We were 5 students on this seminar i will be happy to get some feedback on it

1. TRAMADOL
BY
HUSSAINSAIB
NOURAL-HUDAARKAN
MARYEMAYYED
NABAAMOHAMMED
MUSHTAQASAL
Supervisedby Dr.Emad Noaman

2. WHATISPAIN?

3. INTRODUCTION
HISTORY
MESOPOTOMIA
EGYPT
GREECE

4. PAINRELIEF
CLASSES OFANALGESIC
DRUGS
NSAIDs OPIOIDS ACETAMINOPHE
N

5. OPIOIDS
o Opioidsareaclassofdrugsthatderivefrom,ormimic,naturalsubstancesfoundintheopium
poppyplant.Opioidsworkinthebraintoproduceavarietyofeffects, includingpainrelief.
o Theyaredividedintothreetypes:
syntheti
c
Natural
SEMI-
SYNTHETI
C

6. TRAMADOL
o Tramadol isanFDA-approved opioidmedication forpain relief.Ithas specificindications formoderate toseverepain.It
isconsidereda class IVdrugbytheFDAand has beensinceJulyof2014.Duetopossiblemisuse disorderpotential,
limitations toitsuseshould beforpain that isrefractoryto otherpain medication, such asnon-opioid pain medication.
Therearetwo formsoftramadol: extended-releaseand immediate release.
o Tramadol was patented in1972and launched underthename "Tramal"in1977bytheWest German pharmaceutical
company Grünenthal GmbH.Inthemid-1990s,itwas approvedintheUnited Kingdom and theUnited States .
GERMANY –1977 ,FDA VIVOSINBERLIN

7. TRAMADOL
TRAMADOLISAMAN–MADEPRODUCT,BUTSOMEOFINGREDIENTSARE
FOUNDNATURALLYINROOTSANDBARKOFNAUCLEALATIFOLIA.
o Afterfrequent,prolongedTramadoluse,manypeopledevelopatolerance tothe
drug.Thismeanstheyhavetotakelargerdosestofeelthedrug’seffects.
o TolerancetoandwithdrawalfromTramadolarecommonsignsthatsomeonehasa
Tramadoldependence.TheymayalsoshowsignsofaTramadoladdiction,a
chronic,neurobiologicaldiseasewithgenetic,psychosocial,andenvironmental

8. TRAMADOL
AMAN SUFFERS FROM TRAMADOL ADDICTION INHISWORK

9. TRAMADOL
72%
28% 28% OFPEOPLE WHO USED
TRAMADOL AREFELL INTHEHELL
OF ADDICTION BASED ON STUDY
ON ADDICTED PEOPLEINLOS
ANGELOS USA.
37 %
37%OFTRAMADOL TAKERS
ARESUFFERINGFROM
WITHDRAWAL SYMPTOMS 63%

10. TRAMADOL
o Tramadolisaprescription-onlypainkiller.
o Thismeansyoucan'tbuyitlegallywithoutaprescription.Peoplewhotake
tramadolillegally,orabusetheirprescription,sometimescrushupthetabletsand
snortthem.
o ITISILLEAGALINSAUDIARABIA,UAEANDJORDAN.
o BUTLEGALINIRANANDINDIA.
o UNFORTUNATELY,INIRAQYOUCOULDGETITWITHOUTA
PRESCRIPTION.

