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Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.
Scott J. Zashin, MD, specializes in the treatment of rheumatologic and musculoskeletal conditions using both traditional and alternative therapies.
ConZip (tramadol) is a synthetic opioid analgesic medication used to treat moderate to moderately severe pain in adults and adolescents 12 and older. ConZip and other brands of tramadol (e.g., Ryzolt, Ultram) belong to the class of drugs known as partial opiate agonists, which means they bind to opioid receptors in the brain to provide pain relief.
Tramadol may have a useful place in your treatment regimen, but it’s critical that you are fully informed about the drug before you use it due to the risk of dangerous and life-threatening side effects. The U.S. Drug Enforcement Administration listed Tramadol as a schedule IV controlled substance in August 2014 due to the risk of addiction and overdose.
ConZip comes in extended-release capsules and is also available as a generic. There are also generic tablets and extended-release tablets, as well as a topical cream named EnovaRX-Tramadol.
ConZip decreases the body’s ability to feel pain. It works similarly to morphine, but ConZip is about one-tenth as potent.
ConZip is used for moderate to moderately severe pain conditions, such as neuropathic pain (nerve pain) or osteoarthritis pain. It may also be prescribed for low back pain or rheumatoid arthritis.
The immediate-release generic tramadol tablets can be used for acute pain, while the extended-release capsules and tablets are usually used to treat chronic pain when continuous treatment is needed.
The topical prescription EnovaRX-Tramadol may be prescribed for people with musculoskeletal pain.
Tramadol is not approved for as-needed pain relief. It is not a nonsteroidal anti-inflammatory drug (NSAID). It works differently than NSAIDs and has different side effects.
Tramadol not approved for children under 12, as they are at greater risk of experiencing drug-induced breathing problems and death compared to older children and adults.
Tramadol is sometimes used off-label as a treatment for premature ejaculation, but the risk of addiction means it is not a long-term treatment option.
ConZip is not a first-line treatment for pain since it carries very serious risks of addiction, overdose, and death. The drug is prescribed as a second-line or alternative treatment after other drug options, such as non-opioid analgesics, have been ineffective or inadequate in managing pain.
All opioids carry the risks of addiction, abuse, and misuse, even at recommended doses. But compared to immediate-release opioids, there is an increased risk of overdose and death with extended-release opioid drugs such as ConZip, due to the larger amounts of tramadol they contain.
Slow-release capsules are gradually absorbed, reaching lower peak blood concentrations than the slow-release generic tablets, so sometimes ConZip or generic capsules might be preferred to tablets.
As with all Schedule IV controlled substances in the U.S., after a prescription is first written, you can get a maximum of five refills in a six-month period. After you hit that limit or reach the six-month mark (regardless of the number refills), a new prescription is required from your healthcare provider.
Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others contraindicate use or prompt careful consideration.
ConZip can have severe and life-threatening side effects, including respiratory depression (impaired breathing), so your healthcare provider will do a full medical and mental health history and physical examination before prescribing it to you.
Be sure to tell your healthcare provider about any respiratory conditions or personal or family history of alcohol or drug addiction.
Tramadol should not be used if any of the following apply:
There are additional medical circumstances that can make taking ConZip risky or prohibit its use, including:
Tramadol's active form is O-desmethyltramadol (M1), which partially acts on opioid receptors. Other partial opioid agonists include:
Full opioid agonists, such as morphine, codeine (codeine is metabolized into morphine), and OxyContin (oxycodone), bind more firmly to opioid receptors for stronger effects.
Due to ConZip's risks of addiction, it is important to use the lowest effective dosage for the shortest duration possible, as recommended by your healthcare provider.
ConZip comes in 100-, 200-, and 300-milligram (mg) capsules. Generic tramadol may also be prescribed as an immediate-release 50-mg tablet or as an extended-release 100-, 200-, or 300-mg tablet.
The topical cream starts as a powder that is mixed into a base for application; the mixing is typically done by a healthcare provider or pharmacist.
The starting dose for extended-release tramadol is 100 mg. It may be increased in 100-mg increments every five days up to a maximum daily dose of 300 mg.
The half-life of tramadol in the blood is typically between five and nine hours, and even longer for people who have been taking multiple doses. This is the time it takes half of a dose to be inactivated by the body. Complete elimination takes about five to six times as long as the half-life.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Do not take two doses or you will be at risk of overdose.
If you take too much tramadol, seek urgent medical care. Symptoms of a Tramadol overdose include decreased pupil size, difficulty breathing, problems staying awake, unconsciousness, coma, heart attack, or seizure.
Call for emergency help, even if you are unsure whether you should. Tramadol overdoses can be treated with Narcan if detected early enough.
All listed dosages are according to the drug manufacturer. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.
