Gas chromatographic method using nitrogen-phosphorus detection for the measurement of Tramadol ( Generic Ultram ) and its O-desmethyl metabolite in plasma and brain tissue of mice and rats.

The objectives of this study were first to investigate the compatibility and physical stability of drug admixtures destined for s.c. administration through elastomeric infusion pumps to terminally ill cancer patients followed up at home by staff of the Palliative Care Unit (AECC), "La Paz" Hospital, Madrid and secondly, to evaluate the local side-effects related to the infusion of some of the drug mixtures to a population of 50 patients. The drug mixtures prepared included combinations of two, three, four and five of the following drugs: morphine hydrochloride, 60 mg/day; midazolam hydrochloride, 15 mg/day; haloperidol lactate, 7.5 mg/day; hyoscine-N-butyl-bromide, 60 mg/day; dexamethasone sodium phosphate, 16 mg/day; metoclopramide hydrochloride, 40 mg/day, and Tramadol ( Generic Ultram ), 400 mg/day. Out of 86 mixtures evaluated in vitro, 52 were found to be physically compatible. Precipitation was always obtained when dexamethasone sodium phosphate at the concentrations assayed was combined with haloperidol lactate and/or midazolam hydrochloride. However, no precipitation occurred when morphine hydrochloride, the opioid most frequently used in patients of this type, and dexamethasone sodium phosphate were combined. Of the drug mixtures that were physically compatible, 18 were administered to the patient population evaluated. Very good symptom control was obtained with all of them, and especially with the mixture of morphine + midazolam + haloperidol + hyoscine, which is the one most frequently administered to cancer patients for palliative care in the final stages of life in our Unit.


Arousal in various analgosedation schedules

The patterns of recovery of patients who received seven different analgesic and sedative treatments were investigated with regard to the time at which the subjects awoke. For observations of the neurologic status, we developed a special score. The analgesic and sedative therapies were given at three various doses. The combination of fentanyl/midazolam, alfentanil/midazolam and ketamine/flunitrazepam showed the best results. Piritramid/promethazine, pethidine/flunitrazepam, pethidine/promethazine and Tramadol ( Generic Ultram )/methohexital required more time for awakening. On the basis of these results, we prefer to use the combination of fentanyl/midazolam, alfentanil/midazolam and ketamine/flunitrazepam to judge all patients' neurologic scores.

Involvement of potassium channels and nitric oxide in Tramadol ( Generic Ultram ) antinociception.

It has been considered that Tramadol ( Generic Ultram ), a centrally acting analgesic, shows its effect via opiatergic, noradrenergic, and serotonergic systems. It has a low affinity for opioid receptors, and its effect can be partly blocked by naloxone. Since the noradrenergic and serotonergic mechanisms are still unknown, other systems which are associated with pain and analgesia may have a role on the antinociceptive effect of Tramadol ( Generic Ultram ). The aim of this study was to evaluate the effects of K(+) channels and nitrergic systems on the antinociceptive action of Tramadol ( Generic Ultram ). The antinociceptive effects of Tramadol ( Generic Ultram ) were determined in mice by the hot plate test. To examine the effects of K(+) channels and the nitrergic system nonspecific voltage-dependent K(+) channel blockers 4-aminopyridine (4-AP) and tetraethylammonium (TEA), nitric oxide (NO) precursor l-arginine, and the NO synthase (NOS) inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME) were used. Our results indicated that 4-AP, TEA, and l-arginine reduced the antinociceptive effect of Tramadol ( Generic Ultram ). However, l-NAME augmented the antinociceptive effect of Tramadol ( Generic Ultram ). The reduction of the effects of Tramadol ( Generic Ultram ) by l-arginine was reversed by l-NAME. The results of our study suggest that nonspecific voltage-dependent K(+) channels and nitrergic system have a role on the antinociceptive effect of Tramadol ( Generic Ultram ) in mice hot plate test.

Effects of Tramadol ( Generic Ultram ) on haemodynamics and blood gases in the early postoperative period

A variety of opioids is available for treatment of acute pain. Sometimes administration is limited due to typical side effects such as respiratory depression or pressure increase in the pulmonary circulation. Tramadol ( Generic Ultram ), a synthetic opioid, was investigated in a dosage of 1.5 mg/kg body weight i.v. with regard to changes in haemodynamic parameters and in blood gases. The haemodynamic parameters generally remained stable; all changes were statistically non significant. There were no signs of respiratory depression. The risk of pain therapy with opioids seems to be reduced further by the introduction of this agent.