Trouble with Tramadol

 

In 1962 at the family-owned German pharmaceutical company Grunenthal, the drug tramadol would first be synthesized. The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer. While the chemical structure is the same, these mirror images of each other have different three-dimensional configurations, which results in different pharmacological effects. Commercially supplied tramadol is a racemic mixture of these two versions.

Branded as Ultram in ‘95, it would first be marketed for pain relief as an alternative to other opiates with more abuse potential. It was an easy sell, especially considering at the time it was not a controlled substance. This meant that prescribing tramadol was far easier than other pain medications and without all the paperwork and strings attached to satisfy the DEA. A 1999 study using post-marketing surveillance to monitor for abuse of Ultram would support the decision to not schedule it after concluding that abuse was occurring in only 1 out 100,000 patients. After about a decade on the market however that would change, and the DEA would move it to Schedule IV due to abuse concerns.

Tramadol’s pain-relieving effect is achieved by activation of the mu opioid receptor, it also blocks serotonin and norepinephrine reuptake. As it is processed in the liver by the CYP2D6 enzyme it creates a metabolite that has even higher affinity for the opioid receptor and a longer half-life called M1. Without knowing your personal genetics, it is a complete roll of the dice which of these pathways will be most dominant. Variances in CYP2D6 expression occur across the population explaining the diverse results of it not working at all or patients becoming quickly dependent on it.

The serotonin and norepinephrine reuptake inhibition are thought to contribute to pain relief by helping block pain signals. Unfortunately, it also leads to potential adverse events like serotonin syndrome and seizures. Drug interactions increase these risks especially antidepressants that are already acting by increasing serotonin. By altering the activity of the CYP2D6 enzyme, these other mechanisms of action can be reduced or potentiated in relation. Those with particularly high CYP2D6 enzyme activity are called ultra-metabolizers and they can generate enough of the M1 metabolite to cause respiratory depression even at standard doses. Due to these risks, the FDA has issued guidance that the medication should be avoided in these patients. This is also the reason it is a risk category C for expecting or nursing mothers, which means that risks cannot be ruled out. Case reports of infant death in nursing mothers taking Codeine which is remarkably like tramadol have been linked to CYP2D6 enzyme.

Tramadol is messier than most divorces and the moral of the story here is the exceptional failure of our one size fits all approach to medicine and dosing. It is a splendid example of how two things can be true at the same time for different people. How else could a drug be so dangerous that it must be scheduled by the FDA despite having five years of post-marketing surveillance that indicates exactly the opposite? The Dutch Pharmacokinetic Working Group has released dosing guidelines based on individual genetics which can help determine CYP2D6 activity but cautions that as the ratio of tramadol and M1 changes so does the analgesic effect, so dose adjustments are simply impossible to determine.

Further Reading and References:

https://pubmed.ncbi.nlm.nih.gov/28520365/
https://www.sciencedirect.com/science/article/pii/S0753332218373694?via%3Dihub#bib0045
https://pubmed.ncbi.nlm.nih.gov/10617309/
https://www.frontiersin.org/articles/10.3389/fphar.2018.00148/full
https://www.painphysicianjournal.com/current/pdf?article=MjM3OA%3D%3D&journal=89 

Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health, and Medicine Reporter
https://substack.com/discover/pharmacoconuts 

hyattjn@gmail.com 

Bitcoin GtjoZgxE7WpTkWRE6JiEiXfUpqbWKxH4g 

Litecoin ML1N31UVz6sRfo2m2oLaorXgPexUtv3Q3t 

www.jeffersongroverva.com 

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  1. Arahant Member
    Arahant
    @Arahant

    Is this one of those effects from Neanderthal genes? I know I ran across something about that recently. Or maybe it is just the opposite. Those are slow metabolizers, rather than ultra-metabolizers.

    • #1
  2. TheRightNurse, radiant figure of feminine kindness Member
    TheRightNurse, radiant figure of feminine kindness
    @TheRightNurse

    So then,  I’m guessing you’re opposed to it being described as a partial opioid agonist.  How do you feel about it being used as a primary treatment for chronic pain and depression, given the serotonin and norepi effects?  They’ve been doing studies in the UK, that last I heard were showing some significant positive results.

     

    • #2
  3. John H. Member
    John H.
    @JohnH

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer. 

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read ’em!)

    • #3
  4. OldPhil Coolidge
    OldPhil
    @OldPhil

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of. 