11. TRAMADOL
RALIVIA TRIDURAL ZYTRAM ULTRAM
BRAND NAMES

12. ORALLY:
CAPSULE
ROUTESOF ADMINSTRATION:
TABLET
INJECTION :
I.M,IVAND
S.C
THEREARE SUPPOSITORIESANDDROPS(ORALLY)BUTINFEW
AMOUNTS

13. PHARMACOKINETICS
 Quickabsorption: Peakplasmaconcentration in1-2hours(fastpainrelief).
Highbioavailability: 70-80%reaches bloodstream, effectivelydeliveredtotargetsite.
Moderate distribution:Crossesblood-brainbarrierforCNSeffects,butcanbefoundinsmall
amounts inplacentalandbreastmilk.
Extensivemetabolism: PrimarilybyCYP2D6intheliver,creating theactivemetaboliteO-
desmethyltramadol(OTD).
Eliminationhalf-life:Around 6hours,butcanvarywithindividualfactors.
Excretion :Mainlythrough urine(50-75%within24hours)

14. CONTRAINDICATIONS
Uncontrolled Seizures:Itlowersthe seizurethreshold, increasingtheriskofseizures,especiallyin
those withuncontrolled epilepsy,dueitaffectsbrainchemistry,potentially triggeringuncontrolled
electricalactivityinthebrainleadingtoseizures.
Breathingproblems :Canworsenasthmaorsleepapnea,leadingtodangerousbreathingdifficulties.
Recent headinjury:Raisespressureinsidetheskull,potentially causingfurtherbraindamage.
Mixingwithalcohol:Doubles downondrowsinessandbreathingproblems, potentially fatal.
Severe liverorkidneydisease:Bodycan'tproperly remove thedrug,leadingtodangerousbuildup.

15. CONTRAINDICATIONS
 Stomach/bowel blockage:Worsens theblockage,creating serious
complications.
 Historyofopioid abuse:Highriskofaddictionduetosimilareffects
toopioids.
 Takingcertainmedications :Caninteractpoorly withsedatives,
tranquilizers,orantidepressants,increasingsideeffects.
CHILDRENUNDER
18
BREASTFEEDIN
G
PREGNANCY

16. PAINTRANSMISSION
 Painbeginsatthe nociceptors (thebranchingendsof
sensoryneurons)found withintheperipheral nervous
system
Thesignaliscarriedthrough the spinothalamic tracttothe
thalamusandthento thesomatosensory cortex wherepain
isperceived .
mureceptors present inthecentralandperipheral nervous
system, delta,kappa(Gprotein binding)found inhigh
concentration inthedorsalhornofthe spinalcord.
Activationofthese receptors byanagonistcausesdecrease
inreleasingneurotransmitters suchassubstanceP,make

17. MECHANISMOFACTION
 Tramadolworksbychangingthewayourbrainandnerves
systemrespondtopain.
 itactcentrallyasanalgesicanditisstructurallyrelatedto
MorphineandCodeine,lesspotentthanMorphine,ithas
adualmechanism
 Opioidreceptorbinding:actasmu-opioidreceptorinthe
centralnervoussystemproducingpainreliefbyreducing
theperceptionofpainsignalsandalteringthebrain
responsetopain(moderateaffinityformureceptorbut
weakfordeltaandkappa).
 inhibitionofserotoninandnorepinephrinereuptakeboth
involvedinmoodregulationandpainperceptionthus
enhancinginhibitoryeffects onpaintransmission.

18. TOXICITY OF TRAMADOL
 The toxic dose of tramadol, like with any
medication, varies depending on individual
factors such as age, weight, medical
history, and tolerance to opioids.
Exceeding the recommended dose of tramadol
can lead to serious side effects and even
overdose.
 For adults, ingesting a single dose of
tramadol greater than 400 milligrams can

19. INDICATIONSOFTRAMADOL
-It’s usedtotreatmoderate toseverepainboth acuteandchronicpainby
actingoncentralnervoussystem
Itiscommonly prescribed tomanage:
POSTOPERATIVE
ANDLOWER
BACKPAIN
DENTALPAIN
MALIGNANT
PAIN
OAANDRH
PAIN
DIABETIC
NEUROPATHY
FIBROMYALGIA

20. WITHDRAWALSYNDROME
 Long termuse ofhighdoseofTramadolcausesTolerance,physicaldependence and
withdrawalsyndrome .
 WhatisWithdrawalSyndrome?
 Withdrawalsyndrome:isdefinedastheunpleasantsymptomsthatareexperiencedwhen
apersonwithphysicaldependencediscontinuestheuseofanabuseddrugabruptly.
 Withdrawalisthe resultofthebodybecoming chemicallyaddicted,oraltered,from
takingTramadolonacontinuous basis—evenafteronlyafewweeks.
 Inmost cases withdrawalsymptoms beginin 8-24hoursAfter thelastdose andthey
generallylastfor 5-7 days.

