Tramadol restrictions?

Re: Tramadol restrictions?

Glenn Hodgson — Sun, 24 Feb 2013 22:56:36 GMT

I sometimes use temgesic in this type of scenario. Makes for a comfortable nights sleep for dog and side effects minimal short term (I class the common sedation/lerhargy as a desired effect though!, not a side effect)

Re: Tramadol restrictions?

james herriot lied — Sun, 24 Feb 2013 22:22:57 GMT

[quote user="james herriot lied"]

I like it, particularly after a bit of 'gnarly' surgery or with highly strung patients where it's safe to assume that all the pain receptors are sensitised. It's not bad for ensuring a decent night's sleep. Just this minute come away from a tail amputation - my definition of 'gnarly' surgery - in an adult lab (strong wind, slamming door, ouch). That'll be on carprofen and tramadol over the weekend.

[/quote]

And wouldn't you know it........ didn't make a d*mn bit of difference, probably made the dog more agitated and certainly constipated it up into the bargain - not great when the nether regions are already in pain. Dispensed low dose diazepam and I've got the owners coming back in (they live just round the corner) every few hours for a top-up of vetergesic, which zonks him out and gives respite. Next step is in for ketamine if he's not getting reasonable analgesia tonight.

Shouldn't have said a word. Still think it's a good drug, but perhaps a bit less enthused at this very moment in time.

Re: Tramadol restrictions?

Michael Woodhouse — Sun, 24 Feb 2013 21:06:37 GMT

If you have a 30kg lab on a couple of Tramadol three times per day they can get through a box in just over a fortnight. Whether we give them 3 weeks or 3 months it is still a load of drug that we either trust them to behave with or not.

My gran used to have a cupboard full of morphine tablets, as the doctor kept giving a repeat script for all her meds and she wasn't taking all the morphine.

What they do with the meds once dispensed is up to them, it stops being our problem.

Re: Tramadol restrictions?

Jo Cobbett — Sun, 24 Feb 2013 20:38:18 GMT

[quote user="Mike Dale"]

Strangely, I was pondering the question of safety only yesterday when I saw over two months worth of dispensing about to head out of the door.

I put a ban on dispensing more than three weeks supply at a time and insist on monthly clinical check ups. I reckon if an animal is in enough pain to need tramadol then it should be monitored much more closely anyway - especially as most of our clients seem to be a little blind to signs of pain in their pets at the best of times..

[/quote]

We had a client come in a couple of weeks ago who has two labradors on tramadol (alongside NSAIDs for arthritis). She asked for 3 months worth for both of them. I said no - that's a crazy amount of opioid to be sending out in one go!

I'm always amazed by the number of clients who, when you mention tramadol when discussing their dog's medication, say "oh yes, I'm on that too".

Re: Tramadol restrictions?

Rob Loxley — Fri, 22 Feb 2013 22:58:59 GMT

[quote user="Martin Atkinson"]

[quote user="Clive Ansell"]

I suppose it just a matter of time before someone gets it licenced and increases the price several 100%?

[/quote] They already have, so you are already using it off cascade unless it comes from Summit http://www.svprx.co.uk/our-products.html

[/quote]

Summit don't have a full license (MA) as such, they are producing it as a veterinary 'special'. I'd humbly suggest that using a licensed human drug comes above using an extemporaneously prepared 'special' (see VMGN13 p6-7)

Re: Tramadol restrictions?

Michael Woodhouse — Fri, 22 Feb 2013 22:05:25 GMT

[quote user="Neil Wheadon"]A recent webinar suggested it lasted an hour, is it worth it?[/quote]

Clinically it seems to last much longer than that. My own little dog was on it for a hort while and ~6-8 hours later you could tell it was wearing off.

I think it is great.

Re: Tramadol restrictions?

Dagmar Steele — Fri, 22 Feb 2013 19:11:22 GMT

[quote user="Neil Wheadon"]

A recent webinar suggested it lasted an hour, is it worth it?

Neil

[/quote]

I'm not a huge fan of Tramadol anyway. It does have it's uses, but I've seen it fail many times and the side effects (mainly nausea and depression) are far too common for my taste...

Re: Tramadol restrictions?

Neil Wheadon — Fri, 22 Feb 2013 18:08:53 GMT

[quote user="Dagmar Steele"]and so we should be[/quote]

I agree entirely and am increasingly worried about the way Tramadol is dished out almost like Smarties. I looked at an intenet forum a few weeks ago and saw that it causes real issues http://www.talktofrank.com/drug/tramadol is number 4 if you google it and there are other sites. Yes phenobarb is dangerous but is it taken for pleasure? I find it bizarre that it's locked in DD cupboards in some practices whilst in others it's on the shelf. Even if clients are seen on a regular basis, how do we know that the pet is getting it?