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    • #4
  5. TheRightNurse, radiant figure of feminine kindness Member
    TheRightNurse, radiant figure of feminine kindness
    @TheRightNurse

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol.  Save yourself the money and just use the extra strength(500mgx2 three times a day).

    • #5
  6. OldPhil Coolidge
    OldPhil
    @OldPhil

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Thanks

    • #6
  7. TheRightNurse, radiant figure of feminine kindness Member
    TheRightNurse, radiant figure of feminine kindness
    @TheRightNurse

    John H. (View Comment):

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer.

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read ’em!)

    This is where things get interesting in genetics as one antiomer fits the lock and another doesn’t.  This is not exactly unique, as genetic testing is starting to demonstrate.  You can actually do your own generic testing to discover the efficacy of a number of common drugs via websites like Genomind.  It’s really interesting stuff.

    Healthcare is moving toward more personalized care based upon this information.

    • #7
  8. kedavis Coolidge
    kedavis
    @kedavis

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite.  The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    • #8
  9. Annefy Member
    Annefy
    @Annefy

    TheRightNurse, radiant figure … (View Comment):

    John H. (View Comment):

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer.

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read ’em!)

    This is where things get interesting in genetics as one antiomer fits the lock and another doesn’t. This is not exactly unique, as genetic testing is starting to demonstrate. You can actually do your own generic testing to discover the efficacy of a number of common drugs via websites like Genomind. It’s really interesting stuff.

    Healthcare is moving toward more personalized care based upon this information.

    Heard about it. Haven’t witnessed it 

    • #9
  10. kedavis Coolidge
    kedavis
    @kedavis

    Annefy (View Comment):

    TheRightNurse, radiant figure … (View Comment):

    John H. (View Comment):

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer.

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read ’em!)

    This is where things get interesting in genetics as one antiomer fits the lock and another doesn’t. This is not exactly unique, as genetic testing is starting to demonstrate. You can actually do your own generic testing to discover the efficacy of a number of common drugs via websites like Genomind. It’s really interesting stuff.

    Healthcare is moving toward more personalized care based upon this information.

    Heard about it. Haven’t witnessed it

    Is that one of those places where you give them a DNA sample and then China knows exactly how to kill you and your family?

    • #10
  11. Headedwest Coolidge
    Headedwest
    @Headedwest

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    • #11
  12. kedavis Coolidge
    kedavis
    @kedavis

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger.  I don’t remember the name, but it’s something to maybe ask about.

    • #12
  13. John H. Member
    John H.
    @JohnH

    Now I have done, if not all the Further Reading, then quite a bit of Further Clicking. The most concise find was the Wikipedia article. And now I see the problem. One enantiomer acts on one pathway, the other enantiomer acts on another pathway, and both enantiomers act – interchangeably? – on yet a third pathway. That last one is where the cytochrome exercises its influence. What I haven’t yet figured out is whether the conversion to the more active mu-opioid-receptor agonist M1 is equally efficient for both enantiomers.

    I am in any case surprised that both are sold together. Well, I understand why: it’s cheaper. Breaking a racemic mixture is a bit of an art. The one time I did it, I got lucky. German chemists may need to be just as lucky.

    • #13
  14. Basil Fawlty Member
    Basil Fawlty
    @BasilFawlty

    kedavis (View Comment):

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger. I don’t remember the name, but it’s something to maybe ask about.

    Diclofenac?

    • #14
  15. DaveSchmidt Coolidge
    DaveSchmidt
    @DaveSchmidt

    kedavis (View Comment):

    Annefy (View Comment):

    TheRightNurse, radiant figure … (View Comment):

    John H. (View Comment):

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer.

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read ’em!)

    This is where things get interesting in genetics as one antiomer fits the lock and another doesn’t. This is not exactly unique, as genetic testing is starting to demonstrate. You can actually do your own generic testing to discover the efficacy of a number of common drugs via websites like Genomind. It’s really interesting stuff.

    Healthcare is moving toward more personalized care based upon this information.

    Heard about it. Haven’t witnessed it

    Is that one of those places where you give them a DNA sample and then China knows exactly how to kill you and your family?

    No, the CCP just wants to kill off the freedom-loving Scots-Irish gun-totin’ hillbillies.  The rest they need as labor and product consuming slaves. 

    • #15
  16. Arahant Member
    Arahant
    @Arahant

    DaveSchmidt (View Comment):
    No, the CCP just wants to kill off the freedom-loving Scots-Irish gun-totin’ hillbillies.

