Tramadol causes constipation: Does tramadol cause constipation?

11.08.202329.06.2023 by alexxlab

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

Drug information

Tramadol Information for Consumers
Tramadol Information for Healthcare Professionals
(includes dosage details)
Side Effects of Tramadol
(detailed)

Related support groups

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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 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, which 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 stage – 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 in 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 it is 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 is 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:

Abuzarova G.R. /The role of tramadol in oncology and surgery// Abstracts X Ross. National congress “Man and medicine”; M.; 2003.
Abuzarova G.R., Gallinger E.Yu. Pchelintsev M.V. / Algorithm for pharmacotherapy of chronic pain syndrome in an oncological clinic // Vrach; 2011.-№ 6.
Pain ed. Yakhno N.N. / Guide for doctors / / Ed. Medpress info; 2009
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 ).
Osipova N.A., Abuzarova G.R. /Treatment of chronic pain in incurable patients at home// Doctor; 2002.-№ 4.
Novikov G.A., Osipova N.A. /Treatment of chronic pain of oncological genesis//Ed. MMA named after Sechenov; 2005.

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):

Blood in the urine
Chest pain
Convulsions
Seizures
Dark urine
Syncope
Numbness of extremities
Icteric discoloration of eyes and skin0183
- 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 causes constipation: Does tramadol cause constipation?