INTRODUCTION TO TRAMADOL FOR DOGS

• Tramadol is a painkiller medication that is used to treat moderate to severe pain. It affects not only the mu-opioid receptors, but also serotonin and norepinephrine receptors.

• Its low affinity for the opioid receptor makes tramadol have a more benign side effect profile than some other commonly used painkillers, and is generally well-tolerated in patients.

• Since tramadol has a unique binding profile, it is used to treat some types of pain, such as neuropathic pain, which may not always respond to other pain medications.

USES OF TRAMADOL IN VETERINARY MEDICINE

1. Tramadol is widely used in veterinary medicine, especially for treating pain in dogs.
2. It is often used to treat pain resulting from conditions like cancer, arthritis, and post-surgical inflammation in dogs. It has mild anti-anxiety properties, making it useful for reducing the skittishness that pain can often produce in animals.
3. Tramadol for dogs is often safer than using other pain medications, such as non-steroidal anti-inflammatory drugs like Tylenol, since it does not cause damage to the stomach or liver of canines.
4. Tramadol for dogs comes in both liquid, pill, powder, and ampule form. Often the medication must be mixed into food to be given to dogs, since it has an unpleasant taste.

INDIVIDUALIZATON OF TRAMADOL DOSAGE

Good pain management practice dictates that the dose be individualized according to patient need using the lowest beneficial dose. Studies with tramadol in adults have shown that starting at the lowest possible dose and titrating upward will result in fewer discontinuations and increased tolerability.

• In all patients with creatinine clearance less than 30 mL/min, it is recommended that the dosing interval of       tramadol be increased to 12 hours, with a maximum daily dose of 200 mg. Since only 7% of an administered dose is removed by hemodialysis, dialysis patients can receive their regular dose on the day of dialysis 

• The recommended dose for adult patients with cirrhosis is 50 mg every 12 hours.

• In general, dose selection for an elderly patient over 65 years old should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy. For elderly patients over 75 years old, total dose should not exceed 300 mg/day.

TRAMADOL - ADVICE TO PATIENTS

• Potential for seizures and/or serotonin syndrome with concomitant use of serotonergic drugs or drugs that substantially decrease the metabolism of tramadol.
  
• Potential for drug to impair mental alertness or physical coordination; avoid driving or operating machinery until effects on individual are known.
  
• Importance of women informing their clinician if they are or plan to become pregnant or plan to breastfeed.
  
• Importance of the single-dose and 24-hour dose limit and the time interval between doses, since exceeding these recommendations can result in respiratory depression, seizures, and death.
  
• Importance of swallowing extended-release tablets whole; do not crush, chew, or split the tablets.
  
• Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and alcohol consumption.
  
• Importance of avoiding alcohol-containing beverages or products.
  
• Importance of informing patients of other important precautionary information.
  

TRAMADOL DESCRIPTION

• Ultram (tramadol hydrochloride) is a centrally acting analgesic. 
• The chemical name for tramadol hydrochloride is (±)cis-2-[(dimethylamino)methyl]-1-(3-methoxyphenyl cyclohexanol hydrochloride. 
• The molecular weight of tramadol hydrochloride is 299.8.  
• Tramadol hydrochloride is a white, bitter, crystalline and odorless powder.  
• It is readily soluble in water and ethanol and has a pKa of 9.41.  
• The water/n-octanol partition coefficient is 1.35 at pH 7.  
• Ultram tablets contain 50 mg of tramadol hydrochloride and are white in color.
• Inactive ingredients in the tablet are corn starch, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate, titanium dioxide and wax.
  

TRAMADOL - DISADVANTAGES IN BRIEF

1. risk of seizures 
2. risk of abuse, dependence and tolerance
3. relatively high incidence of nausea and vomiting
4. withdrawal symptoms following abrupt discontinuation 
5. short half-life necessitates dosing of immediate-release formulation every 4 to 6 hours