From the Guidelines
A patient can be on both long-acting tramadol and oxycodone PCA, but this combination requires careful medical supervision due to potential risks, as noted in the SPAQI consensus statement 1. When considering this combination, it's crucial to weigh the benefits against the potential for increased toxicity, particularly due to the serotonergic and noradrenergic activity of tramadol, which may be exacerbated by other medications 1. Key considerations include:
- The patient's renal function, as tramadol is not recommended in renal insufficiency (GFR <30 mL/min/1.73 m2) and ESRD, while oxycodone should be used with caution and dosage adjusted in such cases 1.
- The risk of respiratory depression, sedation, and other opioid-related side effects, which can be mitigated by careful calculation of the total daily morphine milligram equivalent (MME) dose and close monitoring for signs of excessive sedation or respiratory depression 1.
- The importance of patient education regarding the risks of this combination therapy and the need for immediate reporting of concerning symptoms. In terms of specific dosing, a common approach might involve extended-release tramadol 100-200 mg every 12 hours, combined with oxycodone PCA set at 1 mg per dose with a 6-10 minute lockout period, though dosing must be highly individualized based on patient response and medical history 1. Ultimately, the decision to use both long-acting tramadol and oxycodone PCA should be made on a case-by-case basis, with careful consideration of the potential benefits and risks, and under the close supervision of a qualified healthcare provider, as emphasized by the SPAQI consensus statement 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Opioid Combination Therapy
- The use of long-acting tramadol and oxycodone PCA (patient-controlled analgesia) can be considered in patients requiring pain management, as both medications have been used to treat pain [(2,3)].
- Tramadol is a mixed-mechanism opioid drug that exerts its effects via binding mu receptors and blocking the reuptake of monoamines, whereas oxycodone is a full opioid agonist 2.
- The combination of tramadol and oxycodone may be used to achieve adequate pain control, but it is essential to consider the potential risks of respiratory depression, especially with oxycodone 4.
Respiratory Effects
- A study comparing the respiratory effects of tramadol and oxycodone found that oxycodone caused significant respiratory depression, whereas tramadol had effects similar to those of placebo 4.
- Another study suggested that atypical opioids like tramadol may be a safer option than conventional opioids for pain treatment due to their lower risk of respiratory depression 3.
Clinical Considerations
- When using tramadol and oxycodone PCA, it is crucial to monitor patients closely for signs of respiratory depression and other adverse effects, such as nausea, vomiting, and constipation [(2,5)].
- The use of tramadol and oxycodone PCA should be individualized, and the dosage should be adjusted according to the patient's response and medical history [(6,5)].