Ultracet: Difference between revisions

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| pregnancy = Avoid; neonatal opioid withdrawal documented.{{citation needed}}

| legal = [[USLegal:Schedule IV|Schedule IV controlled substance]] in US (tramadol was reclassified from non-controlled to Schedule IV in 2014 after recognition of dependence risk)

| mechanism = <vote slug="ultracet-mech-claim">Tramadol is a weak μ-opioid receptor agonist whose major analgesic activity comes from CYP2D6-mediated bioactivation to O-desmethyltramadol (M1), with substantial additional contribution from serotonin and norepinephrine reuptake inhibition; the dual mechanism resembles SNRI antidepressants in some respects.</vote> '''Serotonin syndrome risk''' with SSRIs, SNRIs, MAOIs, and other serotonergic agents. Seizure risk especially at high doses, in patients with epilepsy, or with concurrent serotonergic ~~medications~~. CYP2D6 PGx affects efficacy through M1 conversion<ref name="cpic-opioid-cyp2d6">CPIC Guideline for CYP2D6, OPRM1, and COMT and Opioid Use, 2021. https://cpicpgx.org/guidelines/cpic-guideline-for-codeine-and-cyp2d6/</ref>.

| mechanism = <vote slug="ultracet-mech-claim">Tramadol is a weak μ-opioid receptor agonist whose major analgesic activity comes from CYP2D6-mediated bioactivation to O-desmethyltramadol (M1), with substantial additional contribution from serotonin and norepinephrine reuptake inhibition; the dual mechanism resembles SNRI antidepressants in some respects.</vote> '''Serotonin syndrome risk''' with SSRIs, SNRIs, MAOIs, and other serotonergic agents. Seizure risk especially at high doses, in patients with epilepsy, or with concurrent serotonergic medicines. CYP2D6 PGx affects efficacy through M1 conversion<ref name="cpic-opioid-cyp2d6">CPIC Guideline for CYP2D6, OPRM1, and COMT and Opioid Use, 2021. https://cpicpgx.org/guidelines/cpic-guideline-for-codeine-and-cyp2d6/</ref>.

}}

== References ==

MDElliottMD (talk | contribs)