May 21, 2009 - 3:55pm
Lst night at work I was in a lot of pain, so my friend gave me a couple Ultram. They seemed to help a lot. Now, when I take my regular dose of Suboxone this afternoon is there any chance it could precipitate W/D's?
May 25, 2009 - 8:38pm
#2
Old thread i know.But no, You
Old thread i know.
But no, You can take Tramadol while one Buprenorfin/naloxone. Its only going to boost the Bupe and vice verca.
I use this combo somedays. Gives me energy.
May 25, 2009 - 9:16pm
#3
Ultram
Ultram is a Seratonin Reuptake Inhibitor, I don't believe it is Selective though, as in an SSRI like Prozac. It's main active potentiality is a placebo effect, the Nurses' guidlines emphasize the importance of stressing it's value and strength as an analgesic to the patient. In other words, sell it, sell it, sell it . . . like any other placebo. It is NOT an opiate and the guidelines stress that fact. This is so that they, the Nurses, don't precipitate withdrawals in an opiate dependent patient. If you check this out with any of the extreme CPs on this board, they will agree that Tramadol--Ultram is a joke.
Q
May 26, 2009 - 10:34am
#4
Yet again I reiterate, ULTRAM
Yet again I reiterate, ULTRAM IS CONSIDERED AN OPIATE. Refer to previous posts for ample documentation of this simple fact. It reduces pain by binding with opiate receptors and by binding with serotonin receptors in the spine. It can be used with suboxone because the serotonin effect is not blocked by the suboxone. If someone were physically dependant on Ultram, taking suboxone could percipitate withdrawal. If someone were on Suboxone regularly, taking Ultram in addition to Suboxone is an accepted practice.
I have a patient who is on 240mg of Methadone a day. He also takes Vicoden ES 7.5/750, which is like spitting in the ocean narcotic wise. He had tried Norco 10/325 and insisted that it did not work as well as the Vicoden ES. The big difference between the two was the amount of Tylenol. I took him off Vicoden and put him on Tylenol around the clock at a modest dose. Tylenol is not a placebo. Neither is the narcotic effect of Ultram or the seratonin effect of Ultram.
May 26, 2009 - 4:31pm
#5
Ultram is classified as
a centrally acting analgesic which binds to the mu-opioid receptors. Oxycodone is classified as an Opioid analgesic (agonist). Big difference, Dr. Lois. Also it is contraindicated in use with patients who are physically dependent on opioids. My source is F.A. Davis's "Drug Guide for Nurses" ed. 5 pg. 1177 and 897.
This is plain enough for me. When did they change the spelling of Vicodin to Vicoden? I never said that Tylenol was a placebo Dr. Lois. Also, did you mean to say that Tylenol does't have a placebo effect or are you saying that narcotics are placebos or what? Since you're a Dr. then I would think that you could make yourself a little more clear. There is the physical placebo and there is the psycho-physiological placebo effect. One more thing for you to chew on . . . since you seem to be making such a strenuous attempt to say I'm wrong, why didn't you bring up the fact that Ultram/Tramadol also inhibits the reuptake of norepinephrine in the CNS (Which, by the way, includes the spinal chord but definitely not the skeletal spine, which is how you put it.)?
Q
No problemo w/the edit guys. I was trying to make my point a little too strongly, huh?
{EDIT-X}
May 27, 2009 - 8:43am
#6
My spelling has been
My spelling has been notoriously bad since first grade. (I think this is why most doctors have bad handwritting)
Technically, opiates are a class of plant alkaloids found in the opium poppy or their derivatives which act on opioid receptors. Opioids are substances that bind to opioid receptors. Commonly the terms are used interchangably, but to say ULTRAM IS AN OPIOID would be more technically correct. I believe this is largely a semantic issue, as most of us are not pharmacologists. Like oxycodone, ultram IS an opioid agonist analgesic. It binds to MU receptors, and it can cause tolerance, dependance, and addiction. Unlike oxycodone it is not derived from or structurally similar to narcotic alkaloids found in the opium poppy.
Sorry if you didn't understand my point. Tylenol is not a placebo, but a highly effective analgesic, like ultram. Ultram is certainly not a joke, and calling it a placebo discourages people who might find it a highly effective drug.
May 26, 2009 - 7:55pm
#7
Tylenol is not a placebo
I have never called Tylenol a placebo. Where did you get that from? My only point is that Ultram's main active potentiality is similar to the main active potentiality of a placebo. It's all in the mind. An effective sales pitch, combined with the minor SRI and NRI components make for an effective and relatively harmless analgesic. I am against it being prescribed for a patient who is in serious pain, that is all. Let's stay cool and please stop saying that I think Tylenol is a placebo, OK? Thank You,
Q
May 26, 2009 - 9:24pm
#8
Ultram
Dr. Lois is correct. Ultram is an opioid.
