Survey of the prescribing of tramadol hydrochloride in primary care for patients over 65 years of age.

Quantitative, cross-sectional survey of 222 patients older than 65 from three general practices in one PCT area who had received a prescription for tramadol in the previous 6-month period. Tramadol was shown to be prescribed in older patients. It was used for the management of pain for a range of indications, although not always following expert pain management guidelines. Tramadol is associated with a wider range of adverse effects than are other weak opioids. Although no direct correlation could be made with the prescribing of tramadol, patients in this sample experienced adverse effects, including falls, while using tramadol or other concomitant treatments. Patients in the survey sample had a significant renal deficit and were taking numerous concomitant and potentially interacting medicines. The survey demonstrated a link between increasing concomitant medication and the occurrence of adverse effects. The authors conclude that the use of tramadol should be reviewed. Although there is no doubt that tramadol is an effective agent for treating mild to moderate pain, it is associated with a range of adverse effects which have the potential to cause significant morbidity. There is no evidence to suggest that tramadol is any more effective than other weak opioids in the management of pain, and, when considering its adverse effect profile and the added cost of prescribing compared with codeine phosphate, its place in therapy is questionable