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No conclusion could be drawn on how tramadol or tramadol/paracetamol compared with available pharmacological treatments because of the limited number of studies that evaluated such therapies.
One concern regarding the use of opioids is respiratory depression. In the HoogewijsӠstudy, patients had considerably higher PaCO2 in the Tramadol compared to the Propacetamol group (48 + 6 mmHg vs. 42.2 + 3.4 mmHg)(15). In our study PvCO2 15 min after administration of the first dose did not differ significantly with that of the baseline in neither of the groups (P= 0.085 and 0.244 for the Tramadol and Propacetamol groups, respectively).
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Christie Keith said... Obviously we can't know for sure what is going on with your dog. In general, I'd say that it IS hard to know if this is an opioid response (Tramadol is sort of an opioid and sort of not)or if it's from pain. Usually, this kind of opioid response is accompanied by whining and a lack of recognition of the owner. In fact, whining is the single symptom the first vet who prescribed Tramadol to a dog of mine warned me about, as being from too high a dose for that dog. I have never seen it from Tramadol, but I have seen it from Fentanyl and from morphine. This does not sound like what your dog is experiencing, however.Sometimes we do see dogs whose owners say they are "sedated" when what they are is finally getting some deep sleep because their pain is under control. This does not at all sound like what you are describing, either.So, the answer is ... you need to talk to a vet who IS familiar with Tramadol and with pain management. This will be easy. Your vet can simply call and do a consult with any vet school's anesthesia consultants. They will be able to tell him how to evaluate the effect of this drug on your dog.Your vet also could go onto VIN (if he or she is not already a member, they can obtain a free 30 day trial membership; www.vin) and consult with the analgesia/anesthesia consultants there. It sounds to me like your dog is in a lot of pain and really needs some expert pain management here. Fortunately, that IS available, even if your own vet isn't an expert in that area. Please let us know how he does!Christie and Nancy
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Use in the Elderly In subjects over the age of 75 years, serum concentrations are slightly elevated and the elimination half-life is slightly elevated and the elimination half-life is slightly prolonged. The aged also can be expected to vary more widely in their ability to tolerate adverse drug effects. Daily doses in excess of 300 mg are not recommended in patients over 75 (see DOSAGE AND ADMINISTRATION).
ULTRAM may induce psychic and physical dependence of the morphine-type ( -opioid) (see
citation needed] It has been suggested that tramadol could be effective for alleviating symptoms of depression and anxiety because of its action on GABAergic, noradrenergic and specifically serotonergic systems. However, health professionals have not yet endorsed its use on a large scale for disorders such as this.
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No conclusion could be drawn on how tramadol or tramadol/paracetamol compared with available pharmacological treatments because of the limited number of studies that evaluated such therapies.
Christie Keith said... I'm so glad you came back with an update! Please let us know how she does!I didn't think it could possibly be the Tramadol, glad you sought out a new vet.
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7:56 PM, agilitydogmom said... Hi Nancy,Thanks so much for your reply. I was able to reach my vet and she authorized giving my dog up to 1/2 a 50 mg tramadol every four to six hours as needed. That really knocked down the pain and life is much more bearable for her now. Of course the leg still hurts like mad if it gets moved or bumped, but she seems to be able to rest comfortably. So far I am really impressed with this med. Even at that high dose she is not out of it. It does make her a little sleepy, which in her current condition is probably a good thing. But she can still get up and navigate properly to go out to go to the bathroom. Every day she seems a little better and I am now giving the pills every six hours instead of every four hours.My vet did say that Tramadol at high dosage is likely to cause constipation, but I feel like that's not nearly as bad of a problem as being in horrible pain. The pain patch you asked about had been applied that morning so it may not have reached full strength yet, which probably contributed to the difficult first night she had.Thanks again, your tramadol page was really helpful to me!
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cldh1522 said... Our geriatric dobe X had her first dose of tramadol last night at bedtime. A couple of hours later I noticed her awake and pantingsomething that has never happened beforeI'm sure as a result of the tramadol. I also noticed the panting after her dose this morning. I see panting listed as a side effect on another website. On the other hand, her pain seems to be somewhat diminished. Is there any reason to discontinue the meds because of this?
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In our study, although pain intensity score was comparable between the two groups at any time, patients in the Propacetamol group needed considerably higher dose of morphine for pain control (8.50 + 5.15 vs. 4.75 + 4.9;P = 0.025) than Tramadol group. It seems that equal pain control in the Propacetamol group was achieved at the expense of more morphine consumption. Need for rescue medication was also more in the Propacetamol group, as 10 patients (50%) in this group needed additional morphine compared to 3 patients (15%) in the Tramadol group (P= 0.041).
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Nancy Campbell RVT said... How much does your Irish Setter weigh? I've not heard any reason why a dog wouldn't be able to remain on Tramadol, if it is helping with pain.
