What will enhance the effects of tramadol

Trace elements are frequent ingredients in dietary supplements and may enhance tramadol's analgesic effect either through synergic mechanisms or through analgesic effects of their own. Swiss Weber male mice were divided into nine groups and were treated with a combination of the trace elements Mg, Mn, and Zn in three different doses and a fixed dose of tramadol. Two groups served as positive tramadol alone and negative saline controls. Nociceptive assessment by tail-flick TF and hot-plate HP tests was performed at baseline and at 15, 30, 45, and 60 min after intraperitoneal administration.

Your dosage, drug form, and how often you take the drug will depend on:. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. Always speak with your doctor or pharmacist about dosages that are right for you. Tramadol can cause or worsen seizures.

These drugs include other opioid pain drugs or certain medications for depression, other mood disorders, or psychosis. If you take too much tramadol, you may be treated with a medication called naloxone.

This drug also raises your risk of seizures. If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call or go to the nearest emergency room. Taking it again could be fatal cause death. The use of drinks that contain alcohol can increase your risk of certain side effects from tramadol. These include slowed breathing, decreased heart rate, decreased blood pressure, or confusion. You should not drink alcohol while taking tramadol.

For people with seizures: If you have seizures or a history of seizures, tramadol can cause or worsen seizures. Talk with your doctor about whether tramadol is safe for you. For people with mental health problems: If you have thoughts about intentionally hurting yourself, or have hurt yourself, do not take tramadol. For people with addiction problems: If you have problems with addiction, such as addiction to alcohol or drugs, do not take tramadol. Also avoid this drug if you have a history of addiction.

For people with head injuries: Tramadol can increase the pressure inside your head. This can worsen your condition or make it harder for doctors to diagnose or find the cause of problems in your brain. For people with stomach problems: Tramadol can make certain stomach problems worse. It can also make it harder for doctors to diagnose or find the cause of problems. For people with breathing problems: Tramadol may slow your breathing and cause shallow breathing.

Shallow breathing means you take small, short breaths. If you already have a breathing problem, such as asthma, talk with your doctor about whether this drug is safe for you. For pregnant women: Tramadol is a category C pregnancy drug. That means two things:. This drug should only be used if the potential benefit justifies the potential risk to the fetus.

Call your doctor right away if you become pregnant while taking this drug. For women who are breastfeeding: Tramadol may pass into breast milk and cause serious effects in a child who is breastfed. These effects can include slowed breathing and death.

Talk to your doctor if you breastfeed your child. For seniors: The kidneys or liver of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Seniors 65 years of age and older are at higher risk of side effects from the extended-release forms of this drug. Tramadol oral tablet is used for short-term or long-term treatment. Your length of treatment depends on how severe your pain is.

If you stop taking the drug suddenly, you may have symptoms of withdrawal, which can include:. For this drug to work well, a certain amount needs to be in your body at all times. If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:. But if your symptoms are severe, call or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects. I think the officials are doing well by seizing fake tramadol and prosecuting illegal sellers.

I and most of the people who use tramadol know can support the police in this regard because we know most of the illegal sellers in this city. We can give them information … … 35 years old, male, driver.

I heard the police are seizing fake tramadol and punishing the illegal sellers. I know some of those sellers and can help the police. If those fake sellers are punished, we can good tramadol and not fake ones 33 years old, male, assistant. For the sake of getting quality and standard tramadol from licensed shops, I am willing to support the police to arrest fake sellers. I know some of them and can help the police to arrest them 30 years old, male, driver. This study offers a useful understanding of varied reasons for using tramadol for non-medical purposes among commercial vehicle drivers and assistants in Kumasi, Ghana.

The study is novel in that it provides an in-depth description of the opinions of people who use tramadol, the ways in which they use and what they see as their key motivations. These opinions are useful in informing strategies for curbing tramadol misuse in Ghana. The study found a range of motivations for using tramadol for non-medical purposes, and in many cases, these motivations were explicitly linked to their performed daily activities whilst at other times participants spoke of motivations in the broader social context.

The motivations fell into four main inter-linking identified categories: 1 sexual; 2 psychological; 3 physical; and 4 economic motivations. It must be emphasised that there was a great deal of overlap between the categories and a very strong theme to emerge was perceived improved sexual performance and satisfaction associated with the use of tramadol.

Further, the identified motivations appear to be related to how long participants had been using the drug for non-medical purposes, to the intensity of their dependence and how they were introduced to the drug.

