ISSN: 2455-3484

Journal of Addiction Medicine and Therapeutic Science

Case Report       Open Access      Peer-Reviewed

Tramadol Dependency Treatment: A New Approach

Jamshid Ahmadi*

Professor of Addiction Psychiatry, Founding Director, Substance Abuse Research Center, Dual Diagnosis Ward, Shiraz University of Medical Sciences, Shiraz, Iran

Author and article information

*Corresponding author: Jamshid Ahmadi, Professor and Founding Director, Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Tel: +98-71-3627 93 19; Fax: +98-71-3627 93 19; E-mail: [email protected]
doi : 10.17352/2455-3484.000010
Submitted: 16 October, 2015 | Accepted: 26 October, 2015 | Published: 28 October, 2015
Keywords: Tramadol; Withdrawal; Clonidine; Baclofen; NSAID

Cite this as

Ahmadi J (2015) Tramadol Dependency Treatment: A New Approach. J Addict Med Ther Sci. 2015; 1(2): 41-43. Available from: 10.17352/2455-3484.000010

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© 2015 Ahmadi J. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Tramadol induced disorder is a new problem.

Objective: To explain the efficacy of low dose of clonidine, baclofen and ibuprofen (NSAID) in the treatment of severe and chronic tramadol dependency (2000 mg daily).

Method: To evaluate the usefulness of non-narcotic drugs in the management of severe tramadol withdrawal symptoms.

Results: Clonidine 0.3 mg, baclofen75 mg and ibuprofen 1200 mg per day is very effective in the management of severe tramadol withdrawal symptoms and craving.

Discussion: Our findings indicates that low dose of clonidine, baclofen and ibuprofen (NSAID) is beneficial in the treatment of severe tramadol dependency. This is a fascinating result.

Conclusion: To our knowledge dramatic effects combination of clonidine, baclofen and ibuprofen in these situations has not been published yet, and this finding is a considerable addition to the literature.

Indexing and Abstracting

Introduction

We describe a patient with severe tramadol withdrawals who dramatically responded to combination of clonidine, baclofen and ibuprofen (NSAID).

Tramadol is a weak mu receptor agonist. It increases secretion of endorphin, dopamine and serotonin in the brain. It is usually prescribe as a moderate pain killer for a short period [1].

In Iran some patients use tramadol to treat their premature ejaculation, to increase their sexual desire and to enhance their sexual function.

Psychiatric and psychological problems have been growing disorders in the world including Iran [2]-[24]. In psychiatric diseases, substance related disorders, especially stimulants induced disorders have been considered as progressive worldwide problems. At the present time, patients with stimulants abuse and stimulants induced psychiatric disorders referred to clinics and hospitals are growing [25]-[57].

The approved FDA (Food and Drug Association) use of clonidine (alpha 2 adrenergic receptor agonist) is for the treatment of hypertension, baclofen for the treatment of spasticity and NSAIDS for the reduction of pain [1].

Now we are using combination of clonidine (for the treatment of diarrhea, lacrimation, rhinorrhea and nausea), baclofen and ibuprofen (NSAID) as a new approach for the treatment of severe tramadol withdrawals and craving.

We ourselves made a reliable and valid scale to evaluate the withdrawal craving according to DSM-5 (Diagnostic Statistical Manual of Mental Disorders; edition 5) criteria for tramadol craving only, ranging from 0 to 10 (0 means no craving at all and 10 means severe craving and temptation all the time).

Craving scale: 0-1-2-3-4-5-6-7-8-9-10.

To our understanding and knowledge we could not find enough controlled published study on this matter.

Therefore, study of this case could represent a new result.

Case Presentation

AJ was a single, 26 year old worker with high school education. He lived with his parents in Shiraz city of Fars province in southern Iran.

AJ began drinking of alcohol at age of 17 and after several months he became a regular daily drinker. Since three years Prior To Admission (PTA) due to severe migraine headache, he stopped drinking alcohol and began abuse of tramadol. After a couple of months he increased the dosage of tramadol to 2000 mg per day. Because of tramadol induced convulsions, and depression, he was admitted in psychiatric ward. During hospitalization he received clonidine 0.3 mg, baclofen75 mg and ibuprofen 1200 mg per day for the treatment of tramadol withdrawals. He also received olanzapine 20 mg and sodium valproate 400 mg per day for the treatment of depression and migraine headache. He was improved and discharged after two weeks of hospitalization. With the exception of sodium valproate, all other medications (clonidine, baclofen, ibuprofen and olanzapine) were discontinued. He was asked to continue sodium valproate 400 mg daily for treatment of headache. AJ was in good condition for five months, then (one month before the second hospital admission) AJ again began tramadol abuse and shortly increased the dosage to 2000 mg per day. He also reported occasional abuse of methadone since three years PTA.