Here is an excerpt from the package insert:
Quote:
CLINICAL PHARMACOLOGY
Pharmacodynamics
ULTRAM® is a centrally acting synthetic opioid analgesic. Although its mode of action is not completely understood, from animal tests, at least two complementary mechanisms appear applicable: binding of parent and M1 metabolite to μ-opioid receptors and weak inhibition of re-uptake of norepinephrine and serotonin.
Opioid activity is due to both low affinity binding of the parent compound and higher affinity binding of the O-demethylated metabolite M1 to μ-opioid receptors. In animal models, M1 is up to 6 times more potent than tramadol in producing analgesia and 200 times more potent in μ-opioid binding. Tramadol-induced analgesia is only partially antagonized by the opiate antagonist naloxone in several animal tests. The relative contribution of both tramadol and M1 to human analgesia is dependent upon the plasma concentrations of each compound...
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8205
I bolded the first sentence for emphasis.
Why do you doubt Dr. Lois? She is a long-time member who cites facts that are easily verifiable. Many of her citations are from Medscape's researchers notes and experiments. These are top-notch scientists. Sure, they could be wrong but they certainly are more legitimate than most of us posters when it comes to pharmacology.
May 27, 2009 - 12:25am
#9
Suboxone
If I am trying to wean off 5/325 Percocett's - probably 8+ a day for a month or so, should I take Suboxone? What are it's side effects and is it addictive as well?
May 27, 2009 - 8:41am
#10
I am sorry if you still did
I am sorry if you still did not get the point. I never said you called Tylenol a placebo. You called Ultram a placebo and a joke. While many people negate the strong analgesic effect of acetaminophen, it is an effective pain reliever. Similarly, many people negate the strong analgesic effect of Ultram, but it too is a potent pain reliever. The story was simply to demonstrate how even a person on large doses of an extremely potent narcotic analgesic (methadone) got significant benefit from what is often popularly considered a mild and even useless anagesic (acetaminophen). It is a story about acetaminophen to illustrate a more general point about drugs like Ultram.
May 27, 2009 - 3:29pm
#11
hmm
How many Ultram's does it take to change a light bulb ? Ultram's cant change a light bulb there placebo and a joke
May 28, 2009 - 12:37am
#12
Here's an idea for a poll...
How many users have experienced significant analgesia from Ultam/ Ultracet...While the P.I. sheet (which has been modified significantly since the drug came to U.S. market,) indicates it's an opiod, it is an atypical opiod.
The fact that tramadol is only very minimally antagonised by Naltrexone is evidence of it's weak affinity for the mu receptor (approx. 1/6th morphine)....Interesting to note that nobody menitoned it's action as a monoamine oxidase reuptake inhibitor.
A poll would be great. This will demonstrate tramadols "potent" pain killing properties, or lack thereof; at least amongst users of this great site.
P.S. Since when did spelling have anything to do with handwriting? It's all fun and games until some sloppy 'scipt causes serious issues...As for spitting in the ocean, you gave another great example: patient experiencing significantly improved analgesia upon cessation of opiod therapy... 
P.S.S. A little bird told me Tramadol was schedule IV in KY.
May 27, 2009 - 10:42pm
#13
Ultram
I thought Ultral was mostly targeted for back pain, low back pain relief... i've been prescribed Ultram before and truthfully it seemed to help along with other pain medicine (lortab) but definately not alone, no relief at all, and that was when I first began to take pain medicine
May 28, 2009 - 12:41am
#14
There's the....
first vote...
May 28, 2009 - 2:53am
#15
i used ultram 1 time an 1 time only
it bout burned a hole in my stomach, or it felt that way, maybe if it was on a full stomach it would have been different
i will abstaint from this poll for now , leaving for later i might get to be the tiebreaker
Dr. Lois what would the use of this medication , taken with hydrocodone do, will the ultram neutralize the other
May 28, 2009 - 10:18am
#16
Poll
My wife and I have both tried Ultram/Tramadol back in the days before I had cancer and before her DDD was very advanced. We were newbies to the pain med thing, so I'd say we were prime targets for the "Explain therapeutic value of medication to enhance the analgesic effect." instuctions given in F.A. Davis's "Drug Guide for Nurses" 5th ed. pg.1178. My wife is reg. here on pharmer as Aurelia5. Our votes are no and no. Ultram/Tramadol did not provide significant pain relief for either of us, whether it was taken alone or with an OTC NSAID like Tylenol.
