Gary asked
Hello, I have been taking on average 200 mg. of tramadol daily for chronic pain for about 12 years. I have never had to increase my dosage over the years and most days it works quite well. That said, about a couple years ago it seems that my bowels really started slowing down despite my fiber intake. What does research show about long-term use of tramadol on the GI system? Thanks.
Answer
Tramadol, like all opioid medications, is associated with constipation. The risk of constipation increases with continuing use.
Per the package insert for tramadol, the incidence rate of constipation for individuals is nearly 50% in those using the medication up to 90 days!
Source: Ultram (Tramadol) Package Insert
Tramadol Constipation
Although tramadol is associated with a high incidence of constipation in individuals, it is considered to be an opioid that has the least effect on the bowels, according to certain studies. In fact, the effects of tramadol on the GI tract may be somewhat minimal:
Tramadol has a minor delaying effect on colonic transit, but no effect on upper gastrointestinal transit or gut smooth muscle tone.
Additional studies have found similar results, that tramadol only has minor effects on the GI tract.
Nevertheless, most individuals who take opioids, like tramadol, daily for long periods of time will require some sort of laxative therapy.
Aside from medication, all of the following can prevent symptoms of constipation from tramadol:
- Adequate fluid intake
- Adequate fiber intake
- Exercise
In terms of pharmacologic approaches to opioid induced constipation, all of the following are considered safe for long term use:
- Polyethylene glycol (Miralax)
- Docusate (Colace)
While stimulant laxatives, such as bisacodyl can be used, they can cause cramping and may lose effectiveness over time.
For more serious cases of opioid induced constipation, the following are available via prescription:
- Methylnaltrexone (Relistor)
- Naloxegol (Movantik)
Summary
- Tramadol is an opioid medication that is associated with a high incidence of constipation when used for long periods of time.
- Tramadol has a minimal effect on the GI tract when compared to other opioids, but constipation risk increases with prolonged use.
- There are a variety of treatment options for opioid induced constipation, such as Miralax.
