From the Guidelines
No, tramadol is not an NSAID (non-steroidal anti-inflammatory drug). Tramadol is an opioid pain medication that works differently from NSAIDs. According to the NCCN clinical practice guidelines in oncology 1, tramadol is a weak mu-opioid receptor agonist with some norepinephrine and serotonin reuptake inhibition, which is indicated for treating moderate to moderately severe pain. The guidelines recommend a maximum daily dose of 400 mg for IR formulations and 300 mg/day for ER formulations, for adults with normal hepatic and renal function.
Some key points to consider when prescribing tramadol include:
- Tramadol should be used with caution or avoided in patients taking other serotonergic or monoamine oxidase inhibitors (MAOI)-like medications due to risk of serotonin syndrome 1
- Tramadol is less potent than other opioids and is considered to be approximately one tenth as potent as morphine 1
- Tramadol can cause adverse effects such as vomiting, dizziness, and weakness, and requires careful monitoring for other adverse effects 1
In terms of its mechanism of action, tramadol works primarily by binding to mu-opioid receptors and inhibiting the reuptake of serotonin and norepinephrine in the brain, which is distinct from the mechanism of NSAIDs that reduce pain and inflammation by inhibiting cyclooxygenase enzymes. As an opioid medication, tramadol carries risks of dependence, addiction, and respiratory depression, especially at higher doses, though these risks are generally lower than with traditional opioids like morphine or oxycodone 1.
From the FDA Drug Label
Tramadol Hydrochloride contains tramadol, a centrally acting synthetic opioid analgesic. The FDA drug label does not answer the question.
From the Research
Definition of NSAID
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medications that reduce inflammation and relieve pain 2.
- NSAIDs work by inhibiting the production of prostaglandins, which are hormone-like substances that cause pain and inflammation.
Tramadol Mechanism of Action
- Tramadol is a centrally acting analgesic that works through a combined mechanism of weak mu receptor binding and the inhibition of serotonin and norepinephrine reuptake 2.
- Tramadol has a unique pharmacokinetic and pharmacodynamic profile, with opioidergic, noradrenergic, and serotonergic actions 3.
- Tramadol modifies the crosstalk between neuronal and non-neuronal cells in peripheral and central sites, and has modulatory effects on several mediators involved in pain signaling 3.
Comparison with NSAIDs
- Tramadol is not an NSAID, as it does not work by inhibiting the production of prostaglandins 2.
- Tramadol has a different mechanism of action compared to NSAIDs, and is classified as a mixed-mechanism opioid drug 4.
- Tramadol is often used as an alternative to NSAIDs for the treatment of chronic pain syndromes, due to its favorable adverse-effect profile 2.