As you age, even though you may have taken a medication for decades, your body may react differently to it later in life. One reason for this is that your metabolism has slowed down. Some medicines need to be processed by your liver to benefit your health; slower digestion and liver function mean it may take longer for a drug to get into your bloodstream. Later, remnants of the medicine need to be eliminated from your body by the liver and kidneys. Slowdowns at this stage mean it may take longer for a drug to leave your body, so its effects last longer.
Studies also show that certain medications are less safe for older people, and it is important that you work with your provider or pharmacist to use medications that are safe for your age. The American Geriatrics Society’s Beers Criteria lists medications that may not be safe in older people and can be used as a tool when you talk with your provider or pharmacist about using safe medications.
What is Tramadol?
Tramadol is a prescription drug that’s available as an immediate-release and extended-release tablet. Tramadol comes as tablets and extended-release oral capsules. Immediate-release drugs are released into the body right away. Extended-release drugs are released into the body slowly over time.
Both tramadol oral tablets are also available as generic drugs. The immediate-release tablet is also available as the brand-name drug Ultram. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.
Tramadol belongs to a class of drugs called opioid agonists. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.
Tramadol works by changing how your brain senses pain. Tramadol is similar to substances in your brain called endorphins. Endorphins bind to receptors (parts of cells that receive a certain substance). The receptors then decrease the pain messages that your body sends to your brain. Tramadol works in a similar way to decrease the amount of pain your brain thinks you’re having.
Tramadol is a controlled substance. This means it can only be used with a doctor’s close supervision.
How do elderly patients respond to tramadol?
A study that evaluated the risk of safety events associated with chronic tramadol use compared to other chronic opioid use or no opioids among older adults with osteoarthritis reported that tramadol use by the elderly was associated with increased risk of falls/fractures, cardiovascular (CVD) hospitalization, safety event hospitalizations, emergency room (ER) visits, and mortality.
According to Mayo Clinic, elderly patients taking tramadol are more likely to have unwanted side effects such as:
- Constipation
- Dizziness, or fainting
- Kidney, heart, or lung problems
- Lightheadedness
- Stomach upset
- Weakness and age-related liver
Although tramadol side effects can result in elderly hallucinations often accompanied by auditory or visual disturbances this is not common.
Generally, caution and an adjustment in the dose for elderly patients receiving tramadol is recommended. The maximal recommended dose for adult patients with cirrhosis is 50 mg every 12 hours. For elderly patients over 75 years old, the total daily dose should not exceed 300 mg/day. Approximately 120 mg of oral tramadol is equivalent to 30 mg of oral morphine.
Thus, although tramadol use may be appropriately recommended within a pain management strategy for older adults with osteoarthritis, careful monitoring for adverse safety events is warranted.
What are the likely side effects of tramadol in elderly patients?
The following are some of the common side effects that can occur in older people who take tramadol:
• constipation
• diarrhea
• dizziness and vertigo
• drowsiness
• dry mouth
• headache
• heartburn
• itchiness
• nausea
• stimulation of the central nervous system
• sweating
• vomiting
• weakness
Less common side effects
People may experience other side effects that occur with an incidence of less than 5%, such as:
• allergic reactions
• confusion
• constriction of the pupil
• difficulty breathing
• disturbance in coordination
• drop in blood pressure upon standing up
• fainting
• frequent urination
• hives
• menopausal symptoms
• rapid heartbeat
• rash
• retention of urine
• serotonin syndrome
• suicidal tendencies
• visual disturbance
• weight loss
• whole-body discomfort
Serious side effects
Serious side effects may also occur in some people.
Some serious side effects include:
• heart rhythm problems called QT prolongation
• respiratory depression
• serotonin syndrome
The following sections discuss these serious side effects.
Heart rhythm problems: QT prolongation is a serious condition affecting the heart rhythm. On an electrocardiogram of the heart, the QT interval represents a portion of the electrical activity during the heartbeat. Some drugs, such as tramadol, can cause QT prolongation. When a person has a prolonged QT interval, they may experience serious heart problems. They may have an irregular heartbeat, which can become life-threatening.
In most cases of QT prolongation related to tramadol, a person has taken tramadol with other drugs that prolong the interval. Although the combination of QT-prolonging drugs can be dangerous, some people are born with long QT syndrome. These people should let their doctor know about their condition before taking tramadol. People who overdose on tramadol also have an increased risk of QT prolongation.
Respiratory depression: Respiratory depression is a serious side effect that may occur in people taking tramadol. If a person has difficulty breathing while taking tramadol, they must seek emergency medical attention. People can experience respiratory depression with the usual dosages of tramadol. Respiratory depression usually occurs when the person starts taking tramadol or when they increase their dosage.
People who overdose on tramadol are at an even greater risk of respiratory depression. Combining certain drugs with tramadol can also increase the risk of respiratory depression.
Some people are more at risk than others. Some people’s bodies break down tramadol into O-desmethyltramadol much more quickly and completely. This can result in higher levels of this compound in the bloodstream and lead to respiratory depression.
Some groups of people may have additional risk factors for respiratory depression:
• obstructive sleep apnea
• obesity
• severe lung disease
• neuromuscular disease
Some adolescents may be taking other medicines that put them at greater risk of respiratory depression. In these situations, tramadol can cause life-threatening respiratory depression.
Serotonin syndrome: Serotonin syndrome develops when there is too much serotonin accumulating in the body. This can cause mild to fatal symptoms.
In rare cases, people can experience serotonin syndrome when taking tramadol alone or with other drugs.
The symptoms of serotonin syndrome may include:
• agitation
• hallucinations
• coma
• rapid heartbeat
• fluctuating blood pressure
• high body temperature
• muscle rigidity
• nausea
• vomiting
• diarrhea
What can elderly patients do to cope with the side effects of tramadol?
In an ideal world, every older adult would have access to a reliable process for reviewing medications, ensuring that the benefits outweigh the risks and burdens, and monitoring for side effects and problems.
However, as many of us know, our healthcare system is not yet ideal for aging adults. So if you are caring for an older person and want to be proactive about checking on medications.
Many side effects can be successfully overcome by treating them with other drugs. There is a very wide range of remedies available which can help you cope with side effects. Some of these treatments will only be available from your doctor on prescription, whereas others are available over-the-counter from the chemist. In any case, before starting on any new medicine you should discuss your plans with your doctor who can advise on possible interactions between these medicines in order to ensure safety of these combinations in the elderly.
