Talk:Tramadol/Archive 2

Abuse
I took this out because it contradicts the other section and needs better sources. Merge it in if you want. Pasted below:

Although not related to traditional opioids, tramadol can produce euphoria in some users, though not at therapeutic doses. At high but therapeutic single doses (about 75–300 mg), tramadol induces a state of well-being. The high produced by tramadol is similar to other opioids, but with notable differences such as increased energy, empathy, and a significant improvement of symptoms related to depression and anxiety. Effects of tramadol also last much longer than that of opioids due to its complex mechanism and longer half-life. A small study reports less cognitive impairment with tramadol than with morphine. Those who can rapidly convert tramadol through P450 enzyme are more likely to experience euphoria, respiratory depression, constipation, and analgesia. As of 2010(possibly earlier) O-Desmethyltramadol has been made available from a few select Research Chemical suppliers often being sold alongside other drugs such as MDPV, 4-ACO-DMT and JWH-018. Many users claimed the chemical to be on average twice as potent as tramadol itself as well as being more euphoric and effective via routes of administration other than oral.

Persephone12 (talk) 14:20, 20 July 2010 (UTC)

Taking out "abuse, etc"
Good move as there is a contradiction. However, I am currently on the hunt for a source, as all of this information was correct. This is not a good way to find a source, but if you doubt the ability of tramadol to cause euphoria and be abused, just google it up. You will find countless forums of users who prefer tramadol over even morphine-related opioids. And horror stories of tramadol withdrawal. Most tramadol abusers do not find other opioids to appeal to them. This is likely due to tramadol causing a sudden release of serotonin, which in itself will cause euphoria. Specifically in the way that tramadol does this. I am relieved to find that doctors and the federal government are finally waking up about this drug. It has become scheduled in certain states and will likely become scheduled nationally in the near future. This would be a very smart move as many innocent people have become addicted and/or dependent on tramadol. —Preceding unsigned comment added by 69.244.207.16 (talk) 17:35, 24 July 2010 (UTC)

Uses
Where should the closing parenthesis - pairing with the opening one before Nucynta - be in this section?

(Nucynta, a new synthetic atypical opioid made to mimic the agonistic properties of tramadol's metabolite, M1(O-Desmethyltramadol). Tramadol is also molecularly similar to Effexor and has similar SNRI effects, with antinociceptive effects also observed. It has been suggested that tramadol could be effective for alleviating symptoms of depression, anxiety, and phobias[11] because of its action on the noradrenergic and serotonergic systems, such as its "atypical" opioid activity.[12] However, health professionals have not endorsed its use for these disorders,[13][14] claiming it may be used as a unique treatment (only when other treatments failed), and must be used under the control of a psychiatrist.[15][16] Dawright12 (talk) 09:37, 22 November 2010 (UTC)

Is there a link for Tramadol's supposed use in combatting acid reflux (GERD)? If not, I think this should be removed. —Preceding unsigned comment added by 69.201.176.176 (talk) 01:18, 20 December 2010 (UTC)

Reference Footnote #75 is probably spam hiding under a small part of the webpage
Folks, Note #75 is basically a link to a webpage that sells and touts Tramadol. I did not delete it as I will leave that to a discussion and consensus decision. Jack Jackehammond (talk) 07:29, 18 February 2011 (UTC)

Some pharmacodynamics that should be added...
Tramadol has found to be and agonist of the transient receptor potential vanilloid-1 (TRPV1) receptor. Here's the PubMed reference.

I'm not sure how to edit the article, but I think it would be good to add this under Mechanism of Action in the main article. If anyone wants to help improve the article, it would be much appreciated. —Preceding unsigned comment added by 192.104.181.229 (talk) 03:48, 23 February 2011 (UTC)

Drug Screen
Perhaps it should be noted that tramadol does not show up as an opiate/opiod or as any specific opiate/opiod (e.g. oxycodone, methadone, etc.) on home urine drug screens. There is a lab test for tramadol but on home tests available at most pharmacies it does not show up to my knowledge. I cannot find what most people would consider "reliable" sources online but maybe someone with a medical reference book (like a doctor or nurse) could find a reference. I take tramadol hcl and have passed urine drug tests for work that scan for 13 types of drugs (opiates, cocaine, barbituates, benzodiazepines, THC, oxycodone, methadone, methamphetamine, amphetamine, tricyclic antidepressants, PCP, propoxephene, and buprenorphine). --Rotellam1 (talk) 20:39, 30 May 2011 (UTC)


