Buy Tramadol (Tramal) Cas 27203-92-5

Tramadol, sold under the brand name Tramal among others,^[20][1] is an opioid pain medication and a serotonin–norepinephrine reuptake inhibitor (SNRI) used to treat moderate to severe pain.^[16][20] When taken by mouth in an immediate-release formulation, the onset of pain relief usually begins within an hour.^[16] It is also available by injection.^[21] It is available in combination with paracetamol (acetaminophen).

As is typical of opioids, common side effects include constipation, itchiness, and nausea.^[16] Serious side effects may include hallucinations, seizures, increased risk of serotonin syndrome, decreased alertness, and drug addiction.^[16] A change in dosage may be recommended in those with kidney or liver problems.^[16] It is not recommended in those who are at risk of suicide or in those who are pregnant.^[16][21] While not recommended in women who are breastfeeding, those who take a single dose should not generally have to stop breastfeeding.^[22] Tramadol is converted in the liver to O-desmethyltramadol (desmetramadol), an opioid with a stronger affinity for the μ-opioid receptor.^[16][23]

Tramadol was patented in 1972 and launched under the brand name Tramal in 1977 by the West German pharmaceutical company Grünenthal GmbH.^[20][24] In the mid-1990s, it was approved in the United Kingdom and the United States.^[20] It is available as a generic medication and marketed under many brand names worldwide.^[1][16] In 2023, it was the 36th most commonly prescribed medication in the United States, with more than 16 million prescriptions.^[25][26]

Tramadol is used primarily to treat mild to severe pain, both acute and chronic.^[27][28] There is moderate evidence for use as a second-line treatment for fibromyalgia, but it is not FDA-approved for this use.^[29] Its use is approved for treatment of fibromyalgia as a secondary painkiller by the NHS.^[30]

Its analgesic effects take approximately an hour to be realized, and it takes from two to four hours to reach peak effect after oral administration with an immediate-release formulation.^[27][28] On a dose-by-dose basis, tramadol has about one-tenth the potency of morphine (thus 100 mg is commensurate with 10 mg morphine but may vary) and is practically equally potent when compared with pethidine and codeine.^[31] For moderate pain, its effectiveness is roughly equivalent to that of codeine in low doses and hydrocodone at very high doses. For severe pain, it is less effective than morphine.^[27]

Pain-reducing effects last approximately six hours. The potency of analgesia varies considerably as it depends on an individual’s genetics. People with specific variants of CYP2D6 enzymes may not produce adequate amounts of the active metabolite (desmetramadol) for effective pain control.^[19][27]

Sleep medicine physicians sometimes prescribe tramadol (or other opioid medications) for refractory restless legs syndrome (RLS);^[32][33] that is, RLS that does not respond adequately to treatment with first-line medications such as dopamine agonists (e.g., pramipexole) or gabapentinoids, often due to augmentation.^[34]

Tramadol, due to its activity as a serotonin reuptake inhibitor, is effective in the treatment of premature ejaculation per systematic reviews and meta-analyses and is used off-label for this indication.^{[35][36][37][38][39][40][41][42]} However, the British Society for Sexual Medicine 2025 guidelines recommend against use of tramadol for premature ejaculation due to recent reports of habituation.^[42]