Tramadol - Present and future

The atypical opioid tramadol, has recently been introduced into Australia a nd New Zealand. Tramadol's efficacy in a wide range of acute and chronic pa in states, its multi-formulation availability, and its low serious side-eff ect potential at high doses and in prolonged therapy, combine to bestow on it a user-friendly profile, for short- and long-term use in hospitals and c ommunities. This paper reviews the following: its formulation and routes of administration; its unique enantiomeric biochemistry and metabolism; its t riple mechanisms of action; its pharmacokinetics and pharmacodynamics; its analgesic efficacy compared with other opioids; the interactions for its cl inical use in a variety of acute and chronic (including cancer) painful sta tes; its specific use in the elderly, in paediatric and in obstetric patien ts; its adverse event (including drug interaction) and safety profile; its advantages in terms of its relative lack of respiratory depression, major o rgan toxicity and histamine release, and dependence and abuse potential. Th e review looks at new uses for this drug and what can be expected in this a rea in the future.