is a synthetic opioid pain reliever that has been linked to both high blood pressure and low blood pressure. But, neither adverse reaction is common when the medicine is taken as directed.

Studies on tramadol have reported that between 1% and 5% of people taking the extended-release version and a very small number of people taking the fast-acting version developed high blood pressure (hypertension).

Less than 1% of people taking tramadol developed low blood pressure (hypotension) in studies.

Those who had low blood pressure in the studies sometimes had what’s called postural or orthostatic hypotension. Postural hypotension occurs when blood pressure drops when someone stands up from sitting or lying down. Whether it was caused by tramadol is unclear.

Tramadol doesn’t seem to interact with high blood pressure medications, but other interactions are possible.

Taking other drugs can interfere with the way your body processes tramadol or cause other interactions. For instance, tramadol is not a blood thinner, but there are some reports that it may interact with blood thinners, like warfarin.

Many drugs may interact with tramadol, including:

Certain antidepressants

Appetite suppressant drugs

Certain antifungal medications

Certain antibiotics

Other opioids

Seizure medications

Some migraine medications

Malaria drugs

Some heart medications

Blood thinners

While blood pressure changes are not a common side effect of tramadol, some medication interactions can lead to extreme changes in blood pressure.

There are many possible drug interactions for tramadol that can be discussed with your doctor and searched on a drug interactions checker before taking the drug.

People taking tramadol should avoid drinking any alcohol or taking additional opioid medications.

Additionally, there are some people who generally should not take tramadol. These include:

People who are allergic to the drug

People with slowed breathing

People who have acute or severe asthma

Tramadol is the drug’s generic name. It’s sold under several brand names, including:

ConZip

Qdolo

Ultracet

Ultram

Ultram ER

References

Food and Drug Administration (FDA). Highlights of prescribing information: Tramadol hydrochloride extended-release capsules. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022370s000lbl.pdf. [Accessed September 2, 2020].

MedlinePlus. Tramadol. https://medlineplus.gov/druginfo/meds/a695011.html. [Accessed September 18, 2020].

Food and Drug Administration (FDA). Highlights of prescribing information: Ultram (tramadol hydrochloride) tablets. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020281s041lbl.pdf. [Accessed September 9, 2020].

Drugs.com. Drug Interactions between Cymbalta and tramadol. Available at: https://www.drugs.com/drug-interactions/cymbalta-with-tramadol-949-2273-2221-0.html. [Accessed September 18, 2020].

Drugs.com. Tramadol tablets. September 1, 2019. Available at: https://www.drugs.com/pro/tramadol-tablets.html#s-34090-1. [Accessed September 14, 2020].

Drug information

Tramadol Information for Consumers
Tramadol prescribing info & package insert
(for Health Professionals)
Side Effects of Tramadol
(detailed)

Related support groups

Tramadol
(476 questions, 2,654 members)

Medical Disclaimer

Evidence For Tramadol-Warfarin Interaction

Published: October 2006

This article is more than five years old. Some content may no
longer be current.

Prescriber Update 27(2): 23-24.

October 2006

Ruth Savage, Medical Assessor, CARM, New Zealand Pharmacovigilance
Centre, Dunedin

Local and international case reports provide evidence of an interaction
between oral tramadol and warfarin in some individuals, leading to an elevated
International Normalised Ratio (INR) and in some instances bruising or haemorrhage.
The mechanism has not been determined. The interaction usually occurs
3-4 days after tramadol is commenced in patients stabilised on warfarin.
The decrease in INR after tramadol is withdrawn may take several days.
Where it is necessary to prescribe tramadol with warfarin there should be
close monitoring of the INR, especially during the first week of treatment
with tramadol.

CARM reports show marked increases in INR

Up to 31 July 2006, the Centre for Adverse Reactions Monitoring (CARM)
had received a total of 116 reports of suspected adverse reactions to tramadol.
Three of these reports were of increased International Normalised Ratio
(INR), ranging from 7.0 to 12.3 occurring when oral tramadol was given to
patients taking warfarin. Two patients were symptomatic: one with
petechiae and one with melaena. Onset time after tramadol was commenced
was one, two and seven days. A fourth patient taking warfarin was
found to have bruising and a haematoma eight days after commencing tramadol.

The extent to which tramadol contributed to the elevated INR in the four
patients is not entirely clear as one patient may have taken an incorrect
dose of warfarin and the other three were also prescribed antibiotics.
However, tramadol seemed the most likely cause in two of these cases.

Published case reports provide further evidence

Firmer evidence of an interaction with oral tramadol can be found in
two published case reports.^1,2
A 76-year-old man had been on a stable dose of warfarin for six months when
he developed purpura and was found to have an INR of 7. 3. He had been
taking tramadol 50mg three times daily for one month. There had been
no other changes to his prescribed medication, and he had not taken any
over-the-counter medicines.¹ A 61-year-old
woman on a stable regime of medicines including warfarin had recently finished
taking tramadol 50mg six hourly for two weeks. She presented with
extensive bruising of the right upper arm, and was found to have an INR
of 10.6. Warfarin was withheld for three days until her INR reduced
sufficiently for the warfarin to be reinstated, although initially a lower
dose was required.²

Similar reports in Australia

Case reports published in 2004 by the Australian Adverse Drug Reactions
Advisory Committee (ADRAC) detail 11 reports of elevated INR or haemorrhage
when tramadol was taken with warfarin.³
The median onset time after addition of tramadol to stabilised warfarin
therapy was four (range 3-7) days, with the exception of one outlier at
six weeks. Five reports described recovery within 1-4 days of tramadol
being discontinued, with or without reduction in the dose of warfarin.
Two patients, aged 76 and 88 years, died of haemorrhagic stroke.

The interaction may occur in a sub-group of patients

In a pharmacodynamic study⁴ of the effect
of oral tramadol on INR in 19 patients stabilised on phenprocoumon (a coumarin
anticoagulant), two patients had clinically significant increases in INR
to 6.0 and 7.3, respectively, while taking tramadol. However, the
mean difference in INR for all participants did not reach statistical significance.
The mechanism of the interaction is unclear, but these results suggest that
the interaction may be associated with a variation in metabolism and that
only a sub-group of patients will be affected. This possibility is
supported by the small number of case reports in the Australian database
compared with total prescriptions for oral tramadol. ³

Increased INR monitoring necessary when tramadol prescribed
with warfarin

Although the mechanism has not been elucidated, there is evidence for
an interaction between oral tramadol and warfarin in some, but probably
not all, individuals. The CARM case reports, where antibiotics were
also implicated, are a reminder that more than one interaction may be occurring.
The interaction between tramadol and warfarin is documented in the product
information for tramadol.^5-7
It is unclear whether the interaction occurs with injectable tramadol.³

Close monitoring of the INR should be undertaken when it is necessary
to prescribe tramadol for patients taking warfarin, especially during the
first week of treatment with tramadol.

Competing interests (author): none declared.