21. WITHDRAWALSYMPTOMS
Tramadolwithdrawalsymptoms varyfromindividualtoindividual.Itis
bestto taperoffthedrugovertime inorderto minimizenegative
withdrawalsymptoms.
FLU–LIKE
SYMPTOMS
PSYCHO
PROBLEMS
AGRESSION
ITCHING
NUMBNESS
HEADACHE

22. ADVERSEEFFECTS OFTRAMADOL
ADDICTION
CONSTIPATION
DEPRESSION
FATIGUE
DROWSINESS DRY MOUTH NAUSEA ,VOMITING
SEIZURES SWEATING

23. DOSAGEOFTRAMADOL
treatment ofmoderate pain 50-100mgadministered
everyfourtosixhours.Initialdose 50mg.
Treatment Forseverepain, 50-100mg,everyfourtosix
hoursmaybeadministered. 100mgisusuallymore
effectiveastheinitialdose.
Tramadolisnottypicallyrecommended forpediatric
patients under12yearsold,anditsuseinadolescents(12
to 18yearsold)issubject tospecificdosingconsiderations
andcautionduetosafetyconcerns.

24. INTERACTIONS OFTRAMADOL
Tramadol&OpioidAnalgesics
 Tramadol&Benzodiazepines
Tramadol&Alcohol
SelectiveSerotonin Reuptake Inhibitors(SSRIs)
Serotonin-Norepinephrine Reuptake Inhibitors(SNRIs)
TricyclicAntidepressants (TCAs)
Monoamine OxidaseInhibitors(MAOIs)
Triptans
Dextromethorphan

25. HOWTOADVISE APATIENT ORANADDICTEDTO TAKEOFF
TRAMADOL
REMEMBER,THATLIFEISJUST–DAYONE &ONE DAY–SOYOUSHOULDLIVEEVERY
MOMENTANDNEVERMISSTHISGREATGRANTFROMGOD
THEREISALWAYSMORETOLIVETHANTOCOMPLAINORBEINGUNCONCIOUS
THEEARTHISSOHUGEANDTHESKYISSOBEAUTIFULANDTHEGRASSISGORGEOUS
ANDPEOPLESTILLGOODANDHAVEAMERCY,SOYOUHAVETHECHANCETOBELIEVE,
TOLOVE,TOWALK,TOEAT,TOLAUGH,TORUN,TOPLAY,TODRINK,TOFEELPAIN!
FEELINGPAINGIVESAMEANINGTOTHISLIFE
REMEMBER“OURHEARTSANDOURBODIESAREGIVENTOUSONLYONCE “
LIFEISACHANCE SOYOUSHOULDEXPRESSYOURSINCEREFEELINGS.

26. REFERENCES
1-"Tramadol". MedlinePlus. American Society of Health-System
Pharmacists
2-"Tramadol". (https://www.drugs.com/international/tramadol.html)
Drugs.com.
archived(https://web.archive.org/web/20180723182517/https://www.d
rugs.com/international/tramadol.html) from the original on 23
July 2018. Retrieved 22 December 2018.
3- "Tramadol Use During Pregnancy".
(https://www.drugs.com/pregnancy/tramadol.html) Drugs.com. 14
October 2019. Archived
4- 6- "Ultram, Ultram ER (tramadol) dosing, indications,
interactions, adverse effects, and more".
(http://reference.medscape.com/drug/ultram-er-tramadol-

27. THANK
YOU