Many developing countries in the last decade have witnessed increasing trends in the misuse of psychoactive substances with tramadol becoming the major drug in these countries including Ghana [ 6 , 16 ]. Tramadol manifests some effect characteristic close to that of opioid agonists, and its misuse seems to be a problem for Ghana as several reports on the side effects of the drug, especially when taken in higher doses including nausea and vomiting, constipation, sweating, dizziness, seizures and postural hypotension, among others continue to build-up [ 5 , 6 , 16 , 38 , 39 , 40 ].

Our study contributes to the existing literature in various ways. To the best of our knowledge, this is the first study to explore motivations for non-medical purposes tramadol use in Ghana. In relation to empirical literature [ 2 , 7 , 25 ] participants got introduced to tramadol use by two main factors including pressure from friends, relatives and members of the community they live, and curiosity.

These pressures as narrated by the participants were in the forms of threats, coercion, and allurement by friends and workmates and superiors. For most of the participants, their inability to resist the pressure and fear of being sacked from work by their superiors led them into non-medical purpose tramadol use. It is also interesting to note that the constant public campaigns and education on radios and televisions by health officials and private individuals against tramadol misuse have in a way raised the curiosity levels of those who use the drug as reported by some of the study participants.

In the quest to satisfy their curiosity concerning the functions that the drug could perform as widely reported by the public, friends and colleagues, participants got into the use of the drug for non-medical purposes. Wasify et al. Throughout history, sexual health and function have been important components of life [ 42 , 43 ] and our study found three main sexual factors serving as motivations for non-medical purposes tramadol use among the participants.

These include prolonging time of sexual intercourse, treatment for premature ejaculation and ejaculation-related personal distress.

These sexual reasons for the continuous use of tramadol have been reported previously [ 2 , 7 , 16 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. A perceived decline in sexual function and the quest to satisfy partners by meeting their sexual needs and standards cause the affected individuals to search for solutions including patronising sex enhancing products such as tramadol. Our study participants continuously explore various ways to boost and maintain their sexual ability or stimulate sexual desire and this has resulted in their continuous misuse of tramadol.

It is also in line with Manortey et al. Having females buying tramadol for their partners for sexual purposes as a sign of spousal support or endorsement for tramadol use in this study is an indication that sex is a complex activity that is not only meant for procreation but also for enjoyment and natural relaxation.

However, the mechanism through which tramadol improves sexual performance and cures premature ejaculation and ejaculation related issues were not known to the participants though empirical studies demonstrate that the relationship between tramadol and sexual function appears to be controversial [ 16 , 50 ].

However, the use of tramadol for managing premature ejaculation and ejaculation related distress has been cautioned [ 56 , 57 ]. This suggests that additional rigorous well-designed studies are warranted to further investigate the potential long-term effects and risks of tramadol on sexual functions, especially in the Ghanaian context.

Aside from the sexual gratifications for non-medical purposes, tramadol use, participants verbalized some psychological factors as other motivations that drive them to use the drug including euphoria, alertness and attentiveness and sense of hope and belonging. Particularly, participants associated extreme excitement and happiness with tramadol use and therefore continue to use the drug especially in bad occasions. The drug to the participants makes them focused, alert and attentive on their daily activities.

Under the influence of the drug, those who use it care less about what others say or think about them. The use of the tramadol also makes them hopeful of a better future in worrying situations and make them feel belonged. This finding mirrors previous evidence on the antidepressant effect of the drug [ 2 , 6 , 25 , 58 , 59 ].

For instance, [ 52 ] a randomised control trial demonstrated that tramadol has an impact on stimulus processing related to sustained attention.

In addition, this study provides evidence to suggest that certain physical effects including perceived invigorating and analgesic effects of tramadol also served as motivations for non-medical purposes tramadol use among the study participants. In consonance with other existing evidence, [ 2 , 7 , 24 ] participants believed the drug energizes them to carry out their daily activities with no or limited fatigue. They mentioned that under the influence of the drug, they can work tirelessly to give their maximum output which makes them make money for a living.

Again, participants were motivated to use tramadol because of its perceived stress or fatigue relieve effect. To de-stress themselves and relieve their fatigue, participants used relied on tramadol and this finding reflects previous evidence on the analgesic effect of the drug [ 2 , 6 , 24 ].

Significantly, the study observed some factors which are largely economic in nature that also motivate the study participants to use tramadol. The main economic motivating factors for non-medical purposes tramadol use were affordability and availability of the drug. The study found that tramadol is readily available, accessible and affordable compared to other similar drugs.

