Trends in Tramadol: Pharmacology, Metabolism, and Misuse
Karen Miotto, MD,* Arthur K. Cho, PhD,†Mohamed A. Khalil, MD,‡ Kirsten Blanco, BS,§ Jun D. Sasaki, MD,‖ and Richard Rawson, PhD
Tramadol is a unique analgesic medication, available in variety of formulations, with both monoam- inergic reuptake inhibitory and opioid receptor agonist activity increasingly prescribed worldwide as an alternative for high-afinity opioid medication in the treatment of acute and chronic pain. It is a prodrug that is metabolized by cytochrome P450 (CYP) enzymes CYP2D6 and CYP3A4 to its more potent opioid analgesic metabolites, particularly the O-demethylation product M1. The opioid analgesic potency of a given dose of tramadol is influenced by an individual’s CYP genetics, with poor metabolizers experiencing little conversion to the active M1 opioid metabolite and individuals with a high metabolic profile, or ultra-metabolizers, experiencing the greatest opioid analgesic effects. The importance of the CYP metabolism has led to the adoption of computer clinical deci- sion support with pharmacogenomics tools guiding tramadol treatment in major medical centers. Tramadol’s simultaneous opioid agonist action and serotonin (5-HT) and norepinephrine reuptake inhibitory effects result in a unique side effect pro le and important drug interactions that must be considered. Abrupt cessation of tramadol increases the risk for both opioid and serotonin– norepinephrine reuptake inhibitor withdrawal syndromes. This review provides updated important information on the pharmacology, pharmacokinetics, CYP genetic polymorphisms, drug interac- tions, toxicity, withdrawal, and illicit use of tramadol. (Anesth Analg 2017;124:44–51)
Original Articles Chemical sexualities: the use of pharmaceutical and cosmetic products by youth in South Sulawesi, Indonesia
Although young people in their everyday lives consume a bewildering array of pharmaceutical, dietary and cosmetic products to self-manage their bodies, moods and sexuality, these practices are generally overlooked by sexual and reproductive health programmes. Nevertheless, this self-management can involve significant (sexual) health risks. This article draws from the initial findings of the University of Amsterdam’s Chemical Youth project. Based on interviews with 142 youths, focus group discussions and participant observation in South Sulawesi, Indonesia, we found that young people – in the domain of sexual health – turn to pharmaceuticals and cosmetics to: (1) feel clean and attractive; (2) increase (sexual) stamina; (3) feel good and sexually confident; (4) counter sexual risks; and (5) for a group of transgender youths, to feminize their male bodies. How youth achieve these desires varies depending on their income and the demands of their working lives. Interestingly, the use of pharmaceuticals and cosmetics was less gendered than expected. Sexual health programmes need to widen their definitions of risk, cooperate with harm reduction programmes to provide youth with accurate information, and tailor themselves to the diverse sexual health concerns of their target groups.
Chronic kidney disease
Chronic kidney disease (CKD) in diabetic patients is on the
rise owing to the increased prevalence of type 2 diabetes
(T2D) and the aging population . However, we are lack-
ing data for the prevalence of CKD in the diabetic popula-
tion followed-up by primary care physicians in Switzerland
although it is well recognised that in the last decades dia-
betic nephropathy has become one of the leading causes of
end-stage renal disease.
In Switzerland, recommendations for the use of antidia-
betic drugs in CKD were elaborated in 2012 by the Swiss
Society of Endocrinology and Diabetology (SSED) .
Whether these recommendations have reached PCPs and
are followed by them is not clear and has never been eval-
uated. Therefore, the goal of this cross-sectional study was
to examine the prevalence of CKD stages in T2D patients
followed-up by PCPs in Switzerland and to examine ac-
cordingly the prescription of antidiabetic drugs.
Infections & immunity
Applications in the area of infections and immunity are assessed by the MRC’s Infections and Immunity Board.
From global infectious diseases to cellular development of the immune system, the Infection and Immunity Board funds high quality, innovative research addressing key elements of our strategic plan: Research Changes Lives. See Resilience, repair and replacement .
Our remit is broad and responsive, and we are currently developing plans in a number of key areas, including the MRC’s response to the challenges of antimicrobial resistance, as well as developing our strategy for vaccines and immunotherapies, our fungal disease portfolio and our immune ageing portfolio. In addition, we aim to build on our excellent global HIV, TB and malaria research by diversifying our global health portfolio.Read more