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Tramadol comparable to buprenorphine for opioid withdrawal

Extended-release tramadol was more effective than clonidine for opioid withdrawal symptoms and was comparable to buprenorphine, according to recent findings.

“Tramadol hydrochloride is a promising alternative option for effective [opioid use disorder] treatment. Tramadol is a mild-to-moderate opioid agonist with low affinity for the , , and opioid receptors and an active metabolite with agonist activity. The extended-release formulation of tramadol has a long elimination half-life (6 to 10 hours) that supports once-daily dosing,” Kelly E. Dunn, PhD, of Johns Hopkins University School of Medicine, and colleagues wrote. “Retrospective reviews, human laboratory studies and randomized trials report that tramadol suppresses opioid withdrawal symptoms more than placebo and clonidine and is comparable to buprenorphine and methadone without increasing positive drug effects.”

To assess efficacy of tramadol hydrochloride extended-release (ER) for opioid use disorder in supervised withdrawal settings, researchers conducted a randomized clinical trial among 103 individuals with opioid use disorder. Study participants were stabilized with 30 mg of morphine administered subcutaneously 4 times per day. Participants then completed a 7-day taper with clonidine (n = 36), tramadol ER (n = 36) or buprenorphine (n = 31) then transitioned to a double-blind placebo during a post-taper period.

Participants who received buprenorphine were more likely to be retained at the end of taper (90.3%), compared with those who received clonidine (66.1%). Retention among participants who received tramadol ER (72.2%) was comparable to both groups.

Time-course analyses of withdrawal indicated effects of phases on Clinical Opiate Withdrawal Scale scores, with mean scores of 5.19 at taper and 3.97 post-taper (P = .03), and on Subjective Opiate Withdrawal Scale scores, with mean scores of 8.81 at taper and 4.14 post-taper (P < .001). However, researchers did not find group effects or group by phase interactions.

Subjective Opiate Withdrawal Scale scores decreased between taper and post-taper among participants who received clonidine (13.1 vs. 3.1; P < .001) and tramadol ER (7.7 vs. 2.8; P = .03).

From stabilization to taper, concomitant medication use increased among participants who received clonidine (0.64 vs. 1.54; P < .001) and tramadol ER (0.53 vs. 1.19; P = .03).

Concomitant medication use increased among those who received buprenorphine from stabilization to post-taper (0.46 vs. 1.17; P = .006).

Researchers noted these associations suggested higher withdrawal for these groups during those periods.

“These data suggest that tramadol ER is a promising and valuable medication for the management of opioid withdrawal in patients undergoing treatment for [opioid use disorder]. Future studies should evaluate whether relapse varies following supervised withdrawal with tramadol ER vs. other medications and whether tramadol ER can be used to transition patients to naltrexone treatment,” the researchers concluded. – by Amanda Oldt

Disclosure: Dunn reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.