Why isn't Tramadol considered a narcotic?

Question

About 5 months ago, my mother's doctor prescribed her Tramadol (otherwise known as Ultram) for her severe back pain, telling her that it was non-narcotic and non-addictive so she could take as much as she wanted. She'd been on Tramadol since then, and slowly, her dosages increased. One week ago, she had a seizure, and the doctors at the ER said that Tramadol was what caused it. I looked it up on the Internet, and was shocked to find that apparently, Tramadol is VERY addictive and is known to cause seizures if taken at high dosages. Since Tramadol is an opiate and an addictive drug, why isn't it considered a narcotic and why are people told that it's not addictive and is pretty much harmless when it's prescribed to them??

Answer 1

It's not a narcotic, but it is one of the most highly abused drugs out there.

It's a synthetic agent that's not related to opoids, so it's not considered a narcotic.

Answer 2

Tramadol Narcotic

Answer 3

so i went over to webmd and looked, and thats not precisely what it says (my wife takes it too.) It isnt an opiate, and is not VERY addictive. She got poor pain management from her physician, who should probably have had her on opiates from the sound of it. No drug is "harmless," so thats bad advice too. Not the drug's fault, the prescriber's, if he indeed prescribed these escalating doses.

Answer 4

Tramadol (INN) (IPA: [ˈtræmədɒl]) is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. It is a synthetic agent, unrelated to other opioids, and appears to have actions on the GABAergic, noradrenergic and serotonergic systems. Tramadol was developed by the German pharmaceutical company Grünenthal GmbH and marketed under the trade name Tramal. Grünenthal has also cross licensed the drug to many other pharmaceutical companies that market it under various names, some of which are listed below.

Tramadol is usually marketed as the hydrochloride salt (tramadol hydrochloride) and is available in both injectable (intravenous and/or intramuscular) and oral preparations (e.g. Zydol® in UK and Ultram® in US). It is also available in conjunction with paracetamol (acetaminophen) as Ultracet®.

Dosages vary depending on the degree of pain experienced by the patient. Tramadol is approximately 10% as potent as morphine, when given by the IV/IM route. Oral doses range from 50–400 mg daily, with up to 600 mg daily when given IV/IM.

[edit] Mechanism of action
The mode of action of tramadol has yet to be fully elucidated, but it is believed to work through modulation of the GABAergic, noradrenergic and serotonergic systems. The contribution of non-opioid activity is demonstrated by the analgesic effects of tramadol not being fully antagonised by the μ-opioid receptor antagonist naloxone.

Tramadol is marketed as a racemic mixture with a weak affinity for the μ-opioid receptor (approximately 1/6000th that of morphine). The (+)-enantiomer is approximately four times more potent than the (-)-enantiomer in terms of μ-opioid receptor affinity and 5-HT reuptake, whereas the (-)-enantiomer is responsible for noradrenaline reuptake effects (Shipton, 2000). These actions appear to produce a synergistic analgesic effect, with (+)-tramadol exhibiting 10-fold higher analgesic activity than (-)-tramadol (Goeringer et al., 1997).

The serotonergic modulating properties of tramadol mean that it has the potential to interact with other serotonergic agents. There is an increased risk of serotonin syndrome when tramadol is taken in combination with serotonin reuptake inhibitors (e.g. SSRIs), since these agents not only potentiate the effect of 5-HT but also inhibit tramadol's metabolism.

It is suggested that tramadol could be effective for alleviating symptoms of depression and anxiety because of its action on GABAergic, noradrenergic and serotonergic systems. However, use of the drug for treatment of such disorders by a health professional is unlikely.

Tramadol may also be used to treat hypertension when other treatments have failed.


[edit] Metabolism
Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2D6, being O- and N-demethylated to 5 different metabolites. Of these, M1 is the most significant since it has 200 times the μ-affinity of (+)-tramadol, and furthermore has an elimination half-life of 9 hours compared to 6 hours for tramadol itself. In the 6% of the population who have slow CYP2D6 activity, there is therefore a slightly reduced analgesic effect. Phase II hepatic metabolism renders the metabolites water-soluble and they are renally excreted. Thus reduced doses may be used in renal and hepatic impairment.


[edit] Adverse effects
The most commonly reported adverse drug reactions are nausea, vomiting and sweating. Drowsiness is reported, although it is less of an issue compared to other opioids. Respiratory depression, a common side effect of most opioids, is not clinically significant in normal doses. By itself, it does not decrease the seizure threshold, though it may do so if used in combination with SSRIs, tricyclic antidepressants, or in patients with epilepsy. A few seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg).


[edit] Dependence
Some controversy exists regarding the dependence liability of tramadol. Grünenthal has promoted it as an opioid with a low risk of dependence compared to traditional opioids, claiming little evidence of such dependence in clinical trials. They offer the theory that since the M1 metabolite is the principal agonist at μ-opioid receptors, the delayed agonist activity reduces dependence liability. The noradrenaline reuptake effects may also play a role in reducing dependence.

Despite these claims it is apparent, in community practice, that dependence to this agent does occur. This would be expected since analgesic and dependence effects are mediated by the same μ-opioid receptor. However, this dependence liability is considered relatively low by health authorities, such that tramadol is classified as a Schedule 4 Prescription Only Medicine in Australia, rather than as a Schedule 8 Controlled Drug like other opioids (Rossi, 2004). Similarly, tramadol is not currently scheduled by the U.S. DEA, unlike other opioid analgesics. Nevertheless, the Prescribing Information for Ultram warns that tramadol "may induce psychological and physical dependence of the morphine-type."


[edit] Proprietary preparations
Grünenthal, which still owns the patent to tramadol, has cross-licensed the agent to various pharmaceutical companies internationally. Thus tramadol is marketed under many trade names including: Adolonta, Calmador, Contramal, Crispin, Lumidol, Mosepan, Nobligan, Siverol, Tiparol, Toplagic, Tradol, Tradolan, Tralgit, Tramacet, Tramacip, Tramadin, Tramal, Tramahexal, Tramazac, Tramedo, Ultracet, Ultram, Zamadol and Zydol.


[edit] Often used to treat
Moderate pain
Severe pain
Most types of Neuralgia, including Trigeminal Neuralgia.
Multiple other conditions that result in severe pain to the victim.
Post operative pain in canines.
Recently used for chronic depression and/or anxiety.