Because of tramadol dependency, tramadol induced convulsion, agitation and depression He was admitted again.

In psychiatric interview and examinations he was depressed, restless and agitated. In exact physical and neurological examinations we could not find any abnormal findings. Urine drug screening tests were positive for tramadol and methadone. Serology for viral markers (HIV, HCV and HB Ag) was normal. He reported that his two brothers were opium and heroin dependent in the past.

According to DSM-5 criteria, and also complete medical, psychiatric, and substance use history AJ was diagnosed as “opioid (tramadol) dependent and opioid induced mood disorder”

During second hospitalization we began clonidine 0.3 mg, baclofen75 mg and ibuprofen 1200 mg per day for the treatment of severe tramadol withdrawals and craving. In addition we began olanzapine 20 mg and sodium valproate 400 mg per day for the treatment of depression and chlorpromazine 200 mg daily for management of insomnia and agitation.

He was closely interviewed for signs and symptoms of withdrawal every day. 

He was especially monitored and interviewed for tramadol withdrawals and craving, 3 times a day (morning, afternoon, evening).

AJ was taking medications and his condition was improving every day.

Based on the interview and closely monitoring (3 times a day), he experienced much more tramadol withdrawals and craving before taking medication than after taking medication.

Discussion

Our study elucidates that clonidine 0.3, baclofen 75 mg and ibuprofen 1200 mg per day is very effective in the reduction and cessation of tramadol withdrawal and craving. Therefore this study is a considerable addition to the literature.

Conclusions

Low doses of clonidine, baclofen and ibuprofen is very useful in the management of opioids withdrawal. This finding is fascinating.