    🙋

    • #16
  17. JacobHyatt Coolidge
    JacobHyatt
    @JacobHyatt

    TheRightNurse, radiant figure … (View Comment):

    So then, I’m guessing you’re opposed to it being described as a partial opioid agonist. How do you feel about it being used as a primary treatment for chronic pain and depression, given the serotonin and norepi effects? They’ve been doing studies in the UK, that last I heard were showing some significant positive results.

     

    I’m fine with using any drug if it is appropriate.  I have many patients who have been taking tramadol for a long time with good effect.  Due to the unknowns it can be a hard thing to reccomend as a first line treatment but there are always tools further back in the box that might work as well

    • #17
  18. JacobHyatt Coolidge
    JacobHyatt
    @JacobHyatt

    John H. (View Comment):

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer.

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read yes

    • #18
  19. JacobHyatt Coolidge
    JacobHyatt
    @JacobHyatt

    John H. (View Comment):

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer.

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read ’em!)

    Yes different patients will metabolize one or the other at differing rates further complicating it.

    • #19
  20. kedavis Coolidge
    kedavis
    @kedavis

    Basil Fawlty (View Comment):

    kedavis (View Comment):

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger. I don’t remember the name, but it’s something to maybe ask about.

    Diclofenac?

    I think it’s probably Toradol, but apparently it’s not for long-term use.

    • #20
  21. Basil Fawlty Member
    Basil Fawlty
    @BasilFawlty

    kedavis (View Comment):

    Basil Fawlty (View Comment):

    kedavis (View Comment):

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger. I don’t remember the name, but it’s something to maybe ask about.

    Diclofenac?

    I think it’s probably Toradol, but apparently it’s not for long-term use.

    None of them are.

    • #21
  22. kedavis Coolidge
    kedavis
    @kedavis

    Basil Fawlty (View Comment):

    kedavis (View Comment):

    Basil Fawlty (View Comment):

    kedavis (View Comment):

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger. I don’t remember the name, but it’s something to maybe ask about.

    Diclofenac?

    I think it’s probably Toradol, but apparently it’s not for long-term use.

    None of them are.

    In a sense that’s true, of course.  But my MD relative mentioned a typical time limit of 5 days for Toradol because of possible kidney issues.

    • #22
  23. MiMac Thatcher
    MiMac
    @MiMac

    kedavis (View Comment):

    Basil Fawlty (View Comment):

    kedavis (View Comment):

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger. I don’t remember the name, but it’s something to maybe ask about.

    Diclofenac?

    I think it’s probably Toradol, but apparently it’s not for long-term use.

    Almost certainly.

    • #23
  24. W Bob Member
    W Bob
    @WBob

    My vet has prescribed it for my dogs. I thought about taking it a few times until I read this. 

    What I don’t understand is that it wasn’t originally considered an opioid. Now it is. Isn’t something an opioid, or not? Even if it’s a synthetic opioid? 

    • #24
  25. DaveSchmidt Coolidge
    DaveSchmidt
    @DaveSchmidt

    W Bob (View Comment):

    My vet has prescribed it for my dogs. I thought about taking it a few times until I read this.

    What I don’t understand is that it wasn’t originally considered an opioid. Now it is. Isn’t something an opioid, or not? Even if it’s a synthetic opioid?

    It’s a gender thing.  We need an elementary school libraraian to help sort this out. 

    • #25
  26. TheRightNurse, radiant figure of feminine kindness Member
    TheRightNurse, radiant figure of feminine kindness
    @TheRightNurse

    Basil Fawlty (View Comment):

    kedavis (View Comment):

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger. I don’t remember the name, but it’s something to maybe ask about.

    Diclofenac?

    Toradol.  Generic: Ketorolac.

    • #26
  27. TheRightNurse, radiant figure of feminine kindness Member
    TheRightNurse, radiant figure of feminine kindness
    @TheRightNurse

    kedavis (View Comment):

    Basil Fawlty (View Comment):

    kedavis (View Comment):

    Headedwest (View Comment):

    kedavis (View Comment):

     

    TheRightNurse, radiant figure … (View Comment):

    OldPhil (View Comment):

    I have a bad hip; replacement or “resurfacing” is probably in the near future. A couple years ago I had it x-rayed, and the doc told me it was arthritic and prescribed something for pain I described as “nagging, but not agonizing.” The meds worked, but they made my blood pressure shoot up. Then he prescribed Tramadol, which I’ll admit had never heard of.

