Tramadol Use in Patients with Codeine Allergy

Pharmacology and Safety Considerations

• Tramadol's parent compound is active and produces the metabolite M1 (O-desmethyl-tramadol) via the CYP2D6 enzyme, whereas codeine is a prodrug requiring CYP2D6 metabolism to morphine for analgesic effect, as noted by Praxis Medical Insights 1

Alternative Therapies for Moderate Pain

• The European Society for Medical Oncology and American Society of Clinical Oncology support the use of low-dose strong opioids, such as morphine 5-10 mg every 4 hours, combined with non-opioid analgesics for moderate pain, as recommended by the Annals of Oncology and Praxis Medical Insights 2, 3