References
  1. Sadock B, Sadock V, Ruiz P (2015) (Editors) Kaplan & Sadock's Synopsis of Psychiatry: Lippinott Wiliams and Wilkins, Philadelphia (USA).
  2. Ahmadi J, Toobaee S, Alishahi M (2004) Depression in nursing students. J Clin Nurs 13: 124.
  3. Ahmadi J, Pridmor S, Fallahzadeh M (2004) Neurotic scores in medical students. German J Psychiatry 7: 51­55 .
  4. Mackay­Smith M, Ahmadi J, Pridmore S (2015) Suicide In Shooting Galleries ASEAN Journal of Psychiatry 16: 50-56.
  5. Mani A, Dastgheib SA, Chanoor A, Khalili HA, Ahmadzadeh L, et al. (2015) Sleep Quality among Patients with Mild Traumatic Brain Injury: A Cross­ Sectional Study. Bull Emerg Trauma 3: 93-96 .
  6. Ahmadi J, Kamel M, Ahmed MG, Bayoumi FA, Moneenum A (2012) Mental Health of Dubai Medical College Students. Iran J Psychiatry Behave Sci 6: 79-83 .
  7. Pridmore S, Ahmadi J, Reddy A (2012) Suicide in the absence of mental disorder. Working paper of public health 6: 1­11 .
  8. Pridmore S, Brüne M, Ahmadi J, Dale J (2008) Echopraxia in schizophrenia: possible mechanisms. Aust N Z J Psychiatry 42: 565­571 .
  9. Pridmore S, Robinson J, Ahmadi J (2007) Suicide for scrutinizers. Australas Psychiatry 15: 247­248 .
  10. Ahmadi J, Samavatt F, Sayyad M, Ghanizadeh A (2002) Various types of exercise and scores on the Beck Depression Inventory. Psychol Rep 90: 821­822 .
  11. Pridmore S, Ahmdi J, Majeed ZA (2011) Suicide in Old Norse and Finnish folk stories. Australasian Psychiatry 19: 321­324 .
  12. Pridmore S, Ahmdi J (2010) Two cases of ‘Type 3' suicide. Australasian Psychiatry 18: 426­430 .
  13. Pridmore S, Ahmdi J (2011) Usage of download of psychiatry by Muslim countries. Bulletin of clinical psychopharmacology 21: 174 .
  14. Ahmadi J, Ahmadi N, Soltani F, Bayat F (2004) Gender differences in depression scores of Iranian and German medical students. Iran J Psychiatry BehavSci 8: 70­73 .
  15. Ahmadi J (1992) The Future of Psychiatry, (A novel theory and a new approach), Shiraz, Rahgosha Press, Second edition, Shiraz University of Medical Sciences.
  16. Ahmadi J (1994) Human and Biobehaviorism (A new theory and approach), Journal of Healthy Society 3.
  17. Ahmadi J, Benrazavi L, Ghanizadeh A (2001) Substance abuse among contemporary Iranian medical students and medical patients. J NervMent Dis 189: 860­861 .
  18. Ahmadi J, Fakoor A, Pezeshkian P, Khoshnood R, Malekpour A (2001) Substance use among Iranian psychiatric inpatients. Psychol Rep 89: 363­365 .
  19. Ahmadi J, Khalili H, Jooybar R, Namazi N, Mohammadagaei P (2001) Prevalence of cigarette smoking in Iran. Psychol Rep 89: 339­341 .
  20. Ahmadi J, Ghanizadeh A (2001) Current substance use among Iranian medical students. Indian J Psychiatry 43: 157­161 .
  21. Ahmadi J, Khalili H, Jooybar R, Namazi N, Aghaei PM (2001) Cigarette s moking among Iranian medical students, resident physicians and attending physicians. Eur J Med Res 6: 406­408 .
  22. Ahmadi J, Ghanizadeh A (2000) Motivations for use of opiates among addicts seeking treatment in Shiraz. Psychol Rep 87: 1158­1164 .
  23. Ahmadi J, Toobaee S, Kharras M, Radmehr M (2003) Psychiatric disorders in opioid dependants. Int J Soc Psychiatry 49: 185­191 .
  24. Ahmadi J, Pridmore S, Ekramzadeh S (2015) Successful Use Of Electro Convulsive Therapy In The Management Of Methamphetamine Induced Psychosis With Onset During Intoxication. J Addict & Depend 1: 1­2.
  25. Ahmadi J (2015) The Effect of Buprenorphine and Bupropion in the Treatment of Methamphetamine Dependency and Craving. Br J Med & Med Res 10: 1­4 .
  26. Ahmadi J, Sahraian A, Dastgheib SA, Mowla A, Ahmadzadeh L (2015) Management of Methamphetamine­ 201Induced Psychosis by 8 sessions of ECT Sch. J. App.Med. Sci 3: 1565­1566.
  27. Khademalhosseini Z, Ahmadi J, Khademalhosseini M (2015) Prevalence of Smoking, and its Relationship with Depression, and Anxiety in a Sample of Iranian High School Students. Enliven: Pharmacovigil Drug Saf 1: 005 .
  28. Ahmadi J, Amiri A, Ghanizadeh A, Khademalhosseini M, Khademalhosseini Z, et al. (2014) Prevalence of Addiction to the Internet, Computer Games, DVD, and Video and Its Relationship to Anxiety and Depression in a Sample of Iranian. High School Students. Iran J Psychiatry Behav Sci 8: 75­80 .
