Tramadol with dexketoprofen

How it works

Tramadol is a weak mu-opioid agonist that also inhibits serotonin and noradrenaline reuptake, while dexketoprofen inhibits cyclo-oxygenase to reduce prostaglandin-mediated pain and inflammation; the two provide complementary analgesia.

Prescribing in practice

• Combine NSAID and opioid hazards — the dexketoprofen component carries gastrointestinal, renal and cardiovascular risks while tramadol carries respiratory depression, dependence and seizure risk, so use the lowest effective dose for the shortest time.
• Tramadol lowers the seizure threshold and can cause serotonin syndrome, so avoid with other serotonergic drugs and in those with epilepsy.
• Avoid in active peptic ulceration, significant renal impairment and where NSAIDs or opioids are contraindicated, and limit to short courses.

Monitoring

Monitor pain control, sedation and respiratory status, and watch for gastrointestinal and renal adverse effects during use.

Counselling the patient

• Take with or after food and only for short-term pain as directed.
• Avoid alcohol and report black stools, indigestion or excessive drowsiness.
• Do not take other NSAID or paracetamol-opioid products at the same time without advice.

Evidence & guidelines

The combination is supported by acute-pain trials demonstrating additive analgesia, with safety framed by established NSAID and opioid class data.