 * It probably does not show up as it is not tested. Not all drug sreens test all drugs.  Tramadol not a big concern, thus not tested.  Perhaps it ought to be, but it isn't.  — Preceding unsigned comment added by 141.116.212.32 (talk) 20:31, 20 October 2011 (UTC)

Inconsistent
HERE: "As with codeine, in the 6% of the population that have increased CYP2D6 activity (increased metabolism), there is therefore a reduced analgesic effect."

In O-Desmethyltramadol page is written:

"Tramadol is demethylated by the liver enzyme CYP2D6[3] in the same way as codeine, and so similarly to the variation in effects seen with codeine, individuals who have a less active form of CYP2D6 ("poor metabolisers") will tend to get reduced analgesic effects from tramadol."

I made the correction but someone undid it... Redo it ! — Preceding unsigned comment added by Galileuz (talk • contribs) 09:04, 3 July 2011 (UTC)

Availability
The usage and availability section doesn't really cover availability. Either it should be renamed usage, or information about where it is only available under prescription etc. should be added. — Preceding unsigned comment added by 86.8.154.86 (talk) 10:45, 31 August 2011 (UTC)

tramadol is a synthetic analog of the phenanthrene alkaloid codeine
I do not think that tramadol is an analog of codeine.

Tramadol has a two 6 carbon ring structure

Codeine has the typical opiate ring structure. Which is a 5 ring structure that has 4 flat rings including an ether based ring and nitrogen containing ring which sticks out on top of the flat rings.

So in my opinion these structures are almost completely unrelated in a chemical sense of being an analog. — Preceding unsigned comment added by 85.223.37.87 (talk) 15:31, 17 September 2011 (UTC)

NSAIDs
Tramadol is not an NSAID, but does that mean it acts like steroids, or that it can sterilize over long periods of usage?64.183.42.48 (talk) 22:53, 20 September 2011 (UTC)

my dog has been given tramadol 50mg i thought it was for humans, are both the same for dogs and humans?? — Preceding unsigned comment added by 95.146.57.15 (talk) 12:01, 7 November 2011 (UTC)

Tramidol effects on son.
My son was given Tramidol for back injury throughout his time in the Army after injury. He was first given it while serving in Iraq and it continued and was given all throughout another year in Afghanistan. He was still using the prescription when he finished 5 years of enlistment and came home. He tried going off it cold-turkey and had many withdrawal symptons. He then started using street drugs and evenetually, Heroin. He has been in the VA hospital for ReHab and is now going to a intensive PTSD program, yet the Doctors, knowing his problems, and having my son tell them straight off he felt he was addicted to the Tramidol, they renew his prescriptions.

I don't have any medical documentation to back this up, but it seems to me, Tramidol can be addictive as other opiates, depending on each persons genetic makeup. — Preceding unsigned comment added by 70.44.119.245 (talk) 20:05, 10 January 2012 (UTC)


 * This is a complicated matter. While essentially any psychopharmaceutical can cause a dependency syndrome in some persons,  tramadol is much less likely to do this than the opiates per se.  Similarly,  you can't really argue relative dependency liability on the basis of individual cases.  Flatly-stated,  some persons are much more susceptible to dependency than others.  Likewise,  many persons,  while they do undergo physical withdrawl,  don't develop a dependency syndrome no matter what the drug.   Also,  the army is currently doing clinical trials using tramadol as a treatment for PTSD. Nucleophilic (talk) 22:15, 28 February 2012 (UTC)

Tramadol not an "Opioid"
Reading over the above, there seems to be a reasonable cocnesus that,  while it does have some weak agonist activity on one opioid receptor,   both tramadol's action and its molecular structure are not those of an "opioid" per se. Further, it is misleading to make this claim. Again, I suggest that the best thing is just to refer to it as an analgesic and describe the complicated mechanism of action. Nucleophilic (talk) 04:22, 16 April 2012 (UTC)

Recreational use
Removed the following comment. It was uncited and reads like a suggestion to abuse tramadol (if someone is gonna abuse a drug then tramadol is probably not the one to abuse) and I also don't like the idea that someone might follow this advice and risk endangering someone, depending on their job, or risk failing their drug test. If someone can find a citation I'd be more inclined for this to stay but even then only if this is a notable phenomenon (by this I mean people abusing tramadol in preference to other drugs *specifically* in order to be able to pass a drug test). Without some decent evidence I think we can assume this is apocryphal.

