Tramadol ER May Reduce Withdrawal Symptoms

Extended-release (ER) tramadol hydrochloride reduced withdrawal symptoms among patients with opioid use disorder (OUD) more effectively than clonidine, according to a recent study.

The randomized clinical trial included 103 patients with OUD involved in a residential research program, and was conducted from October 25, 2010 to June 23, 2015. The mean age was 28.9 years, 88 (85.4%) participants were men and 43 (41.7%) were white.
________________________________________________________________________________________________________________________________________________________________________

At baseline, patients were stabilized with 30 mg of morphine administered subcutaneously 4 times per day, which was followed by a 7-day tapering period. During the tapering period, 36 patients received clonidine, 36 patients received tramadol ER, and 31 patients received buprenorphine. All patients received placebos in the post-taper period.

Withdrawal symptom management, retention, concomitant medication utilization, and naltrexone induction were assessed as the main outcomes.

Buprenorphine had the highest retention with 28 (90.3%) patients reaching the final taper day, compared with Tramadol ER, which had intermediate retention of 26 patients (72.2%). Clonidine had the lowest retention with only 22 (66.1%) participants reaching the final taper day.

Additionally, time-course analysis of withdrawal showed significant effects of phase for the Clinical Opiate Withdrawal Scale score and the Subjective Opiate Withdrawal Scale score (SOWS), but no groups effects or group × phase interactions. In analyses of area under the curve of (SOWS) scores, the researchers found significant reductions in withdrawal severity between taper and post-taper periods for clonidine and tramadol, but not for buprenorphine.

From stabilization to taper, the use of concomitant medication increased significantly among patients who received clonidine and tramadol ER, which indicated higher withdrawal during the taper period. The use of concomitant medication increased from stabilization to post-taper period among patients in the buprenorphine group, which suggested higher withdrawal during the post-taper phase.

The addition of naltrexone therapy was voluntary and the number of patients initiating naltrexone did not differ significantly between groups.

“The results of this trial suggest that tramadol ER is more effective than clonidine and comparable to buprenorphine in reducing opioid withdrawal symptoms during a residential tapering program,” the researchers concluded. “Data support further examination of tramadol ER as a method to manage opioid withdrawal symptoms.”

—Melissa Weiss

Reference:

Dunn KE, Tompkins A, Bigelow GE, Strain EC. Efficacy of tramadol extended-release for opioid withdrawal: a randomized clinical trial [published online July 12, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.1838.