New thing I learn:
1. Tramadol have 2 mechanism of action:
a) SNRI-serotonin and norepinephrine inhibit pain pathway at dorsal hond.
b) Its by product ODT (after metabolize by liver) have opiod action.
-but metabolize depend on CYP2D6 enzyme. Different ethnic different rate of metabolize. Caucasian is poor metabolizer. Asian higher metabolizer.
So this article try to highlight “why should we give tramadol if the result is unpredictable”.
2. Always aware of interaction of other drugs & tramadol. They might inhibit CYP enzyme or catalyze it.
3. Adverse effect such as seizure, hypoglycemia.
4. At the end its still opiod and might be addicted and cause dependency.
So what I will do with this knowledge.
1. Still give IV tramadol for in patient.
2. Try to minimize Cap tramadol for outpatient.
3. Step up analgesia accordingly without discriminate the tramadol.
4. Pain is subjective, even if the drug is placebo but relieve the patient pain, give it.