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Opioid Medications and Correct Medical Usage—An Update
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Tramadol (Ultram) (also see chap. 23)—a synthetic analog of codeine, with oral potency equal to that of codeine; it inhibits norepinephrine and serotonin (5-HT3) reuptake and has weak central opioid receptor activity (about 30%); half-life is 6.7 hours; peak plasma level in 2.3 hours; has active metabolite; analgesia from tramadol and its metabolite; typically used at 50 to 100 mg every six hours, maximum dose of 400 mg/day. Possible seizure risk with concurrent tricyclic antidepressant, selective serotonin reuptake inhibitor (SSRI), monoamine oxidase inhibitor (MAOI), and opioid useSerotonin syndrome has been reported with the combined use of tramadol and other serotonergic agents including tricyclic antidepressants, MAOIs, bupropion, SSRIs, buspirone, venlafaxine, etc.Ultracet is tramadol (37 mg) in combination with acetaminophen. The combination of these two drugs has been found to have a possibly significant role in multimodal analgesia (12).Tramadol can induce delirium in healthy elder patients (13).
Opioid Medications and Correct Medical Usage—An Update
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Tramadol (Ultram) (also see chap. 23)—a synthetic analog of codeine, with oral potency equal to that of codeine; it inhibits norepinephrine and serotonin (5-HT3) reuptake and has weak central opioid receptor activity (about 30%); half-life is 6.7 hours; peak plasma level in 2.3 hours; has active metabolite; analgesia from tramadol and its metabolite; typically used at 50 to 100 mg every six hours, maximum dose of 400 mg/day. Possible seizure risk with concurrent tricyclic antidepressant, selective serotonin reuptake inhibitor (SSRI), monoamine oxidase inhibitor (MAOI), and opioid use Serotonin syndrome has been reported with the combined use of tramadol and other serotonergic agents including tricyclic antidepressants, MAOIs, bupropion, SSRIs, buspirone, venlafaxine, etc. Ultracet is tramadol (37 mg) in combination with acetaminophen. The combination of these two drugs has been found to have a possibly significant role in multimodal (12). Tramadol can induce delirium in healthy elder patients (13).
Acetaminophen and tramadol hydrochloride-loaded soft gelatin capsule: preparation, dissolution and pharmacokinetics in beagle dogs
Published in Pharmaceutical Development and Technology, 2021
As the combination therapy of tramadol and acetaminophen, the commercial tablet (Ultracet®; Janssen Pharm., Beerse, Belgium) has been developed to solve the weakness of tramadol via the fast absorption and rapid effect of acetaminophen through two different mechanisms of action. However, this combination tablet offered only analgesic effect of acetaminophen in the initial times, since tramadol gave the long onset time of analgesic effect with the Tmax of about 2 h (FDA 2001a, 2001b). Hence, in order to relieve pain in faster and more efficient way, a novel combination formulation with faster and more absorbable tramadol compared to the commercial tablet should be developed.
Comparison of the effects of general, spinal and epidural anesthesia on ureter access and surgical outcomes during flexible ureterorenoscopy for transurethral single stone removal surgeries: a monocentric retrospective study
Published in Annals of Medicine, 2021
Haoliang Cai, Xiaohui Wu, Xi Chen, Wenting Chen
After anaesthesia, 0.038-inch hydrophilic guidewire (Boston Scientific Corporation, Natick, MA, USA) was inserted in the position of modified dorsal condition. The dilatation was obtained by inserting the ureter with a 9.5 F scope (Karl Storz®, Tuttlingen, Germany). When the stone was visualized, a probe compatible with 200 µm of holmium laser (Quanta System®, Litho 30 W, Milan-Italy) was used for surgeries. At 8–15 Hz frequencies and 1.2–3.0 Joule power, the lithotripsy was performed. When the stone was completely fragmented, the procedure was terminated. Doble “J” stent (6 or 4.7 Fr diameter and 24 or 26 cm diameter, Becton Dickinson and Company, Franklin Lakes, NJ, USA) was placed in all patients. The visual Analog Scale (VAS) score for pain assessment was evaluated after the surgical procedure at the 8th and 24th hours. When patients became conscious, patients were prescribed tramadol 50 mg and paracetamol 350 mg (Ultracet, Johnson & Johnson, New Brunswick, NJ, USA) twice a day with 500 mg twice a day levofloxacin (Glevo, Glenmark Pharmaceuticals Ltd., Mumbai, India) for 5 days. After one day of the procedure, the location and status of the stent were accessed by direct urinary tract X-ray and non-opaque stones were evaluated by urinary system ultrasonography (Koninklijke Philips N.V., Amsterdam, Netherlands). After 4 weeks, patients were called for the withdrawal of stent. At this stage, the computed tomography images were also obtained for the evaluation of the stone-free condition. Ureterorenoscopy procedures were performed by urologists (with a minimum of 3-years of institutional experience of urological surgeries). If ureterorenoscopy was performed by resident urologists, there was a specialist always monitoring them.