A recent webinar suggested it lasted an hour, is it worth it?

Neil

Re: Tramadol restrictions?

Dagmar Steele — Fri, 22 Feb 2013 17:10:41 GMT

[quote user="robloxley"]

Are you worried about the owner taking the dog's tramadol or selling it on?
We are 'careful' about how much we dispense to whom, but the same goes for phenobarb, SSRIs and TCAs.

[/quote]

and so we should be. I recently googled butorphanole and ended reading posts on a forum called drugs-forum.com. Boy, you cannot imagine how many people on there were discussing the tablets they had gotten from their vets for their cats/dogs and how to crush them and get them up your nose :-(

Re: Tramadol restrictions?

Martin Atkinson — Fri, 22 Feb 2013 16:55:26 GMT

[quote user="Clive Ansell"]

I suppose it just a matter of time before someone gets it licenced and increases the price several 100%?

[/quote] They already have, so you are already using it off cascade unless it comes from Summit http://www.svprx.co.uk/our-products.html

Re: Tramadol restrictions?

mariette asselbergs — Fri, 22 Feb 2013 16:38:44 GMT

It is good that vets are careful with drug dispensing, but I wonder if we are sometimes plus royaliste que le Roy? I have been on a number of painkillers from the NHS for more than 2 years without ever a clinical or blood check or any enquiries whether I still needed them or maybe sold them on or had become addicted to them or whatever, just collect them every 3 months......(No longer though, new bionic hip has taken care of that , great!)

Mariette

Re: Tramadol restrictions?

Rob Loxley — Fri, 22 Feb 2013 16:29:08 GMT

[quote user="Mike Dale"]

Strangely, I was pondering the question of safety only yesterday when I saw over two months worth of dispensing about to head out of the door.
I put a ban on dispensing more than three weeks supply at a time and insist on monthly clinical check ups.

[/quote]

Are you worried about the owner taking the dog's tramadol or selling it on?
We are 'careful' about how much we dispense to whom, but the same goes for phenobarb, SSRIs and TCAs.

Re: Tramadol restrictions?

james herriot lied — Fri, 22 Feb 2013 16:24:54 GMT

[quote user="Mike Dale"]

Certainly less weird reactions than with Gabapentin although you need to watch for constipation.

[/quote]

Certainly second that, and have had cases of urinary retention on it also - mostly mild, but one which needed decompression.

Re: Tramadol restrictions?

Mike Dale — Fri, 22 Feb 2013 13:38:30 GMT

I find tramadol very effective in a lot of cases where nsaids are not working alone . Certainly less weird reactions than with Gabapentin although you need to watch for constipation.

Strangely, I was pondering the question of safety only yesterday when I saw over two months worth of dispensing about to head out of the door.

Re: Tramadol restrictions?

Bob Russell — Fri, 22 Feb 2013 11:06:54 GMT

I have to say a few of my patients rate it very highly as well!

I warn owners that it is very effective in some patients and not in others. They go away having signed a consent form, clutching the BSAVA advice sheet.

Side effects seem to be minimal but this is based on a fairly small number of patients.

Re: Tramadol restrictions?

Gerry Henry — Fri, 22 Feb 2013 10:50:34 GMT

Some experts I have heard on the subject of tramadol don't rate it highly. at all ...?

Most of the painful dogs I put on it rate it very highly indeed, but against the word of an expert ... well.

Re: Tramadol restrictions?

bob lehner — Fri, 22 Feb 2013 10:04:40 GMT

[quote user="Clive Ansell"]I suppose it just a matter of time before someone gets it licenced and increases the price several 100%? [/quote]

Well if they produced the required evidence on efficacy/dose rates etc. in veterinary species that would be good.

Some experts I have heard on the subject of tramadol don't rate it highly. at all ...?

It's odd how it has become so widely used in a relatively short space of time.

Re: Tramadol restrictions?

Clive Ansell — Fri, 22 Feb 2013 07:23:12 GMT

I suppose it just a matter of time before someone gets it licenced and increases the price several 100%?

Re: Tramadol restrictions?

Michael Woodhouse — Thu, 21 Feb 2013 23:00:39 GMT

I'm not sure it is any worse than paracetamol and codeine. As it is not restricted we have it on the open shelf, but we are a small practice.

Just because people can misuse a drug, there is no evidence that the illegal supply is coming via the human/vet prescription route. Any increase in regulation just forces up the price on a useful drug that is very affordable.

Re: Tramadol restrictions?

CatherineThomas — Thu, 21 Feb 2013 21:41:31 GMT

We have quite tight restrictions on tramadol. It is kept in a locked dangerous drugs cabinet. Only vets and qualified nurses have access to it. And we record it in a book along with ketamine, methadone etc.