Tramadol's Endocrine Effects

Mechanism of Action and Precautions

• Tramadol is an atypical opioid with dual mechanism of action - weak mu-opioid receptor agonist plus norepinephrine and serotonin reuptake inhibition, and its use requires precautions, especially with serotonergic medications, due to the risk of serotonin syndrome, as recommended by the National Comprehensive Cancer Network 1, 2, 3
• The National Comprehensive Cancer Network recommends reduced dosing for older adults (≥75 years) and those with hepatic/renal dysfunction when using tramadol 1, 2, 3
• The maximum recommended daily dose is 400 mg for immediate-release and 300 mg for extended-release formulations, according to the National Comprehensive Cancer Network 1, 2, 3