    The first time I took one, in 10 minutes or so I felt like I was sitting on the ceiling looking down at myself. When that wore off, I looked it up, saw it was an opioid, and took the rest back to the pharmacy for it to toss. I now use Tylenol Arthritis, which is usually fine for when I need it (on the golf course).

    Tylenol Arthritis is the same as tylenol. Save yourself the money and just use the extra strength(500mgx2 three times a day).

    Not quite. The arthritis version is more timed-release, for perhaps up to 8 hours they claim.

     

    Tylenol Arthritis contains two layers—one that releases quickly for fast relief and one that releases slowly to provide lasting relief of up to eight hours. For these layers to work properly, you must swallow the caplets whole with water. There is a total of 650 mg of acetaminophen in each tablet. Regular Strength and Extra Strength Tylenol do not have two layers and contain less acetaminophen per caplet, 325 mg, and 500 mg respectively.

    Clearly individual differences occur in pain medication. For me, taking a Tylenol capsule or tablet is pointless for virtually any pain I have. It does nothing.

    Ibuprofen, however, is quite reliable at quieting pain for me. I have also used Naproxen sodium (Aleve) which lasts longer but gives me significantly less pain relief than ibuprofen.

    I have reached the point where I tell my doctors that I won’t take Tylenol. Why should I stress my liver for no pain relief?

    When I was in the hospital for gall bladder surgery, they gave me something that’s supposed to be similar to ibuprofen but stronger. I don’t remember the name, but it’s something to maybe ask about.

    Diclofenac?

    I think it’s probably Toradol, but apparently it’s not for long-term use.

    Yeah and they’ve cut the doses in half because it’s causing kidney damage in the over 60 crowd.

    • #27
  28. TheRightNurse, radiant figure of feminine kindness Member
    TheRightNurse, radiant figure of feminine kindness
    @TheRightNurse

    W Bob (View Comment):

    My vet has prescribed it for my dogs. I thought about taking it a few times until I read this.

    What I don’t understand is that it wasn’t originally considered an opioid. Now it is. Isn’t something an opioid, or not? Even if it’s a synthetic opioid?

    It is not considered an opioid exactly…unless you look at certain websites.  It has a different mechanism of action, so I guess it depends.  It is controlled like a mild opioid these days and since people are popping them and ODing, I guess they’ll probably just call them that.

    They’re a very slight receptor agonist. 

    In any case, there’s some fun evidence that it might be good at fighting Candida.

    https://pubmed.ncbi.nlm.nih.gov/27982704/

    • #28
  29. TheRightNurse, radiant figure of feminine kindness Member
    TheRightNurse, radiant figure of feminine kindness
    @TheRightNurse

    Annefy (View Comment):

    TheRightNurse, radiant figure … (View Comment):

    John H. (View Comment):

    The chemical structure of tramadol determines its unique and variable pharmacokinetics. The red arrows below point at the most crucial part of the chemical structure, the single chiral carbon which makes tramadol an enantiomer.

    Does this mean some patients metabolize only one enantiomer, others only the other, and still others both? If so, isn’t that quite unusual if not unique? (It probably means I should click all the links you provided, and read ’em!)

    This is where things get interesting in genetics as one antiomer fits the lock and another doesn’t. This is not exactly unique, as genetic testing is starting to demonstrate. You can actually do your own generic testing to discover the efficacy of a number of common drugs via websites like Genomind. It’s really interesting stuff.

    Healthcare is moving toward more personalized care based upon this information.

    Heard about it. Haven’t witnessed it

    *waves*

    Hi there.

    • #29
  30. kedavis Coolidge
    kedavis
    @kedavis

    TheRightNurse, radiant figure … (View Comment):

    W Bob (View Comment):

    My vet has prescribed it for my dogs. I thought about taking it a few times until I read this.

    What I don’t understand is that it wasn’t originally considered an opioid. Now it is. Isn’t something an opioid, or not? Even if it’s a synthetic opioid?

    It is not considered an opioid exactly…unless you look at certain websites. It has a different mechanism of action, so I guess it depends. It is controlled like a mild opioid these days and since people are popping them and ODing, I guess they’ll probably just call them that.

    They’re a very slight receptor agonist.

    In any case, there’s some fun evidence that it might be good at fighting Candida.

    https://pubmed.ncbi.nlm.nih.gov/27982704/

    Who wants to fight Candida?

     

    • #30
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