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The analgesic effects of tramadol are not completely reversed by the opioid antagonist naloxone and some patients who do not respond to codeine do respond to tramadol. This suggests that tramadol has additional mechanisms of action. Tramadol inhibits reuptake of serotonin and noradrenaline and this probably contributes to its analgesic effects.
frogsndogs said... Hi,My 12 year old Sibe was diagnosed with hip dysplasia when he was 2, and up until this past year, we have been able to keep his pain well managed with nutraceuticals (Glucosamine and chondroiton), vitamins and supplements (Vit C, Vit E, Fish Oil), acupuncture (works wonders!), acupressure, and massage. His age is finally catching up with him and early this year we put him on Rimadyl intermittently to control his increased pain. He started urinating frequently and having accidents in the house, so we tested him for UTI and kidney fxn. Both were fine, but we found elevated liver enzymes, so immediately pulled him off of the Rimadyl. Our vet prescribed Zentonil to try to help with the liver (this is working well), and Zubrin for the pain. One capsule of Zubrin was given and he immediately vomited it up - no tolerance. We then tried Metacam. He tolerated it for the first 10 days, then started vomiting again - no tolerance, and it didn't really seem to be helping anyway. Our vet has now prescribed Tramadol (1/2 50mg tablet b.i.d - he is 51 lbs.) and within the first 24 hours we saw an immediate change in his attitude. He is no longer the "grumpy old man" he has been the past few months. He actually wants to trot when we walk to the park, and he is asking to play catch with his ball again. We are wishing we would have been told about this drug months ago. He has been on it less than a week, but in this time we have not seen anything to indicate any adverse reactions. I just thought it would be nice to share some good feedback on this drug. This is a very helpful site and I appreciate everyones' input. I did notice that somebody had asked about interaction with DGP (Dog Gone Pain), but saw no response. Could somebody please address this, as we have been using that intermittently since last year?Thank you!DG in Colorado
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The molecular weight of tramadol hydrochloride is 299.8. Tramadol hydrochloride is a white, bitter, crystalline and odorless powder. It is readily soluble in water and ethanol and has a pKa of 9.41. The n-octanol/water log partition coefficient (logP) is 1.35 at pH 7. ULTRAM tablets contain 50 mg of tramadol hydrochloride and are white in color. Inactive ingredients in the tablet are corn starch, hydroxypropyl methylcellulose,
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During the preparation of the editorial there was a suggestion that the popularity of tramadol may be related to the availability of repeat prescriptions on the Pharmaceutical Benefits Scheme (PBS). The Editorial Executive Committee therefore invited the Pharmaceutical Benefits Advisory Committee (PBAC) to comment.
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MORE ON DOSAGE AND ADMINISTRATION: For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of Tramadol can be improved by initiating therapy with the following titration regimen: Tramadol should be started at 25 mg/day qAM and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg q.i.d.).Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg q.i.d.).After titration, Tramadol 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
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Tramadol capsules 50 mg are listed for two indications on the PBS. One indication is treatment of acute pain conditions where aspirin and/or paracetamol alone are inappropriate or have failed. The PBAC considered that this medication is appropriate for short-term use only, so the maximum quantity is 20 with no repeats in order to encourage appropriate use. The restriction includes a NOTE advising that no applications for increased maximum quantities and/or repeats will be authorised.
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I was given Ultram initially, then changed to Tramadol. I was told the only difference is that tramadol does not contain acetaminophen. I was also told it wasn't addictive, but trying to leave it on my own has been difficult. The symptoms are similar to many of you: terrible headaches, skin crawls, sleeplessness. I'm planning to take a few weeks to enter a detox center and get rid of it once and for all. Richard - Chino, California, USA
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Respiratory Depression When large doses of Ultram are administered with anesthetic medications or alcohol, respiratory depression may result. Cases of intraoperative respiratory depression, usually with large intravenous doses of tramadol and with concurrent administration of respiratory depressants, have been reported in foreign experience. Such cases should be treated as overdoses (see OVERDOSAGE). Ultram should be administered cautiously in patients at risk for respiratory depression.
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Do not crush the tramadol tablet. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death. Do not crush, chew, break, or open a controlled-release, delayed-release, or extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time. If you use the tramadol extended-release tablet, the tablet shell may pass into your stools (bowel movements). This is normal and does not mean that you are not receiving enough of the medicine.
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Tramadol can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Call your doctor if you find that you want to take extra medication or if you notice any other unusual changes in your behavior or mood.
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Patients received either Tramadol 100 mg IV or Propacetamol 2 gr IV at T0 and then 50 mg Tramadol or 1.5 gr Propacetamol at 6, 12, 18 and 24 hours if pain was present. The maximum total dose for Propacetamol and Tramadol were 8 g/d and 300 mg/d, respectively.
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Riedel F, von Stockhausen H-B. Severe cerebral depression after intoxication with tramadol in a 6-month-old infant. Eu J Clin Pharmacol 1984;26:631-632.
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This record should be cited as: Cepeda MS, Camargo F, Zea C, Valencia L. Tramadol for osteoarthritis. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005522. DOI: 10.1002/14651858.CD005522.pub2
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