GasGasGas - The FRCA Primary Exam Podcast GasGasGas - Tramadol for the FRCA Primary Exam
May 9, 2025
Delve into the intricate world of Tramadol in this engaging discussion. Discover its unique multi-mechanism analgesic action and how it functions as a weak opioid. Learn about its pharmacokinetics, including dosing limits and onset times, as well as its side effects and risks like opioid toxicity and serotonin syndrome. Gain insight into its comparative efficacy against other opioids and the importance of considering genetic variations in metabolism. A deep dive into Tramadol not only educates but also enhances your clinical perspective!
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Tramadol’s Triple Mechanism
- Tramadol combines three mechanisms: mu opioid agonism, noradrenaline reuptake inhibition, and serotonin enhancement.
- Its non-opioid actions explain why naloxone cannot fully reverse tramadol's analgesia.
Active Metabolite Magnifies Opioid Effect
- Tramadol is a racemic mixture with an active metabolite, O-desmethyltramadol, that binds mu receptors much more strongly.
- The metabolite has about 300× greater mu-receptor affinity than the parent plus enantiomer.
Practical Dosing Guidance
- Dose tramadol orally at 50–100 mg every six hours with a usual max of ~400 mg per 24 hours.
- For children, consider 1–2 mg/kg but follow local protocols strictly.