"Using tramadol as recreational drug may also be preferred because it is one of the only opioids that is often not screened for by standard urine drug-tests." Edit: If anyone wants this kind of information there are plenty of forums dedicated to it. Privateiron (talk) 01:47, 22 August 2012 (UTC)

Controlled Status
Tramadol is not currently a Controlled Substance in WV or Mo .173.80.31.68 (talk) 13:38, 1 May 2013 (UTC)

Tramadol as a SNRI in the first place
The effect of tramadol is mostly due to its ability to inhibit the reuptake of norepinefrine and serotonin. In addition one of its isomers is a serotonin releasing agent. The effect on the opioid receptors is just a minor effect. Hence the first statement should be that tramadol is a SNRI and serotonin releasing substance with additional minor opioid agonistic effect. — Preceding unsigned comment added by an unknown user 10:49, 21 September 2013 (UTC)

Atypical Opioids
Tramadol is an atypical opioid (reference). I feel that this deserves a mention in the first paragraph, i.e.; "Tramadol ... is a centrally acting, atypical opioid analgesic used to treat moderate to moderately severe pain." Thoughts?
 * (Psychonaut25 - 13375p34k / C0n7r1b5 04:43 AM EST, 15 October 2013 (UTC))


 * I so agree! That not only deserves mention I think it deserves its own paragraph in the lead. Fuse809 (talk) 09:13, 20 April 2014 (UTC)

Citation style
In this edit: The above edit was reverted with the justification that the edit is a violation of WP:CITEVAR. Quite to the contrary, I believe that the above edit is completely consistent with CITEVAR as it restored the originally established citation style. Hence I propose to restore the the above edit. Is there consensus to revert the reversion? Boghog (talk) 19:49, 8 May 2014 (UTC)
 * A mixture of citation styles that was replaced by a single consistent style.
 * In an older version of the article shows a clear preference for the Vancouver system author style. According to WP:CITEVAR, defer to the style used by the first major contributor. The above edit restored that predominate style.
 * The use of a single author parameter to store multiple authors in the cite journal has long been accepted and has not been deprecated. Furthermore the Vancouver system is specifically mentioned in cite journal documentation.
 * The coauthor parameter has been deprecated and the above edit replaced several occurrences of this parameter with a single author parameter.
 * The journal abbreviations in the above edit follow the system used by the National Library of Medicine and PubMed.


 * This is being discussed at Help talk:Citation Style 1. This article didn't use the Vancouver system, it used a hybrid system that used some features from Citation Style 1 (quote marks around journal article titles, italics for books and journal titles) and some from Vancouver (separating author names with commas, writing author names as "Jones J" rather than "Jones, J.". The documentation for {{tl}cite journal}} mentions the Vancouver system, but does not describe it correctly. None of the other cite xxx templates that I can find mention Vancouver. Jc3s5h (talk) 20:23, 8 May 2014 (UTC)


 * This article didn't use the Vancouver system – an earlier version did and according to WP:CITEVAR, the originally established citation style does matter.
 * None of the other cite xxx templates that I can find mention Vancouver – irrelevant. Boghog (talk) 20:35, 8 May 2014 (UTC)
 * but does not describe it correctly – Fixed in this edit. Boghog (talk) 20:42, 8 May 2014 (UTC)


 * The earlier version mentioned by Boghog did not use the Vancouver system. Jc3s5h (talk) 20:42, 8 May 2014 (UTC)
 * It did use an Vancouver system author style. Boghog (talk) 21:02, 8 May 2014 (UTC)

This stripping of journal names down to impenetrable crap like Expert Opin Pharmacother, and author names into run-together gibberish like "Jones HB, Smith TE, Garcia XJ", has to stop. This is not WP:OWN journal, and WP certainly does not have to follow the excessively compressed and jargonistic style preferred by the journals you read. See the essay WP:Specialist style fallacy for an analysis of why attempts to impose on Wikipedia some style quirk from specialist publications is usually both a bad idea and a failure. — SMcCandlish ☺ ☏ ¢ ≽ʌⱷ҅ᴥⱷʌ≼  20:51, 8 May 2014 (UTC)


