트라마돌

오피오이드 유사 (뮤-수용체) 작용제 / 진통제

트라마돌은 주로 경도에서 중등도의 통증 관리에 사용되며 때로는 진해제로도 사용되는 합성 중추 작용 **오피오이드 유사 진통제**입니다. **주요 임상 요점:** * 약한 **뮤-오피오이드 수용체 작용제**로 작용하며 **세로토닌**과 **노르에피네프린**의 재흡수를 억제합니다. * 골관절염이나 암과 같은 만성 통증 상태를 위한 **다중 모드 진통 프로토콜**(예: NSAID, 가바펜틴 또는 아만타딘과 병용)의 일부로 매우 유용합니다. * 만성 통증 상태에서 완전한 진통 효과에 도달하는 데 최대 **2주**가 걸릴 수 있습니다. * **임상 팁:** 모노그래프에는 미국에서 통제 약물이 아니라고 명시되어 있지만, 인간의 남용 가능성 때문에 **미국 DEA는 2014년에 트라마돌을 스케줄 IV 통제 물질로 재분류했습니다**. * 개에서는 일반적으로 내약성이 좋으며 진정이 가장 흔한 부작용입니다. 고양이는 불쾌감(dysphoria)을 경험할 수 있으며 약물의 기호성이 매우 떨어집니다.

작용 기전: Tramadol provides analgesia through a dual mechanism of action: 1. **Opioid Activity:** Tramadol and its active metabolite **O-desmethyltramadol (M1)** bind to **mu-opioid receptors** in the central nervous system. 2. **Monoaminergic Activity:** It inhibits the synaptic reuptake of **serotonin (5-HT)** and **norepinephrine (NE)** → enhancing descending inhibitory pathways of pain transmission in the spinal cord. **Pharmacologic Pearl:** The M1 metabolite is 6 times more potent as an analgesic and has 20 times greater affinity for mu-receptors than the parent drug. Dogs produce very little of the M1 metabolite compared to cats and humans, which explains why tramadol's opioid-mediated efficacy in dogs is often erratic and heavily reliant on its serotonin/norepinephrine reuptake inhibition. Naloxone only partially antagonizes tramadol's analgesic effects.

동물 종별 용량

Cats

Starting dose · 2 mg/kg twice daily · PO · q12h · Based upon the pharmacokinetics of tramadol and ODT in cats.
Current dosing recommendations · 1-2 mg/kg PO q12h · PO · q12h · Maximum analgesic effects may be delayed up to 14 days for chronic pain.
Chronic pain · 1-4 mg/kg PO 2-3 times a day · PO · q8-12h · Reasonable for mild pain; dose and interval may need adjustment for more severe pain.
Analgesia · 2-4 mg/kg · PO · q8h · Oral preparations are highly unpalatable to cats. Watch for dysphoria.
Analgesia · 1-2 mg/kg · IV · as needed
Analgesia · 1-2 mg/kg · SC · as needed

Horses

Chronic laminitis pain · 5 mg/kg PO twice daily for seven days, alone or with ketamine at 0.6 mg/kg/hr IV during six hours each day for the first 3 days of treatment · PO/IV · q12h · 7 days · Pain relief was enhanced.

Dogs

General/Non-responsive pain · 5 mg/kg PO q6-8h and up to 10 mg/kg PO q6-8h · PO · q6-8h · Maximum analgesic effects may not occur immediately and may be delayed up to 14 days for chronic pain conditions.
Analgesic · 2-5 mg/kg four times daily · PO · q6h · Suggested starting dose.

투여 경로

POIVEpiduralSC

금기

Hypersensitivity to tramadol or other opioids
Combination products containing acetaminophen (e.g., Ultracet) are STRICTLY CONTRAINDICATED in cats
Concurrent use with MAOIs (e.g., selegiline, amitraz) due to risk of serotonin syndrome
Patients with a history of epilepsy or seizure disorders
Concurrent use with MAOIs

이상반응

Dogs: Excessive sedation, agitation, anxiety, tremor, dizziness
Dogs: Inappetence, vomiting, constipation, diarrhea
Cats: Dysphoria, mydriasis, dose avoidance (unpalatability)
Humans: Pruritus (approx. 10%)
Injectable form: Respiratory and cardiac depression
Sedation (especially at high doses in dogs)
Dysphoria (more likely in cats)
Nausea
Behavioral changes
Increased risk of seizures

약물 상호작용

Digoxin · Rarely linked to digoxin toxicity in humans.
MAO Inhibitors (amitraz, selegiline) · Potential for fatal serotonin syndrome; concurrent use should be avoided.
Ondansetron · May reduce the effectiveness of both drugs.
Quinidine · May increase tramadol concentrations and decrease M1 (active metabolite) concentrations.
SAMe (S-adenosylmethionine) · Theoretically could cause additive serotonergic effects.
Sevoflurane · Pretreatment with tramadol reduced MAC values by approximately 30% in dogs and 40% in cats.
SSRI Antidepressants (fluoxetine, sertraline, paroxetine) · Can inhibit the metabolism of tramadol to its active metabolites, decreasing efficacy and increasing the risk of toxicity (serotonin syndrome, seizures).
Tricyclic Antidepressants (clomipramine, amitriptyline) · Increased risk for seizures; amitriptyline may inhibit tramadol metabolism.
Warfarin · Increased PT and INR reported in humans (relatively rare).
Amitriptyline · Increased risk of serotonin syndrome · major
Selegiline · Increased risk of serotonin syndrome · major
SSRIs (e.g., Fluoxetine) · Increased risk of serotonin syndrome · major

모니터링

Clinical efficacy (pain scoring, mobility, comfort levels)
Adverse effects (excessive sedation, GI upset, dysphoria, agitation)
Pain scores to assess efficacy
Signs of sedation or dysphoria
Signs of serotonin syndrome (hyperthermia, hypertension, agitation, tremors)
Seizure activity in susceptible individuals

과용량

Acute oral overdoses may cause either **CNS depressive signs** or **serotonin syndrome**. * **Clinical Signs:** Lethargy, mydriasis, ataxia, and vomiting are most common. Stimulatory signs such as tachycardia, tremors, vocalization, agitation, and seizures may also occur. Cats frequently show mydriasis, hypersalivation, and tachycardia. * **Treatment:** Primarily supportive (maintaining respiration, treating seizures with benzodiazepines or barbiturates). * > **Important:** Naloxone may **NOT** be useful in tramadol overdoses. It only partially reverses effects and may actually **increase the risk of seizures**. Cyproheptadine and phenothiazines can be used to treat stimulatory signs (serotonin syndrome).

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