In Ghana, tramadol is not on the list of controlled substances regulated by the Food and Drugs Authority, because it is believed to have a low misuse potential compared with the prototypic opioids such as morphine. This in a way has made the drug readily available in pharmacies, chemical shops and the black market and can be acquired without a prescription [ 7 ].

With this, participants did not incur much cost in acquiring the drug which motivates them to use it. Most of the participants had experienced or continue to experience some unpleasant side effects of tramadol misuse such as vomiting, seizures, loss of appetite, agitation, irritability, stigma, headache, hallucinations, among others.

These findings are in line with previous findings [ 7 , 22 ] on the common adverse effects of tramadol. It also mirrors trend on the common effects of tramadol where majority of the respondents responded to know the side effects of aphrodisiac products particularly tramadol [47].

Whilst the mechanism s through which tramadol causes these adverse effects is largely difficult to explain in this study, the side effect of a headache could possibly be an indication that usage of these substances increases blood pressure which may result in cardiovascular disorders with prolonged use. Second, participants of the study offered some praise to those who introduced them into tramadol use. This finding in a way appears surprising as one may think that the misuse of the drug has harmful side effects on the health and wellbeing of those who use it and therefore the users will rather blame their initiators for introducing them to tramadol use.

Third, knowing the effects of tramadol misuse, participants showed no willingness of stopping using tramadol for non-medical purposes which suggests the dependence and addictive potentials of the drug [ 1 ]. Participants valued the perceived benefits they derive from the drug over stopping using the drug. Interestingly, few of the participants who expressed a desire to quit tramadol misuse were looking for alternative drugs that work as tramadol.

These findings contradict previous results of Fuseini et al. These two findings of the study are indications of how complex and complicated the tramadol misuse fight in Ghana is. Fourth, one good revelation from this study is that many of the participants expressed willingness and desire to support the ongoing efforts of health officials and security agencies to curb tramadol misuse.

Most of the participants claimed knowing most of the unlicensed chemical shops and people selling what they see as fake tramadol. With this, they were willing to collaborate with officials to help seize and eradicate fake tramadol and sellers. The authors see this as a useful ground where health officials and other stakeholders can utilise to form partnerships and alliances to influence those who use it to quit tramadol use. This study has provided knowledge and evidence regarding motivations for non-medical tramadol use in Ghana from the perspective of those who use the drug.

Thus, this study offers a depth of understanding to support the ongoing effort toward addressing tramadol misuse in Ghana. However, two important caveats must be acknowledged here: Our findings cannot be regarded as representative to other groups of people who use tramadol and different settings as the study is purely qualitative with aim of identifying contextual themes that cannot be independent of the individuals and context involved.

To this, a larger quantitative study would be required. This study has ramifications for both policy and practice. The findings are relevant to the social policy directions particularly towards the effort to influence policy formulation and implementation by government and other stakeholders involved in policy making for curbing the menace of tramadol misuse in Ghana.

Our findings indicate that those who use tramadol for non-medical purposes are motivated by diverse factors and aware, having knowledge and experiencing some adverse effects from their misuse.

With this, the way forward in curbing their misuse and subsequent effects is to introduce measures, interventions and policies that provide opportunity for active involvement, engagement and participation by those who misuse tramadol to help influence their decisions to quit using the drug.

The study findings also necessitate the need for a stricter regulatory intervention to restrict tramadol as a controlled substance where access of the drug can be obtained through authorisation, utilisation and distribution records vetting and official inspections by the Food and Drugs Authority. Furthermore, the study findings also indicate that there is the need for intensified psychoeducational and awareness creation programmes for those who use tramadol due to the dependence and addictive potentials of tramadol revealed in the study.

The willingness of those who use tramadol for non-medical purposes to collaborate with officials in dealing with fake tramadol sellers also offers a useful ground where health officials can form partnerships and alliances to influence those who use it to quit using through psychological support, professional counselling, guidance, rehabilitation as well as other psychoeducational programmes.

Moreover, the easy accessibility of tramadol and the reluctance to discontinue the use of the drug by the participants underscore the need for clinically-driven and tailored medication-assisted treatments and programmes that use cognitive behavioural approaches by the Ghana Health Service and other stakeholders.

The combination of behavioural therapies and medications would enhance motivation toward behavioural changes and provide a whole-patient approach to the prevention of tramadol misuse and treatment of its associated disorders. This study provides a qualitative evidence that, due to a range of sexual, psychological, physical and economic factors, commercial vehicle drivers and assistants in Kumasi are motivated to use tramadol and that stopping the drug use appeared to be no option for the participants.