  29. Ahmadi J, Soltani F, Tabatabaee F (2014) Substance Use Disorders in Patients with Lung or Heart Diseases. Sch J App Med Sci 2: 111­120 .
  30. Ahmadi J, Yazdanfar F (2002) Substance use among Iranian university students. The International Journal of Drug Policy 13: 507­508 .
  31. Ahmadi J, Sharifi M, (2013) Lifetime and Current Prevalence of Tobacco Smoking. J Addict Res Ther 4: 145 .
  32. Ahmadi J, Ahmed MG (2013) Dubai Medical College Students' Attitudes towards Substance Use. J Addict Res Ther S6: 005.
  33. Ahmadi J, Keshtkar M, Pridmore S (2011) Methamphetamine Induced Synesthesia: A Case Report. Am J Addict 20: 306.
  34. Ahmadi J, Naghshvarian M, Afshari R (2011) Opioid abuse in male population referred for mandatory Urine Opioid Screen before marriage in Shiraz­Iran. Iranian J Psychiatry Behav Sci 5: 126­130 .
  35. Ahmadi J, Kampman KM, Oslin DM, Pettinati HM, Dackis C, et al. (2009) Predictors of Treatment Outcome in Outpatient Cocaine and Alcohol Dependence Treatment. Am J Addict 18: 81–86 .
  36. Ahmadi J, Kamel M, Ahmed MG, Bayoumi FA, Moneenum AA (2008) Dubai Medical College students' scores on the Beck Depression Inventory. Iranian Red Crescent Journal (IRCMJ) 10: 169­172 .
  37. Ahmadi J, Benrazavi L, Babaeebeigi M, Ghanizadeh A, Ghanizadeh M (2008) Substance use in a sample of medical patients. J Psychoactive Drugs 40: 315­319 .
  38. Ahmadi J, Pridmore S, Alimi A, Cheraghi A, Arad A, et al. (2007) Epidemiology of Opium Use in the General Population. Am J Drug and Alcohol Abuse 33: 483–491 .
  39. Ahmadi J, Kampman K, Dackis C, Sparkman T, Pettinati H (2008) Cocaine withdrawal symptoms identify Type B cocaine­dependent patients. Am J Addict 17: 60­64 .
  40. Ahmadi J, Kampman K, Dackis C (2006) Outcome predictors in cocaine dependence treatment trials. Am J Addict 15: 434­439 .
  41. Ahmadi J, Fallahzadeh H, Salimi A, Rahimian M, Salehi V, et al. (2006) Analysis of opium use by students of medical sciences. J Clin Nurs 15: 379­386 .
  42. Ahmadi J, Menzies P, Maany I (2005) Pattern of cocaine and heroin abuse in a sample of Iranian general population. German J Psychiatry 8: 1­4 .
  43. Ahmadi J, Farrashbandi H, Menzies P (2005) Prevalence of mood and anxiety disorders in a sample of Iranian outpatient opioid addicts. German J Psychiatry 8: 5­7 .
  44. Ahmadi J, Farrashbandi H, Majdi B (2005) Substance­induced anxiety disorder in opioid dependents. Addictive Disorders & Their Treatments 1­4 .
  45. Ahmadi J, Majdi B, Mahdavi S, Mohaghegh M (2004) Mood disorders in opioid dependent patients. J Affective Disorders 82: 139­142 .
  46. Ahmadi J, Maharlooy N, Alishahi M (2004) Substance abuse: prevalence in a sample of nursing students. J Clin Nurs 13: 60­64 .
  47. Ahmadi J, Alavi M, Alishahi M (2004) Substance Use Disorders in a Sample of Iranian Secondary School Students. Social Indicators Research 65: 355­360 .
  48. Ahmadi J, Etminan H, Javanmardi H (2003) Reasons for cessation of opiate use among Iranian opioids dependants. Addictive Disorders & Their Treatment 2: 9­12 .
  49. Ahmadi J, Rayisi T, Alishahi M (2003) Analysis of substance use by primary school students. German J Psychiatry 3: 56­59 .
  50. Ahmadi J, Sharifi M (2003) Cannabis abuse in Iran. Irish J Med Sci 172: 46 .
  51. Ahmadi J, Arabi H, Mansouri Y (2003) Prevalence of substance use among offspring of opioid addicts. Addict Behav Apr 28: 591­595 .
  52. Ahmadi J, Hasani M (2003) Prevalence of substance use among Iranian high school students. Addict Behav 28: 375­379 .
  53. Ahmadi J, Benrazavi L (2002) Substance use among Iranian physical patients. The International Journal of Drug Policy 13: 505­506 .
  54. Ahmadi J, Ostovan M (2002) Substance use among Iranian male students. The International Journal of Drug Policy 13: 511­512 .
  55. Ahmadi J, Benrazavi L (2002) Substance use among Iranian nephrologic patients. Am J Nephrol 22: 11­13 .
  56. Ahmadi J, Benrazavi L (2002) Substance use among Iranian surgical patients. The International Journal of Drug Policy 13: 509­510 .
  57. Ahmadi J, Benrazavi L (2002) Substance use among Iranian cardiovascular patients. Eur J Med Res 7: 89­92 .
 

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