Aim To assess the appropriateness of prescriptions for tramadol hydrochloride and associated adverse effects. Design A quantitative, cross sectional survey. Subjects and setting The inclusion criteria included patients over the age of 65 years who had received a prescription for tramadol in the previous six month period. Patients were selected from three general practices using the Egton Medical Information System (EMIS) search facility. In total 222 patients were reviewed. Results Tramadol was shown to be prescribed in older patients. It is 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 affects than are other weak opioids. Although no direct correlation could be made to 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. Conclusion The use of tramadol in older patients 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 the adverse effect profile and added cost of prescribing in comparison with codeine phosphate, its place in therapy is questionable.
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