 * It is not your journal either. Are you suggesting that we repeal WP:CITEVAR?  And why is "Jones, H.B.; Smith, T.E.; Garcia, X.J." necessarily better than "Jones HB, Smith TE, Garcia XJ"? The later is much cleaner and easier to read. Boghog (talk) 21:05, 8 May 2014 (UTC)
 * With respect to the author format, the WP:specialist style fallacy, does not apply. IMHO, the Vancouver author format is more readable for both specialist and non-specialists. It is also easier for non-specialist editors.  Hence I believe that the KISS principle is far more relevant in this context. Boghog (talk) 21:14, 8 May 2014 (UTC)
 * Finally the journal name abbreviations is a side issue. I have restored the full journal names in this edit. Boghog (talk) 02:17, 9 May 2014 (UTC)

On stuffing multiple authors into '[co]authors='
Both of you seem to be abusing the coauthor/authors parameter. Why not break out each author into last-first parameters? E.g.: |last1= Raffa |first1= RB |last2= Buschmann |first2=  H |last3= Christoph |first3=  T |last4= Eichenbaum |first4=  G |last5= Englberger |first5=  W |last6= Flores |first6=  CM |last7= Hertrampf |first7=  T |last8= Kögel |first8=  B |last9= Schiene |first9=  K |last10= Straßburger |first10=  W |last11= Terlinden |first11=  R |last12= Tzschentke |first12=  TM

Is this just too much trouble? Or is there some other reason? ~ J. Johnson (JJ) (talk) 21:44, 8 May 2014 (UTC)


 * The coauthor parameter is deprecated while a single author parameter is not. Why use verbose "first1, last1, first2, last2" parameters? To generate metadata that no one uses? The use of verbose author parameters overwhelms the wikitext making it harder for editors to locate and edit the text.  The purpose of the citations is to support the prose, not the other way around. Boghog (talk) 21:56, 8 May 2014 (UTC)


 * I believe the 'author=' parameter is intended mainly for cases (such as corporate or group authorship) where 'first/last' is not appropriate. To use it as a replacement for 'coauthors=' is just a way of getting around the ban on the latter. If reducing verbosity is the highest priority, then why bother using templates at all? ~ J. Johnson (JJ) (talk) 22:30, 8 May 2014 (UTC)
 * The templates save space by providing doi, pmc, and pmid links and also insure consistent formatting. Hence using a single author parameter (especially if there a large number of authors) within a cite template IMHO represents a good compromise between functionality, consistency, and compactness. Boghog (talk) 01:35, 9 May 2014 (UTC)
 * Also, as I have stated above, the use of a single author parameter to store multiple authors in the cite journal template has long been accepted and has not been deprecated. Boghog (talk) 01:38, 9 May 2014 (UTC)

I am for consistency. As long is this is the same format the cite template generate in the edit bar. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:46, 8 May 2014 (UTC)


 * So verbosity is not an overriding consideration in whether to use templates, and the trade-off with other factors is somewhat a matter of personal taste. Okay. I think this use of the 'author=' parameter is bad practice, not justified by long use, but probably not worth debating. ~ 20:08, 9 May 2014 (UTC)

"Tramadol has been recently found in a South African tree."
this needs to be rephrased at least bc Tramadol is a trade name not scientific name. 74.60.161.158 (talk) 17:50, 31 May 2014 (UTC)


 * Tramadol isn't a brand name, it's the generic name, hence it's also a scientific name. It is the name set by several medical associations including: the World Health Organization, the American Medical Association, the British Pharmacopoeia and the Therapeutic Goods Administration. Plus if you have this attitude and maintain that tramadol still isn't a scientific name and rather favour a chemical name then we might as well rename the whole article by its chemical name. Which as per WP:PHARMMOS and WP:CHEMMOS we do not do and hence I fail to see why we should do so for this one sentence. Brenton  (talk|email) (I automatically watch all pages I edit) 18:06, 31 May 2014 (UTC)


