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TREATMENT
also associated with a potential mortality risk. Zeng et al conducted a sequential, propensity score-matched cohort study at a general practice in the United Kingdom from January 2000 to December 2015. The main objective of their study was to examine the association of tramadol with all-cause mortality among patients with osteoarthritis. They found that among patients aged 50 years and older with osteoarthritis, an initial prescription of rate of mortality after a one-year follow- up.5 Of note, this study was susceptible
to confounding, and further studies may be needed to assess causality. Another study, which was conducted by Wei et al, assembled three sequential propensity- score-matched cohort studies from 2000 to 2016 in The Health Improvement They included osteoarthritis patients aged 50-90 years who did not have a history of myocardial infarction, cancer, or opioid use disorder, and examined the risk of myocardial infarction associated with tramadol use. This study showed that in the population-based cohort of patients with osteoarthritis, the six-month risk
of myocardial infarction among initial starts of tramadol was higher than that of naproxen, but comparable to that of diclofenac or codeine.13
CONCLUSION
Tramadol is a centrally acting analgesic that exerts its effects via dual mechanistic pathways. Its mechanism offers utility in both nociceptive and neuropathic pain given its action
serotonin and norepinephrine reuptake inhibitor.7,14 While tramadol possesses the potential for respiratory depression, physical dependence, and abuse, the incidence is hypothesized to be lower than other available short-acting
neurotransmitters have tarnished its reputation as a safe opioid given the association with a number of concerning adverse events, including serotonin syndrome and seizures. These concerns have been further exacerbated by evidence of potential increased mortality examining its use in osteoarthritis, and by increasing reports of abuse and overdose. Despite its recommendation for use as a safe and unique opioid option for acute and chronic pain, careful consideration populations in light of these potentially serious adverse events.
REFERENCES
CONTRIBUTORS
■ Ashley J. Weiner, PharmD is a PGY-1 Pharmacy resident at ChristianaCare in Newark. She will be a PGY-2 in Emergency Medicine at The Ohio State University, Wexner Medical Center.
■ Mohamed E. Elmarakbi, PharmD is a PGY-1 Pharmacy resident at ChristianaCare in Newark. He will be a PGY-2 Critical Care Pharmacy resident at UF Health Shands Hospital for the upcoming 2020-2021 residency year.
■ Katelyn McCormick, PharmD, BCPS is a clinical pharmacist in Emergency Medicine at ChristianaCare.
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