Course Summary

Expiration Date: 05/12/2028

Tramadol, a synthetic Schedule IV opioid, offers pain relief through μ-opioid receptor agonism and serotonin-norepinephrine reuptake inhibition. While considered a weak opioid, it carries risks of sedation and seizures. Some medical experts refer to the use of tramadol as a “double-edged sword” because although it can act as an antidepressant, it also increases the risk of serotonin syndrome when used alongside other antidepressant treatments. Dosing adjustments are critical in hepatic or renal impairment and require close monitoring for people with both conditions. Although the potential for misuse is lower than that of stronger opioids, tramadol overdose can lead to serious morbidity and mortality, highlighting the importance of cautious prescribing and patient education.

Course Format

Homestudy

Course Syllabus

  • Introduction
  • Pharmacological Profile
    • Mechanism of Action: Mu-Opioid Receptor Binding and Inhibition of Norepinephrine and Serotonin Reuptake
    • Indications, Dosing, and Administration
  • Clinical Applications: Primary Indications and Efficacy
    • Osteoarthritis Pain
    • Neuropathic Pain
    • Postoperative Pain
    • Off-Label Uses: Fibromyalgia, Restless Leg Syndrome, Premature Ejaculation
  • Contraindications, Precautions, and Drug-Drug Interactions
    • Adverse Effects and Notable Risks
    • Pregnancy and Breastfeeding: Risks and Safer Alternatives
    • Clinically Relevant Drug-Drug Interactions
  • Monitoring and Toxicity
    • Overdose Clinical Presentation: Opioid-Like Toxicity
    • Diagnosis, Management, and Monitoring
  • Tramadol Treatment With Opioid Use Disorder
    • Risk Factors for Misuse
    • Clinical Recommendations
  • Clinical Pearls
  • Case Study: Tramadol-Induced Depersonalization/Derealization Syndrome
    • Differential Diagnosis
  • Summary

Authors

Richard Daniels, PharmD, BCPS

Richard “Cole” Daniels earned his Doctor of Pharmacy(PharmD) from the Skaggs School of Pharmacy at the University of Montana in 2018. Throughout pharmacy school he completed a 3-year internship at Community Medical Center in Missoula, Montana in which he gained valuable experience in an acute care setting. Cole currently serves as a psychiatric clinical staff pharmacist at the Montana State Hospital. He has over 11 years of pharmacy experience having worked in several settings including retail, acute care, and inpatient psychiatric care. Cole has a diverse set of interests. However, acute care medicine, infectious disease, pain management, and asthma/COPD are a primary focus of his at the Montana State Hospital. He obtained board certification as a certified pharmacotherapy specialist in the Spring of 2022.

Elisabeth Gordon, BScPharm, RPh

Elisabeth Gordon earned her BSc(Pharm) from the University of British Columbia in 2004. After graduation, she worked in community retail pharmacies on Vancouver Island, before returning to her rural hometown of Salmon Arm. In 2016 and 2017, Elisabeth trained with Pallium Canada and Victoria Hospice to enhance her knowledge of end-of-life-care and palliative services. She is a volunteer medical supervisor for T1DOutreach, a peer support platform for adults living with type 1 diabetes, and a member of a Canadian peer support group for adults living with Birdshot Uveitis. Elisabeth enjoys working in a small, fast-paced rural pharmacy where she brings compassion and empathy to her everyday practice.