 * What attitude did the poster have? He/she posted a statement that was in error but thought it was correct so brought it up in the talk section.  I'm not sure why you need to get defensive about it.  — Preceding unsigned comment added by 68.36.10.247 (talk) 21:22, 30 August 2014 (UTC)

R/S nomenclature mistake!!
(1R,2R)-Tramadol and (1S,2S)-Tramadol are switched in the image of Tramadol also (1R,2R)-O-desmethyltramadol and (1S,2S)-O-desmethyltramadol are switched in the Pharmacokinetics part (for confirmation I used Marvin sketch)and I have already changed it  — Preceding unsigned comment added by Ph.David (talk • contribs) 18:32, 21 September 2014 (UTC)


 * For comparison, ChemDraw assigned your diagrams the opposite of what you say, and also I got the opposite display when used Marvin (online) to set specific stereochemistry to an originally achiral diagram:


 * Considering C2 of the right-hand structure (where the aminomethyl group is attached wedged), I calculate CIP precedence order of C1 ("C with O") > methylamino ("C with N") > C3 ("CH2") > H (implicit). The least significant is dotted, so the 1→2→3 going counterclockwise means S (in agreement with ChemDraw and not with yours). What is your analysis of that location? Can you post an actual screenshot or exported image from Marvin with its result? DMacks (talk) 08:20, 22 September 2014 (UTC)


 * I used MarvinSketch too and it found that Ph.David's assignment of R and S was incorrect. I think you (Ph.David) must have got the two structures confused, because the original svg was accurate. Brenton  (contribs · email · talk · uploads) 08:34, 22 September 2014 (UTC)
 * I updated my original comment about ChemDraw to include my Marvin result after Brenton added his note. DMacks (talk) 08:39, 22 September 2014 (UTC)

I got the confusion ..... When I imported the IUPAC name of tramadol without R/S nomenclature and drawed the wegde and dash notation ... the draw was rotated so the R/S nomenclature switched

while the original draw of Tramadol gives me your nomenclature Brenton & DMacks



but I have a QUESTION what if the original Tramadol structure was that rotated one ?? then the nomenclature theory would be just a scratch !! — Preceding unsigned comment added by Ph.David (talk • contribs) 13:18, 22 September 2014 (UTC)


 * Your rotated drawing gives the wrong nomenclature because it is rotated with respect to the original. Now the original cannot be rotated with respect to itself. By the way, you could have a look at Cahn–Ingold–Prelog priority rules and work out the nomenclature without the aid of computer programmes. This is a good practice for one's 3D imagination :-) Cheers --ἀνυπόδητος (talk) 17:24, 22 September 2014 (UTC)

Legal Status
Removed, "Similarly, unlike opioid analgesics, tramadol is not currently scheduled as a controlled substance by the U.S. Drug Enforcement Administration. However, it is controlled in certain states", from Australia paragraph in the "Legal Status" section because it makes no sense to mention the DEA and USA laws in the Australia paragraph. The paragraph preceding the above mentioned paragraph talks about USA laws in regards to Tramadol, including the DEA's recent announcement to actually federally schedule Tramadol as a Schedule 4 controlled substance under the Controlled Substances Act. The states that have already scheduled Tramadol have been mentioned in the paragraph preceding the Australia paragraph and mentioning it again in the Australia paragraph is not only redundant, but doesn't belong in a paragraph about Australia's Tramadol laws. User "Boghog" has undone my above change, so I discussed my change here and will undo his action to revert my work. Thank you for your understanding. — Preceding unsigned comment added by EDSandPOTSY (talk • contribs) 07:14, 7 July 2014 (UTC)

Can someone update the status of the patents on the drug? Its a couple months past the May 2014 date so unless something happened to extend the patent which it seemed to be going the other way (moving forward the date the patent is expired) then it is outdated. — Preceding unsigned comment added by 68.36.10.247 (talk) 21:24, 30 August 2014 (UTC)

In Spain this medication is freely available without a prescription from pharmacist shops. Source: personal experience (shingles pain treatment) EdX20 (talk) 20:54, 10 October 2014 (UTC)

Interesting. I was prescribed some recently by my doctor at the VA, in Los Angeles. I had to sign for it at the VA pharmacy, just as I would have for Vicodin. JDZeff (talk) 19:25, 8 December 2014 (UTC)

Pin cushion tree
There is apparently another round in the Pin cushion tree argument but it is pay-walled:

http://www.pnas.org/content/early/2015/06/23/1506011112.full.pdf

©Geni (talk) 15:28, 24 July 2015 (UTC)

Opiate / Opioid
This ref says "Tramadol belongs to the group of medicines called opioid analgesics."

