Abstract
PurposeThere is increasing concern with regard to fatal intoxications with prescription opioids and tramadol poisonings. This study aimed to characterise prescribing patterns for tramadol in primary care in France and Germany and identify long-term treatment and potential risk factors for such treatment.MethodsAdult patients-prescribed tramadol between January 2006 and June 2016 in GP practices in IMS® Disease Analyzer databases in France and Germany were identified. Six-monthly prevalence and mean doses and durations were calculated by gender, age group and type of tramadol product. The proportion of incident use that resulted in treatment ≥ 366 days was calculated. The odds for long-term treatment was analysed in relation to gender, age group, type of tramadol product, start dose, indication and a diagnosis of abuse or misuse.ResultsOverall prescribing of tramadol decreased in Germany and increased, then plateaued in France. Prescribing was higher in females. Predominantly prescribed products were tramadol in combination with paracetamol (COMB) in France and slow release formulations of tramadol (SR-TRAM) in Germany. SR-TRAM had the highest mean doses and durations, followed by immediate release formulations of tramadol (IR-TRAM) and COMB. Around 1.5% of incident tramadol use in France and 8.2% in Germany resulted in long-term treatment. Long-term treatment was associated with increasing age, SR-TRAM and a diagnosis of abuse or misuse.ConclusionsThe risk of long-term treatment appeared to increase with increasing age. Potential risk factors for long-term treatment included initiating treatment with SR-TRAM and a diagnosis of abuse or misuse.
Highlights
Tramadol is a weak opioid analgesic indicated for the treatment of moderate to severe pain
Drug abuse has been reported for tramadol [7, 8], and dependence may occur when tramadol is used for periods longer than weeks to months, in case of high doses [2]
We considered the following categories or types of tramadol products: tramadol in combination with paracetamol, immediate release (IR) formulations of plain tramadol and slow release (SR) formulations of plain tramadol
Summary
Tramadol is a weak opioid analgesic indicated for the treatment of moderate to severe pain. The active metabolite o-desmethyltramadol [2], which is formed by the polymorphic enzyme CYP2D6 [3, 4], and not tramadol itself, is responsible for its opioid effects. Tramadol has been associated with fatal intoxications when used in combination with other pharmaceutical substances, illicit drugs or ethanol [2, 9, 10]. Fatal intoxications with prescription opioids have prompted an increasing concern internationally [11,12,13,14,15,16].
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