Association of Tramadol vs Codeine Prescription Dispensation With Mortality and Other Adverse Clinical Outcomes

SPS commentary:

A related editorial notes findings add to a growing body of literature that reports adverse outcomes associated with tramadol use, such as hypoglycaemia, seizure, and all-cause mortality/ Ultimately, the greatest risk of tramadol may involve the perception that it is inherently safer than other opioids, however, the mechanisms of action and variable metabolism of tramadol in a given population create considerable therapeutic uncertainty and introduce additional risk exposure. It adds that while tramadol may meaningfully reduce pain in a subset of patients, it is also likely to be ineffective or harmful in others, and predicting an individual patient’s clinical response at the point of initial prescribing is challenging. When clinicians determine that patients require an opioid medication for pain, they may be better served to select a pure opioid agonist with a more predictable therapeutic effect and known adverse effect profile, such as morphine or hydrocodone. This would allow clinicians and patients to weigh the risks and benefits of initiating opioid therapy through shared decision making and enhance the level of counselling on safe use, storage, and disposal practices that all opioids deserve.