Pharmacy Rounds Part 1: Tramadol and Death From NSAIDS

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Sean G., M.D. -

I think Tramadol is getting a bad rap here. Ok if u are a seizure pt there is a small risk you may ....HAVE A SEIZURE!....I think that wouldn't be horrible...they are after all.... seizure pts...so if they have more than normal while on tramadol, maybe its not the best drug for them. On the upside...it does work for mild to moderate pain, does not cause sedation(I am able to take it for my back while at work), is really not addictive...its been around since the 90's basically my entire career and I can honestly say I have never seen a "tramadol seeker" in the ED...avoids the kidney and gastric and possible ACS adverse effects of NSAIDS ...and is cost efficient...so I am not sure why you boys be hatin on it......

Michael A. -

I disagree, there are definitely tramadol seekers. I've come across numerous tramadol seekers in the ED through residency and urgent care setting when I was moonlighting (turning down Norco and asking for tramadol because it works better for them). I literally just had a chronic back pain patient in the ED yesterday who specifically asked for tramadol (hence me reviewing this EMRAP episode) and she just had 90 tabs filled on 11/3 and 60 tabs filled on 11/8 by two different physicians.

On the other side of things, I've had people come in upset because their physician gave them tramadol, likening them to sugar pills, and reported OTC acetaminophen works better. Anecdotally, it may be ideal for you and for some, but it clearly has variable degrees of effectiveness, and there are definitely abusers/seekers out there.

Mike -

I usually recommend for cardiac patients to take aspirin (650 mg q4) for pain rather than other NSAIDs. What do you think?

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