This ref says "Class: Opiate Agonists"  Doc James  (talk · contribs · email) 09:05, 25 July 2015 (UTC)

Fibromyalgia
Saying Tramadol is used off-label for Fibromyalgia is a neutral fact. "Based on three small trials with weak study design" sounds like opinion to me. Aren't we striving for NPOV? — Preceding unsigned comment added by 2601:644:100:743B:C8E1:E9DF:94B:3A89 (talk) 02:05, 5 December 2016 (UTC)
 * Thanks for bringing the ref (am assuming that you are the same person) and thanks for starting to talk. That is what the source says; we describe the evidence especially for things like this. Jytdog (talk) 02:18, 5 December 2016 (UTC)
 * You have been reverted by three different editors now. If you had an account you would be blockable. If you edit again without consensus I will just get the page locked Jytdog (talk) 02:22, 5 December 2016 (UTC)
 * Off label is American and we are a global encyclopedia. Thus "not approved in the United States for fibromyalgia." is clearer wording. Doc James  (talk · contribs · email) 02:25, 5 December 2016 (UTC)
 * I was only able to see the abstract, so I was following the wording in there. Most viewers cannot see the entire article. Perhaps after the first revert, someone should have started a talk page to discuss the issue. I guess it's easier to ban people than explain why you are doing something. Not very welcoming. — Preceding unsigned comment added by 2601:644:100:743B:C8E1:E9DF:94B:3A89 (talk) 02:41, 5 December 2016 (UTC)
 * Never edit based on an abstract alone. . Read  WP:NOABSTRACT. This is basic scholarship in any case.  What kind of person argues based on only an abstract?   Jytdog (talk) 03:03, 5 December 2016 (UTC)

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Inappropriate instruction?
Is the statement in the lede "those who take it should not stop breastfeeding" overly prescriptive and a breach of MOS:MED (and WP generally): "Wikipedia is not an instruction manual or textbook and should not include instructions, advice (legal, medical or otherwise)"? 92.19.24.9 (talk) 17:47, 5 November 2017 (UTC)

personal and cognitive function - removal
i've removed this sentence: "Some have also stressed the negative effects of opioids on cognitive functioning and personality.[28]" In the referred paper (https://academic.oup.com/bja/article-lookup/doi/10.1093/bja/87.1.133) it's in fact doubted rather than stressed. — Preceding unsigned comment added by 2A02:2788:1018:A2:809F:E898:557:7CC8 (talk) 19:22, 7 November 2017 (UTC)

Analogues
Tramadol is being seen in an increasing number of fatal overdoses. Mixed with an MAOI seems to be particularly hazardous. While O-desmethyl tramadol was sold as a 'research compound' in the UK, replacing the aliphatic hydroxyl with a fluorine increases potency by another magnitude. Stability of the compound (loss of HF) in vitro prevented further research. The patents use DAST and similar, hazardous agents to produce the analogue, the low cost of tramadol in China would mean that it could become a drug of abuse. A hazardous one at that. I only mention it because tramadol is a schedule 3 drug in the US so analogues would not automatically be controlled. It would be difficult to find a 'pinch point' and the Chinese seem happy to work with toxic reagents but DAST and related fluorinating agents are rarely used so could be considered a precursor chemical. — Preceding unsigned comment added by 81.99.74.135 (talk) 15:37, 8 March 2017 (UTC)

Firstly Tramadol is a schedule 4, not 3. Second, I'm glad the Chinese are making alternatives because misinformed people are spreading these drug fears and, as the wiki shows, the studies themselves indicate the fear and hype is not warranted. All the irrational 'warnings' are doing is hurting people from getting the medications they need to get by. I'm so sick of the "Drug Wars" hurting so many innocent people just to try and exert control over those who don't have it for themselves. Stop with the unfounded fears about Tramadol, it works great and just like anything in the world, if you *abuse* it, then it's obviously not going to work as intended. That's the nature of all abuse. 2601:8D:602:A110:E120:4698:7586:48A3 (talk) 18:47, 19 December 2017 (UTC)Mya_Lysippe

