How do genetics affect tramadol?

The opioid effects of tramadol are greatly affected by a person’s genetics, particularly their capacity for tramadol metabolism through a liver enzyme system called cytochrome P450 2D6. 20% of African Americans, 10% of Caucasians, and 2% of Asians have genetic polymorphisms that reduce the activity of this enzyme, which decreases how much tramadol is metabolized. People who are poor metabolizers at CYP 2D6 may find tramadol ineffective.

Individuals who are CYP2D6 ultra-rapid metabolizers (about 3% of the population) are at risk of life-threatening or fatal breathing side effects from tramadol (respiratory depression) even at regular dosages because they convert tramadol into its active metabolite more rapidly than other people. These people should not use tramadol.

Genetic testing is available through hospitals, specialized clinics, and doctor's clinics. Blood is the preferred specimen type. About 21% of currently approved drugs are processed through CYP 2D6 including opioids, antidepressants, antipsychotics, β-blockers, antiemetics, and tamoxifen, and it is helpful for you and your healthcare provider to know if you are a:

• Poor metabolizer: Process drugs slowly; may need lower dosages to avoid side effects
• Intermediate metabolizer: Process drugs less efficiently; might not be as effective as normal metabolizers
• Normal metabolizer: Process drugs efficiently; likely to benefit from treatment with fewer side effects
• Ultrarapid metabolizer: Process drugs too quickly; may need higher doses for effectiveness.

Before taking this medicine

You should not take tramadol if you are allergic to it, or if you have:

• severe asthma or breathing problems
• a stomach or bowel obstruction (including paralytic ileus)
• if you have recently used alcohol, sedatives, tranquilizers, or narcotic medications or
• if you have used an MAO inhibitor in the past 14 days (such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine)
• are pregnant or planning a pregnancy
• are breastfeeding.

Tramadol should not be given to a child younger than 12 years old. Ultram ER should not be given to anyone younger than 18 years old. Do not give tramadol to anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Seizures have occurred in some people taking tramadol. Your seizure risk may be higher if you have ever had:

• a head injury, epilepsy, or other seizure disorder
• drug or alcohol addiction or
• a metabolic disorder.

To make sure tramadol is safe for you, tell your doctor if you have ever had:

• breathing problems, sleep apnea
• liver or kidney disease
• urination problems
• problems with your gallbladder, pancreas, or thyroid
• a stomach disorder or
• mental illness, or suicide attempt.

Pregnancy

If you take tramadol during pregnancy, your baby could be born with life-threatening withdrawal symptoms or seizures and may need medical treatment for several weeks. Fetal death and miscarriage have also been reported. Should not be used in pregnant women unless the benefits outweigh the risks.

Breastfeeding

It is not known if tramadol passes into human milk. Ask a doctor before using tramadol if you are breastfeeding. Tell your doctor if you notice severe drowsiness or slow breathing in the nursing baby.