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Review
. 2014 Mar 24;7:149-61.
doi: 10.2147/JPR.S49502. eCollection 2014.

Review of Extended-Release Formulations of Tramadol for the Management of Chronic Non-Cancer Pain: Focus on Marketed Formulations

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Free PMC article
Review

Review of Extended-Release Formulations of Tramadol for the Management of Chronic Non-Cancer Pain: Focus on Marketed Formulations

Arshi Kizilbash et al. J Pain Res. .
Free PMC article

Abstract

Patients with chronic non-malignant pain report impairments of physical, social, and psychological well-being. The goal of pain management should include reducing pain and improving quality of life. Patients with chronic pain require medications that are able to provide adequate pain relief, have minimum dosing intervals to maintain efficacy, and avoid breakthrough pain. Tramadol has proven efficacy and a favourable safety profile. The positive efficacy and safety profile has been demonstrated historically in numerous published clinical studies as well as from post-marketing experience. It is a World Health Organization "Step 2" opioid analgesic that has been shown to be effective, well-tolerated, and valuable, where treatment with strong opioids is not required. A number of extended release formulations of Tramadol are available in Canada and the United States. An optimal extended release Tramadol formulation would be expected to provide consistent pain control with once daily dosing, few sleep interruptions, flexible dosing schedules, and no limitation on taking with meals. Appropriate treatment options should be based on the above proposed attributes. A comparative review of available extended release Tramadol formulations shows that these medications are not equivalent in their pharmacokinetic profile and this may have implications for selecting the optimal therapy for patients with pain syndromes where Tramadol is an appropriate analgesic agent. Differences in pharmacokinetics amongst the formulations may also translate into varied clinical responses in patients. Selection of the appropriate formulation by the health care provider should therefore be based on the patient's chronic pain condition, needs, and lifestyle.

Keywords: Tramadol; analgesics; chronic pain; drug delivery; opioids; pharmacokinetics.

Figures

Figure 1
Figure 1
Schema of WHO 3-step analgesic ladder. Note: Data from WHO http://www.who.int/cancer/palliative/painladder/en/. Abbreviation: WHO, World Health Organization.
Figure 2
Figure 2
CIP-Tramadol proprietary delivery architecture. Note: Figure and pharmacokinetic data reproduced with permission from Cipher Pharmaceuticals Inc.
Figure 3
Figure 3
Combined delivery mechanisms of CIP-Tramadol in the gastrointestinal tract. Note: Pharmacokinetic data obtained from Durela® Health Canada product monograph (2011). Figure and pharmacokinetic data reproduced with permission from Cipher Pharmaceuticals Inc.
Figure 4
Figure 4
Plasma (±)-Tramadol concentrations (ng/mL) following a single-dose oral administration of CIP-Tramadol ER capsules (300 mg). Note: Figure and pharmacokinetic data reproduced with permission from Cipher Pharmaceuticals Inc.
Figure 5
Figure 5
Mean steady-state Tramadol plasma concentration of CIP-Tramadol ER capsules 200 mg once daily. Note: Figure and pharmacokinetic data reproduced with permission from Cipher Pharmaceuticals Inc.
Figure 6
Figure 6
Pharmacokinetic comparison of CIP-Tramadol and Ultram ER under fed and fasted conditions. Note: Figure and pharmacokinetic data reproduced with permission from Cipher Pharmaceuticals Inc.

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References

    1. Pain: Hope Through Research [webpage on the Internet] Bethesda: National Institute of Neurological Disorders and Stroke; 2009. [Accessed September 17, 2013]. Available from: http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#215763084.
    1. Assessment and Management of Chronic Pain [webpage on the Internet] Bloomington: Institute for Clinical Systems Improvement (ICSI); 2011. [Accessed September 17, 2013]. Available from: http://www.guideline.gov/content.aspx?id=36064&search=chronic+pain.
    1. Trescot AM, Helm S, Hansen H, et al. Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician. 2008;11(2):S5–S62. - PubMed
    1. Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006;174(11):1589–1594. - PMC - PubMed
    1. Dominick CH, Blyth FM, Nicholas MK. Unpacking the burden: understanding the relationships between chronic pain and comorbidity in the general population. Pain. 2012;153(2):293–304. - PubMed

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