Typo in lede
It says "may be sold in combined with paracetamol" which is ungrammatical. it should be changed, maybe to say "in combination with" or "with xxx in combined form" morsontologica (talk) 08:06, 7 January 2019 (UTC)
 * I have fixed it. Thanks for catching the error and reporting it here.  -- Ed (Edgar181) 13:27, 7 January 2019 (UTC)

For future reference (though this particular user was apparently experienced with Wikipedia), all readers are encouraged to jump in and correct these sorts of errors. Copyediting is an essential part of Wikipedia :) Caitlin.swartz (talk) 08:59, 30 March 2019 (UTC)

Outdated reference?

 * I apologize in advance if this is a dumb question.*

Reference 17 (Lee CR, McTavish D, Sorkin EM (1993)) is ~26 years old and contains outdated information, as our understanding of Tramadol has changed significantly. However, the cited information presented in this Wiki page appears to be currently accurate. Furthermore, there's only one sentence which appears to rely on this citation (the one regarding morphine equivalents). Is it necessary to update the source in this specific example? Thank you. 2603:301E:103:8200:58F9:50A5:F1AA:DEFD (talk) 09:19, 30 March 2019 (UTC)

Btw, I'm in the process of a name change. Hence the string username. 2603:301E:103:8200:58F9:50A5:F1AA:DEFD (talk) 09:21, 30 March 2019 (UTC)

Serotonin (SERT) action pharmocologically relevant ??
The article should probably caveat the action on increasing serotonin as not pharmocologically relevant. The SERT dissociation constant is very large. SSRIs have much smaller ones, by 1-2 orders of magnitude. I think the serotonin effects are too small to be practically relevant. Danski14(talk) 01:13, 16 September 2018 (UTC)


 * With some SSRIs it doesn't matter. It has a black box warning interaction with Zoloft, Paxil, and some other SSRIs,  Zoloft for example has a lower 5HT2C binding affinity than tramadol and O-DSMT, while tramadol can potentially compete at NET but they're pretty similar there.    Anecdotally I was accidentally prescribed both at the same time once and by the 2nd day was noticing early effects of serotonin syndrome and went back to the doctor in a fairly "cracked out" state and white-boarded the whole mess of why it was a problem to mix them for the poor orthopedic specialist who followed most of it and switched me over to vicodin at equivalent dose.
 * It's been about 6 years since I was up all night studying it but the problem seemed to mainly exist with SSRIs that had some binding affinity lower than tramadol at certain 5HT subtypes...  Sadly I can't recall the specific problem that caused.  Tramadol is also a serotonin releasing agent and relatively potent for what it is, with possibly stronger SRA effects from metabolites since they all do different stuff and have their own affinities / dissociation constants everywhere.  Full-concentration / thereapeutic dose SSRIs after a month  don't reach full SERT occupancy (or they'd probably just kill people, really) so there's still a chance for more reuptake inhibition to stack on top of that the SSRI is producing regardless of the higher Kd and full inhibition isn't something wanted.  I think 5-HT3 and 7 were major issues since antidepressants aren't normally agonists at those receptors and released serotonin will preferentially bind to the non-occupied ones, depending on the antidepressant 1A and 1B might be left alone too, although I recall it having less problems with those.  Zoloft was a specific black box warning at the time.
 * The exact quote from this ref is --
 * 5.9 Serotonin Syndrome Risk
 * Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol, including ULTRACET, during concomitant use with serotonergic drugs. Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonergic neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), certain muscle relaxants (i.e., cyclobenzaprine, metaxalone), and drugs that impair metabolism of serotonin (including MAO inhibitors, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue) [see Drug Interactions (7)]. This may occur within the recommended dosage range.
 * Honestly that's all the evidence I need, since prescribing warnings are too sparse for many drugs, if anything. Removing something specifically warned about because of interpretation of limited receptor binding affinities isn't proper.
 * A Shortfall Of Gravitas (talk) 14:57, 22 May 2023 (UTC)
 * A Shortfall Of Gravitas (talk) 14:57, 22 May 2023 (UTC)

If you have adequate sources to support this claim, feel free to add content Caitlin.swartz (talk) 08:50, 30 March 2019 (UTC)