Opioid painkillers are among the most powerful among all painkillers and are used in managing pain that is extremely severe. Other OTC formulations for pain management are typically used for mild to moderate pain. Patients suffering from chronic pain and severe pain are typically prescribed a schedule, that includes opioid painkillers of the appropriate dosage/strength. One among the most commonly used painkillers of this category is Tramadol, available in standard release and slow release formulations. By virtue of the mechanism of action, these drugs are known to cause certain specific undesirable effects. A common question encountered by specialists is – does tramadol cause constipation? Following subsections answer the question and offer a detailed look at the opioid and its effects.

What is tramadol?

As outlined above, Tramadol is an opioid painkiller, that is generally prescribed to be taken once in four hours or six hours for managing chronic pain. Belonging to the category of centrally-acting opioid agonist, it is medically known as a serotonin/norepinephrine reuptake inhibitor (SNRI). It has a structure that is similar to that of morphine. Despite being an effective pain killer, it is known for its tolerance, and the manner in which it delivers desired outcomes. Medically labelled as a drug with a multimodal mechanism of action, it is regarded as an opioid painkiller with relatively lesser risks. This is mainly because of the different ways in which it acts. For instance, it works on opioid receptors, and it also has an impact on the serotonin and norepinephrine. These are neurotransmitters that are responsible for pain modulation.

The analgesic properties of Tramadol, and the effects on the pathways give the drug, the ability to regulate, mitigate pain and the response to pain stimuli. It has an impact on different pain modulators in the CNS (Central Nervous System), apart from the impact on inflammation. By virtue of the effects on pain as well as inflammation, it is known to be effective in different conditions, listed below:

In addition to the above, the multimodal mechanism of action of the drug delivers other effects. For instance, it is known to have anxiolytic properties, and is also known to help patients experience lesser shivering when in pain.

What are the side effects of tramadol?

All medications come with the burden of undesirable effects, and opioids are no exception. Opioids have additional effects of dependence, constipation and possible abuse. Similarly, opioids also come with the possibility of overdose due to abuse, and this could, in turn, result in adverse effects that include respiratory complications, apart from possible fatality. As a result of belonging to the category of SNRI, it could also expose the patient to possible seizures, apart from serotonin syndrome, if taken alongside other drugs that increase serotonin levels.

Commonly reported effects include a flushed appearance, and possible dizzy feelings, apart from nausea and vomiting sensations. The patient may experience overall fatigue and may feel drowsy. The throat may turn sore, and there is also the likelihood of congestion. Other effects include throbbing headache and itching sensations not linked to other conditions.  Due to the impact on involuntary actions of the body, the patient may find changes in appetite, and may also experience an upset stomach.

The impact on the CNS may lead to certain behavioral changes, and this includes possible feelings of anxiety, apart from spasms and tremors. The individual may undergo certain changes in emotional outlook and may also end up hallucinating at times. It is important to note that these effects are not common in occurrence and are usually limited only to those patients who end up dependent on the drug. Effects also include allergic reactions, similar to that of hives, and this needs to be handled at the earliest. For instance, symptoms such as difficulty in breathing, and outbreak of sores in the mouth or excessive itching are possible indications of allergic reactions. This could develop into a serious condition, and it is therefore necessary to seek urgent treatment.

Serious side effects of tramadol

There are other serious effects attributed to Tramadol, including urinary retention, possible impact on vision, decreased sensation, pain in the chest, and severe cramps. The patient may sometimes find it difficult to balance properly, while some are known to experience a distinct tingling sensation. The hands, feet and nose may turn clammy, due to lesser oxygen supply to the limb extremities. Women are likely to experience changes in menstruation cycle, and this could impact routines.

Does tramadol cause constipation?

With all the information about possible effects of tramadol, it is time to answer the important question about constipation. As mentioned above, the drug’s mechanism of action has an impact on the central nervous system and it also includes involuntary actions of the body. This has a result on the digestive tract, and consequently, individuals taking opioids for pain relief end up with constipation. This may result in stronger or adverse effects in elderly patients, and it is therefore necessary to use the pain killer with the necessary levels of precaution.

Additionally, patients who take tramadol along with drugs that belong to the category of anticholinergic drugs, may end up with aggravated constipation. Drugs that belong to the category of anticholinergic medications include drugs prescribed for urinary incontinence, Parkinson’s, COPD, asthma, and psychiatric disorders, among others (this is not a complete listing, but only a broad reference).  Therefore, patients and caregivers are to intimate the treating specialist about the use of these drugs, so as to stop either of the medications or alter the dosage sufficiently to prevent undesirable effects.

How much Tramadol can I take at once?

It is necessary to stick to the recommended dosage to avoid overdosing. The maximum dose is always kept below 400 mg per day, regardless of the condition, and it is important to ensure that the sum total of dosage always sticks to this thumb rule. When recommended for chronic pain, the dosage for adults begins with an initial dose of 100 mg daily, and increased gradually, if required, subject to a maximum dose of 300 mg daily. When recommended for severe pain, the initial dosage is 25 mg daily, which is gradually increased, if required, subject to a maximum dosage of 400 mg daily. As outlined earlier, the medication is typically taken with a gap of four to six hours between two doses.

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