Brand Name: Ultram

Available in 50 mg tablets 

Background

The search for the relief of pain has existed for centuries if not millennia. It has long been known that opiates are able to produce excellent analgesia as well as feelings of euphoria. Unfortunately, they are also habit-forming and cause respiratory depression, sedation, and hallucinations. As science has progressed and understanding of pain perception has improved, opiates have been modified in many ways to decrease their negative side effects. Tramadol represents an extension of these efforts. In order to understand how it might work in a pet, let us begin with how it works in humans.

In people, tramadol is metabolized by the body into a more active compound called the M1 metabolite. It is the M1 metabolite that is felt to be responsible for the drug's effects. The M1 metabolite is a weak opiate, but just like other opiates, it has the ability to relieve pain and suppress cough. The M1 metabolite does more, however. It also acts as a serotonin reuptake inhibitor, which makes it an anti-anxiety medication as well. Since anxiety exacerbates pain perception, the relief of anxiety is felt to enhance the pain relief effect of tramadol. There is actually more. The M1 metabolite inhibits norepinephrine uptake, which is another mechanism of pain relief, putting tramadol in the alpha agonist class of pain relievers in addition to the opiate class of pain relievers. Clearly, this medication has many effects contributing to pain relief and it is used widely for painful conditions in humans but what happens in a dog or a cat's body is still being worked out.

We know that cats make the M1 metabolite and it appears that tramadol is an effective pain reliever in this species. The dosing interval is still being worked out, and it may be that there is enough individual variability that some trial and error are needed for a particular patient. We want a dose that provides pain relief without sedation or hallucinations, and each cat may have a different dosing need. Problems with the long-term use off tramadol in cats are mostly about the difficulty in giving a cat pills that taste bad; it is famous for its bitter taste.

The problem in dogs is that they make little of the M1 metabolite. Instead, they make much more of something called the M2 metabolite and the effects of the M2 metabolite are not clear. It is also not clear whether unmetabolized tramadol has significant pain-relieving properties or if some individual dogs make substantially more of the M1 metabolite than other individuals. The lack of the M1 metabolite in the dog has created a great deal of controversy regarding whether tramadol truly is an effective pain reliever in dogs or what its role in pain relief actually is. Studies testing tramadol against actual anti-inflammatory pain relievers have not shown much benefit to tramadol used alone. It may be that tramadol is able to improve the efficacy of other analgesics when they are combined.

How this Medication is Used

• Tramadol is given two to three times daily and is able to stimulate its own removal from the body with subsequent doses. For example, after a week of use in a dog, tramadol is removed from the body seven times faster than it was on the first day of use. This tolerance effect limits the use of tramadol for long-term use.
  
  
• Tramadol can be used as either a pain medication or as a cough suppressant.
  
  
• Tramadol is now a controlled substance, which means specific paperwork is required for the veterinarian to prescribe it. Its sales are tracked, and the pet owner will be required to provide information, such as date of birth, in order to purchase it and certain forms will be required if it is purchased through a pharmacy.
  
  
• If a dose is accidentally skipped, resume the next dose as scheduled. Do not double up on dosing.
  
  
• Store tramadol at room temperature, protected from light, and locked up securely as it is a controlled substance.

Side Effects

Side effects are considered rare but we list the following for completeness:

• Upset stomach is occasionally observed with tramadol.
• Pupil dilation and panting may occur.
• Tramadol has some ability to suppress coughing.
• Decreased heart rate may result but should not be problematic.
• Constipation may be a side effect.
• Overdose may be seen as seizures, tremors, drooling, and mental alterations. Seek veterinary assistance at once should any of these occur.
• Sedation side effects are made worse when used at the same time as antihistamines. The potential for lessening respiratory ability is worse when used with benzodiazepine antianxiety drugs. The general potential for tramadol toxicity is increased when used at the same time with cimetidine (an antacid), erythromycin  (an antibiotic), and metoclopramide (an antinauseal motility modifier for the stomach).

If a pet develops apparent sedation or bizarre behavior, the tramadol dose should be reduced.

Interactions with other Drugs

The beauty of this pain reliever is that it is compatible with all the COX -inhibiting non-steroidal anti-inflammatory drugs, possibly even synergizing with them. The same is true with tramadol combined with gabapentin and amantadine.  It is also compatible with joint pain neutraceuticals such as glucosamine, MSM, chondroitin sulfate, etc.

Tramadol is NOT compatible with selegiline. Animals taking either to control Cushing's syndrome or to control senility may not take any sort of narcotic medication including tramadol. Similarly, tramadol is not compatible with other psychoactive drugs such as serotonin reuptake inhibitors, tricyclic antidepressants, or monoamine oxidase inhibitors. If you are not sure if your pet is on one of these medications, check with your veterinarian.

Tramadol may not be compatible with SAMe, a liver and joint support nutraceutical. Until further studies are performed, these two treatments should not be used together.

Tramadol can induce sedation when combined with amitraz, the active ingredient in many tick control products.

Concurrent use of tramadol and cyproheptadine, an appetite stimulant, can reduce the effect of the tramadol.

Concerns and Cautions

• Tramadol is removed from the body by the liver (70%) as well as via kidney excretion (30%). Should either of these systems be diseased, a dose reduction may be necessary.
  
  
• A human product called Ultracet® is available. It contains acetaminophen in addition to tramadol. This product is NOT safe for cats at any dose and requires specific veterinary instruction if it is to be used in dogs. Never use your own medication on your pet.
  
  
• Tramadol pills must be cut into small pieces for proper doses of cats and very small dogs. The cut pills have a bad taste and may not be accepted by some pets, especially long term.

Tramadol can cause seizures in humans and thus should be used cautiously in animals with a history of seizures.

If discontinuing tramadol after long-term use, taper it off rather than abruptly discontinue it.

It is our policy not to give dosing information over the Internet.