I accept that Tramadol is also potentially addictive, but I found a decade ago when I swapped using Endone to Tramal, that my patients no longer required another five boxes, but were likely to use just a bit over one box after knee replacement surgery. Tramal is much less addictive than Endone.
Some surgeons are preferring Tapentadol – although I wonder whether less serotonergic effect is actually better, and the fast acting option is not covered by the Pharmaceutical Benefits Scheme. Nausea is unlikely if the patients if the starting dose is 50mg at a time, and the patients actually have enough pain to justify it. Hallucinations do rarely occur, in which case we swap to something else.
Interaction with SSRI’s (Selective serotonin reuptake inhibitors) is rare – serotonin syndrome with normal doses of SSRIs or SNRIs (Serotonin and norepinephrine reuptake inhibitors) and normal doses of Tramal have not been observed by this author despite being used in hundreds of cases. The more depressed a patient is – the more they should avoid narcotics!