Q and a5
PS: To FeliksDCat; Excellent updates on your post #12 . . . I had no idea that it was also a monoamine oxidase reuptake inhibitor. Thanks for the research, good buddy.
PPS: I reentered this thread only to cast our votes, no other reason.
May 28, 2009 - 11:24am
#17
Poll on Tramadol
We can set up an official poll on tramadol after the current poll is closed. How do you want it structured?
Maybe something like:
If you are currently prescribed tramadol or have been prescribed tramadol in the recent past, please let us know your opinion on the drug's analgesic action:
Choice #1 - provided excellent pain killing ability
Choice #2 - provides mediocre pain killing ability
Choice #3 - provides poor pain killing ability
Choice #4 - has no analgesic action
Or something like that. Give us your thoughts and Goat or I will set it up.
May 28, 2009 - 12:45pm
#18
Kirby-
I appreciate you asking my opinion, but I like your format just fine.
This ought to be interesting. Thanks for your time Kirby!
May 28, 2009 - 1:00pm
#19
Hey kirby, that sounds like a
Hey kirby, that sounds like a great poll because this topic keeps popping up from time to time. I think it might upset Dr. Lois because it could discourage people from wanting to use it based on a bunch of people that are in pain management and already take schedule II narcotics. I am sure it helps some people that have never taken anything stronger than a tylenol, but for all I knew I was getting a placebo when I was prescribed them.
I also just went back and reread Dr. Lois' post talking about how one of her patients on methadone actually got some relief from tramadol. I am not saying its impossible, but I am definitely skeptical about that. I was only taking norco and I got ZERO pain relief when my doctor thought it would be a great idea to prescribe it as a break through pain medication for me.
May 31, 2009 - 10:10am
#20
Patient on Methadone got pain
Patient on Methadone got pain relief from good old tylenol in the example I used. I have often used Ultram along with potent mu receptor agonists for the seratonin receptor effects with good results. I have also used ultram with suboxone with good effect.
May 31, 2009 - 10:48am
#21
In KY
Ultram has been classified as C-IV, although i'm not sure how long it has had this status. I have been prescribed Ultram several times over the years and have found it to be marginally more effective than APAP. It does tend to upset my gut (which is one of the signifigant sources of pain for me). I can't really say though, because all of the times that i've been prescribed this medication, I have had other opiates (hydrocodone, oxycodone) as an adjunct.
Ray
June 1, 2009 - 12:15pm
#22
I've used Ultram and Ultram
I've used Ultram and Ultram ER both before. Were they as good for my breakthrough pain as the Hydrocodone? No. Were they better than any OTC? Yes.
I guess that is how I feel about it...
June 1, 2009 - 12:59pm
#23
tramadol
I was on tramadol...it didnt do much for me.
June 3, 2009 - 12:14pm
#24
Tramadol
Ultram is NOT an opiate. P-E-R-I-O-D...If it was you would fail a drug test.You would also suffer opiate withdrawal.
June 3, 2009 - 1:47pm
#25
Ultram
Might be good for minor aches and pains if combined with Ibuprofen or APAP but I have never received any relief for my situation. My opinion is a Dr. who writes you a script for Ultram when you are in true pain either doesn't care or is afraid to write anything stronger. My vote is no it's not a good analgesic at all.
June 3, 2009 - 3:01pm
#26
Joecamel
Can you not read english....Ultram IS an opiate, albeit a weak one, it still is...Where are you getting your information?
June 3, 2009 - 8:43pm
#27
Dude Ultram or any other form
Dude Ultram or any other form of tramadol is a joke.
June 4, 2009 - 1:32am
#28
ultram is really a dangerous
ultram is really a dangerous drug. if taken not as prescribed. i had a friend that was addicted to them, and he was found dead due to a seizure. people need to be very careful when taking them not as prescribed.
mixing them with another med would probaly have negative effects.
June 15, 2009 - 7:14pm
#29
http://www.pharmer.org/forum/
Well..I was going through a Naltrexone Detox and they prescribed me Ultram for the pain with the withdrawls.. And Naltrexone and Naloxone (which is the opiate antagonist in Suboxone) are related, so I'd say no... Mostly because Ultram really isnt an opiate, and it has a pretty weak affinity at the receptors. Also, I was prescribed Lortabs when I had my wisdom teeth out, they knew I was on Suboxone, and I had no probs.... Everybody is different, so there's no guarantees.