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.