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Basic Information

Whatis Tramadol?

Tramadol is a synthetic, centrally acting opioid analgesic. It alsoinhibits the reuptake of adrenalin and serotonin. Tramadol is used in humanmedicine for the management of osteoarthritis pain and is gaining acceptance inveterinary medicine to treat mild to moderate pain in dogs and cats. Inaddition to its analgesic properties, tramadol may also have some mildanti-anxiety effects.

Tramadol is used preoperatively, peri-operatively and in chronic painsituations. It is a scheduled drug and can provide analgesia with less sedationor fewer of the undesirable side effects found with other opioids. Tramadol maybe used concurrently with non-steroidal anti-inflammatory drugs. It can be givenorally with or without food.

Dogsand Cats

Tramadol is used in dogs and cats for management of chronic and acutepain. There is a fairly large range in dose and dose intervals in theliterature, which may be indicative of inter patient variability. Based on onesmall study of eight cats, it would appear that twice a day dosing is adequate,and that the incidence of side effects may be higher in cats than in dogs.

This is a relatively new drug in veterinary clinical practice.Preliminary results are promising and there should be more clinical experienceand studies published in the relatively near future.

Rabbitsand Ferrets

Tramadol has been used in rabbits and ferrets for the management of mildto moderate pain. Uses in the rabbit include postoperative pain, fracture care,and pain after dental procedures. It may be used with NSAID drugs.

Horses

There are limited reports on injectable tramadol use in horses andfoals. One particularly interesting report discusses the use of tramadolsedation for endoscopic examination. The tramadol sedation produced nosignificant changes in arytenoids cartilage abduction, which would make it anattractive drug for the evaluation of the upper airway. Tramadol may also beused for long-term pain management through an epidural catheter.

Side Effects

•           Tramadol is generallywell-tolerated in dogs and cats.

•           Potential side effectsin the dog could include central nervous system depression, sedation,dizziness, GI disturbances, loss of appetite, vomiting and constipation.

•           There is littleinformation available in the cat, but additional side effects may also includedysphoria and mydriasis.

Precautions

•           Tramadol iscontraindicated in animals with a history of hypersensitivity to opioids.

•           Tramadol has been shownto lower the seizure threshold in humans. It should be used with caution inanimals with seizure disorders or with other drugs that may also lower theseizure threshold.

•           Tramadol should be usedwith caution with other CNS or respiratory depressant drugs.

•           Tramadol should be usedwith caution or at a lower dosage in older animals, debilitated animals, andanimals with decreased liver or kidney function.

•           Physical dependence isnot as likely as with other opioid medications, nevertheless, animals that havebeen receiving tramadol on a chronic basis should be withdrawn gradually.

•           Diversion of this drugfor human use can occur. Veterinarians may need to be cognizant of “drugseeking” client behavior.

Drug Interactions

•           Tramadol should beavoided or used with caution in patients taking other drugs that also increasecirculating serotonin levels, including monoamine oxidase inhibitors (MAOs),selective serotonin reuptake inhibitors (SSRIs), SAMe or tricyclicantidepressants (TCA). Elevated serotonin levels can lead to "serotoninsyndrome." Symptoms of serotonin syndrome include sedation, restlessness,altered mentation, muscle twitching, hyperthermia, shivering, diarrhea, loss ofconsciousness and death.

•           Other drugs that mayinteract with tramadol include: digoxin, quinidine, and warfarin.

Overdose

•           Oral overdose can leadto respiratory depression, coma, seizures, cardiac arrest, and death.

•           Naloxone should not beused in the case of overdose with Tramadol. Tramadol is not a classic opioidand will not be completely reversed by naloxone.

About the Author

Dr. Barbara Forney is a veterinary practitioner in Chester County,Pennsylvania. She has a master's degree in animal science from the Universityof Delaware and graduated from the University Of Pennsylvania School OfVeterinary Medicine in 1982.

She began to develop her interest in client education and medicalwriting in 1997. Recent publications include portions of The Pill Book Guide toMedication for Your Dog and Cat, and most recently Understanding EquineMedications published by the Blood-horse.

Dr. Forney is an FEI veterinarian and an active member of the AAEP,AVMA, and AMWA.