a-t 2015; 46: 16

HYPOGLYCAEMIA WITH THE OPIOID ANALGESIC TRAMADOL (TRAMAL, GENERICS)

The weak opioid analgesic tramadol (TRAMAL, generics), which also inhibits serotonin and noradrenaline re-uptake, has been associated with hypoglycaemia for a considerable time (1-3). An observational study now confirmed this suspicion. The authors compared the risk of hospitalisation due to hypoglycaemia with tramadol to that with the equally weak opioid codeine (CODI OPT), based on the UK General Practice Research Datalink and a British hospitalisation registry. The study cohort consisted of 334,034 patients with non-cancer-related pain, who were first prescribed one of these two analgesics between 1998 and 2012. According to a case-control analysis, the use of tramadol was associated with a significantly greater risk for hospitalisation due to hypoglycaemia compared to codeine (adjusted odds ratio [OR] 1.52; 95% confidence interval [CI] 1.09-2.10), particularly during the first 30 days (OR 2.61; 95% CI 1.61-4.23). The increased risk during the first 30 days of tramadol use was corroborated by a cohort analysis of first-time users (hazard ratio [HR] 3.60; 95% CI 1.56-8.34) as well as by a case-crossover analysis, in which all the cases act as their own controls (OR 3.80; 95% CI 2.64-5.47). The risk also applies to patients who do not use antidiabetics. According to the case-crossover analysis, the risk for fatal hypoglycaemia was also increased (OR 6.21; 95% CI 2.23-17.26) (4). Rodent studies have demonstrated the blood-glucose-lowering efficacy of tramadol (4,5). The incidence of serious hypoglycaemia with the analgesic was assessed by the authors of the observational study as rare (4). Because this involves a potentially life-threatening complication, attention must be paid to corresponding signs also when prescribing tramadol for non-diabetic patients (5), -Ed.


1Grünenthal: Summary of Product Characteristics TRAMAL LONG, as at Aug. 2013
2Rev. Prescrire 2011; 31: 831
3BOURNE, C. et al.: Br. J. Clin. Pharmacol. 2013; 75: 1063-7
4FOURNIER, J.-P. et al.: JAMA Intern. Med., publ. online on 8 Dec. 2014 (8 pages); doi:10.1001/jamainternmed.2014.6512
5NELSON, L.S., JUURLINK, D.N.: JAMA Intern. Med., publ. online on 8 Dec. 2014 (2 pages); doi:10.1001/jamainternmed.2014.5260

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