Respiratory depression is more likely in elderly, frail, or debilitated patients because they may not clear the drug as quickly as younger, healthier people. There is also the dangerous risk of drug interactions for older people who take other medications.
The risks of sedation and respiratory depression are also increased in anyone with head injuries, brain tumors, or increased intracranial pressure.
If you have these risks, you may need to take lower doses of ConZip and will need to be monitored more closely when using it.
Both poor and rapid metabolizers of tramadol may need dosage adjustments or to stop taking the drug completely.
Take your medication exactly as directed. Take ConZip with a glass of water at scheduled times. You can take it with or without food.
Swallow your tramadol pills whole and do not split, chew, crush, dissolve, snort, or inject extended-release tablets. Breaking the pill may cause too much of the drug to be released into your system at one time, which could lead to overdose or death.
Store the medication at room temperature between 68 to 77 degrees F. Keep it separate from other medications and out of reach of children.
Accidental ingestion of even one dose of ConZip can result in a fatal overdose.
Tramadol is usually well-tolerated when taken properly. Side effects are usually temporary, but there is a risk of very serious adverse effects that can be deadly. Let your healthcare provider know if you have any side effects while taking tramadol.
Common side effects may include:
Seek urgent medical help if you have any of the following symptoms while taking ConZip:
Do not stop taking this medicine suddenly without talking to your healthcare provider first. You may need to gradually reduce the medication with careful monitoring to avoid withdrawal.
Symptoms of withdrawal include:
A 2015 government report showed a steep rise in emergency room visits due to tramadol abuse between 2005 and 2011. Even at prescribed doses, the drug can be addictive.
If you suspect you are becoming dependent on tramadol or taking more than prescribed to get the desired effect, get professional guidance to wean off the medication, (as well as alternatives for pain relief).
In addition to addiction risks, there are other serious health conditions that can occur while taking ConZip, including:
ConZip may also impair mental or physical abilities and affect your ability to drive a car. Avoid hazardous activities until you know how the drug affects you.
Tramadol interacts with many other medications, which can lead to life-threatening interactions including breathing problems, sedation, and coma. Your healthcare provider will weigh the pros and cons of your medication regimen and may consider changing your other prescriptions or closely monitoring you if you have to take tramadol.
Medications used to treat depression, anxiety, panic disorders, or insomnia can interact with tramadol and increase the risk of respiratory depression and/or serotonin syndrome. These drugs include:
Combining tramadol with CNS depressants increases the risk of extreme sedation, as well as dangerous slowing of the heart and breathing rate that can lead to coma and death. CNS depressants include:
Mixed agonist/antagonist and other partial agonist opioid analgesics, such as Sublocade (buprenorphine), butorphanol, nalbuphine, and pentazocine may reduce the analgesic effect of ConZip and lead to withdrawal symptoms.
The effects of blood thinners and medications used for high blood pressure and heart conditions can be altered when taken with tramadol. These cardiovascular medications include:
Drugs used to treat bacteria, fungal, or viral infections can interact with tramadol and you may need to be carefully monitored while on both medications.
There are many other types of drugs that can interact with tramadol, such as allergy medications, anti-seizure medications, and migraine medications. Some include:
If taken with recreational or controlled substances, like alcohol, narcotics, anesthetics, tranquilizers, and sedatives, tramadol can affect breathing—even causing breathing to stop.
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World Health Organization. Tramadol: update review report. June 2014.
Rodieux F, Vutskits L, Posfay-barbe KM, et al. When the safe alternative is not that safe: tramadol prescribing in children. Front Pharmacol. 2018;9:148. doi:10.3389/fphar.2018.00148
Martyn-st james M, Cooper K, Kaltenthaler E, et al. Tramadol for premature ejaculation: a systematic review and meta-analysis. BMC Urol. 2015;15:6. doi:10.1186/1471-2490-15-6
U.S. Food and Drug Administration. Highlights of prescribing information: Tramadol. Updated August 2017.
Ryan NM, Isbister GK. Tramadol overdose causes seizures and respiratory depression but serotonin toxicity appears unlikely. Clin Toxicol (Phila). 2015;53(6):545-50. doi:10.3109/15563650.2015.1036279
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Langley PC, Patkar AD, Boswell KA, Benson CJ, Schein JR. Adverse event profile of tramadol in recent clinical studies of chronic osteoarthritis pain. Curr Med Res Opin. 2010;26(1):239-51. doi:10.1185/03007990903426787
Lanier RK, Lofwall MR, Mintzer MZ, Bigelow GE, Strain EC. Physical dependence potential of daily tramadol dosing in humans. Psychopharmacology (Berl). 2010;211(4):457-66. doi:10.1007/s00213-010-1919-3
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