DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20194258

Prescribing patterns of tramadol in hemodialysis patients

Manem Saritha, Pathapati Rama Mohan

Abstract


Background: Pain is the most common complaint in hemodialysis patients. Tramadol had become analgesic of choice in these patients, and its prescription is increasing day by day. With this background, we evaluated the prescribing trends of tramadol in patients undergoing maintenance hemodialysis.

Methods: A total of 70 prescriptions were audited to assess the prescribing trends of tramadol (usually prescribed as a combination of 37.5 mg tramadol and 325 mg of paracetamol two times a day). Included prescriptions were from both male and female patients above 18 years of age undergoing maintenance hemodialysis. Demographic, clinical and medication use were recorded from the patients.

Results: The mean age of patients was 48±11.7 years, duration of dialysis 2.2±1.4 years. Tramadol consumptions were observed in 40/70 (56%) of patients. Majority of tramadol consumption was found in 30/40 (75%) males, 23/40 (59%) between 40-59 years and 28/40 (70%) undergoing two dialyses per week and 13/40 (32.5) were diabetics. During our exploratory analysis, we found that 15/40 (38%) of tramadol users, were concurrently prescribed with clonidine as add on antihypertensive. We noticed that the tramadol pill count during the preceding week was 81 in patients concurrently using clonidine and 139 in the patients who were not using clonidine (p>0.05).

Conclusions: In our study, tramadol consumptions were observed in 56% of patients. We also noticed analgesic interaction between clonidine and tramadol.


Keywords


Clonidine, Interaction, Potentiation, Analgesic, Hemodialysis, Tramadol

Full Text:

PDF

References


Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis. 2007;14(1):82-99.

Perlman RL, Finkelstein FO, Liu L, Roys E, Kiser M, Eisele G, et al. Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study. Am J Kidney Dis. 2005;45(4):658-66.

Harris TJ, Nazir R, Khetpal P, Peterson RA, Chava P, Patel SS, et al. Pain, sleep disturbance and survival in hemodialysis patients. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2012;27(2):758-65.

DeOreo PB. Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. American journal of kidney diseases: the official journal of the National Kidney Foundation. 1997;30(2):204-12.

Dewar K HS, Pham PT, et al. Chronic kidney disease and pain. J Am Soc Nephrol. 2006: 226.

Claxton RN, Blackhall L, Weisbord SD, Holley JL. Undertreatment of symptoms in patients on maintenance hemodialysis. J Pain Symptom Management. 2010;39(2):211-8.

Barakzoy AS, Moss AH. Efficacy of the world health organization analgesic ladder to treat pain in end-stage renal disease. J Am Soc Nephrol. 2006;17(11):3198-203.

Pope JE, Anderson JJ, Felson DT. A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure. Arch Int Med. 1993;153(4):477-84.

Davison SN. Pain in hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis. 2003;42(6):1239-47.

Kaye AD. Tramadol, pharmacology, side effects, and serotonin syndrome: a review. Pain Physician. 2015;18:395-400.

Izzedine H, Launay-Vacher V, Abbara C, Aymard G, Bassilios N, Deray G. Pharmacokinetics of tramadol in a hemodialysis patient. Nephron. 2002;92(3):755-6.

Conway B, Fogarty D, Nelson W, Doherty C. Opiate toxicity in patients with renal failure. BMJ. 2006;332(7537):345-6.