Tramadol Prescriptions for Pain Relief Linked to More Complications than Codeine

PainRelief.com Interview with:
Carlen Reyes PhD
Médico de familia
Gestora de proyectos de investigación IDIAP Jordi Gol

PainRelief.com: What is the background for this study? What are the main findings?

Response: Tramadol and codeine are two “weak” opioids frequently prescribed for different non-cancer pain indications, however, few are the studies that compare the adverse outcomes between them using large routinely collected primary care data. We aimed to fulfil this gap by analysing the risk of adverse events with the tramadol and codeine dispensations in a large primary care health care data (SIDIAP database) from Spain. 

We found that the dispensations of tramadol were associated with a greater risk of cardiovascular events, mortality and fractures compared to the dispensations of codeine. 

PainRelief.com: What should readers take away from your report?

Response: We found that the dispensations of tramadol were associated with a greater risk of cardiovascular events, mortality and fractures compared to the dispensations of codeine. However, our results are based on the number of packages of drugs dispensed and not on the actual dose prescribed. Logically we could think that the more packages dispensed of one drug the more dose the patient is taking but this is not always true given the availability of different doses commercialized of tramadol and different doses prescribed. For this reason, further prospective head to head comparisons that analyse the dose-response are needed to confirm our results. 

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Further prospective studies on tramadol and codeine that analyse the dose prescribed need to carried out to confirm our results. 

Citation:

Xie J, Strauss VY, Martinez-Laguna D, et al. Association of Tramadol vs Codeine Prescription Dispensation With Mortality and Other Adverse Clinical Outcomes. JAMA. 2021;326(15):1504–1515. doi:10.1001/jama.2021.15255

Editorial:

Kim HS, McCarthy DM, Lank PM. Tramadol, Codeine, and Risk of Adverse Outcomes. JAMA. 2021;326(15):1483–1484. doi:10.1001/jama.2021.14306

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