It is, therefore, imperative for stakeholders to take into consideration the findings of the study in order to guide the design and implementation of policies toward curbing tramadol misuse. Whilst further evidence is required to document the extent of these motivations in other settings and groups and how they might be best addressed, it makes sense for health officials and security agencies to involve those misusing tramadol in the fight against non-medical purpose usage of the drug as such opportunity for involvement, participation and partnership exist per the findings of the study.

Zhang H, Liu Z. The investigation of tramadol dependence with no history of substance abuse: a cross-sectional survey of spontaneously reported cases in Guangzhou City, China.

Biomed Res Int. Abuse and misuse of tramadol among the youth in the Wassa Amenfi west municipality in the Western region of Ghana. Psychol Psychology Res Int J. Google Scholar. Affinity, potency and efficacy of tramadol and its metabolites at the cloned human mu-opioid receptor.

Naunyn Schmiedeberg's Arch Pharmacol. CAS Google Scholar. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. PubMed Google Scholar. Salm-Reifferscheidt L. Tramadol: Africa's opioid crisis. Lancet London, England.

World Health Organisation. Tramadol: Pre-review report agenda item 5. Facilitators to the continuous abuse of tramadol among the youth: a qualitative study in northern Ghana. Nursing Open. Tramadol abuse and sexual function. Sex Med Rev. Prescription opioid abuse in the UK. Br J Clin Pharmacol. Nonmedical use of prescription drugs in the European Union.

BMC Psychiatry. National survey on drug use and health. J Addict. Tramadol dependence: a survey of spontaneously reported cases in Sweden. Pharmacoepidemiol Drug Saf. An appraisal of psychotropic drugs and their consequences among the construction industry workers in Nigeria, Adamawa state case study. Niger J Technol. Tramadol abuse among patients attending an addiction clinic in North-Eastern Nigeria: outcome of a four year retrospective study. Adv Psychology Neurosci.

Roushdy R, Sieverding M. Geneva: WHO; Seizures associated with intoxication and abuse of tramadol. Clin Toxicol. Oguntona S, Adelowo O. Common side effects of tramadol encountered in a private rheumatology clinic. Res J Health Sci. Hassan N. Tramadol has become a household for the youth of Kpandai District; Okertchiri, JA.

Competing paradigms in qualitative research. Handb Qual Res. Int J Afr Nurs Sci. Complementary and alternative medicine in midwifery: a qualitative exploration of perceptions and utilisation of CAM among trained midwives in rural Ghana. Evid Based Midwifery. Qualitative research practice: a guide for social science students and researchers: sage; Britten N.

Qualitative research: qualitative interviews in medical research. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. Cope DG, editor Methods and meanings: credibility and trustworthiness of qualitative research. Oncology nursing forum; Rigour in qualitative case-study research.

Nurs Res. Qualitative inquiry and research design: choosing among five approaches: sage publications; Lincoln YS, Guba E. Qualitative inquiry. CA: Thousand Oaks; The Sociodemographic and clinical characteristics of tramadol dependence among Egyptians and their relationship to the associated insomnia. Addict Disord Treat. Polomeno V. Sex and babies: pregnant couples' postnatal sexual concerns. J Perinat Educ. Evaluating factors associated with the use of aphrodisiacs among adult male residents in Ashaiman municipality, Ghana.

Open Access Library J. Tramadol for the management of premature ejaculation: a timely systematic review. Int J Impot Res. Wong BL, Malde S. Tramadol opioid abuse is associated with a dose-and time-dependent poor sperm quality and hyperprolactinaemia in young men.

Atuobi-Bediako SO. Factors associated with aphrodisiac use among men in Agbogbloshie in Greater Accra region: University of Ghana; An epidemiological study of tramadol HCl dependence in an outpatient addiction clinic at Heliopolis psychiatric hospital. Menoufia Med J. Prevalence of male sexual dysfunction among Ghanaian populace: myth or reality?

Bio-psychosocial factors associated with the use of sexual enhancers among Ghanaian men. J Urol. Fenner A. Sexual dysfunction::Tramadol is an effective therapy for mild to severe premature ejaculation. Nature Rev Urol. Role of tramadol in premature ejaculation: a systematic review and meta-analysis. Urol Int. Mulhall JP. Current and future pharmacotherapeutic strategies in treatment of premature ejaculation.

A randomized double-blind, placebo-controlled multicenter study to evaluate the efficacy and safety of two doses of the tramadol orally disintegrating tablet for the treatment of premature ejaculation within less than 2 minutes.

Eur Urol.