From the FDA Drug Label
At therapeutic doses, tramadol hydrochloride has no effect on heart rate, left-ventricular function or cardiac index. Orthostatic hypotension has been observed. NUCYNTA tablets may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients.
- Tramadol has less effect on blood pressure compared to tapentadol, as it does not affect heart rate, left-ventricular function, or cardiac index at therapeutic doses, although it may cause orthostatic hypotension.
- Tapentadol may cause severe hypotension, including orthostatic hypotension and syncope, especially in patients with compromised blood volume or those taking certain CNS depressant drugs 1. Based on the information provided, tramadol appears to have a lesser effect on blood pressure compared to tapentadol 2.
From the Research
Tramadol is generally considered the opioid with less effect on blood pressure compared to other opioids, due to its unique dual-mechanism of action as a mu-opioid receptor agonist and a noradrenaline reuptake inhibitor. When managing pain in patients with blood pressure concerns, tramadol is often preferred because it has a lower risk of abuse and a more favorable side effect profile compared to traditional opioids like morphine 3. Typical dosing for adults with acute pain is 50-100mg every 4-6 hours as needed, with adjustments based on patient response and renal function. While tramadol can still cause some hypotension, this effect is usually mild and transient when given orally. The mechanism behind tramadol's relatively favorable blood pressure profile involves its dual mechanism of action, which reduces the need for higher doses of traditional opioids and minimizes the impact on the sympathetic nervous system compared to other opioids 4. However, all opioids should be used cautiously in hemodynamically unstable patients, with careful monitoring and dose titration to minimize cardiovascular effects. Starting with lower doses and slowly titrating upward is recommended for patients with blood pressure concerns.
Some key points to consider when using tramadol in patients with blood pressure concerns include:
- Tramadol has a lower risk of abuse compared to traditional opioids like morphine 3
- Tramadol has a more favorable side effect profile compared to traditional opioids like morphine 4
- Tramadol can be used in patients with moderate-to-severe acute pain, and its dual mechanism of action makes it a good option for patients with both nociceptive and neuropathic pain 5
- Tramadol should be used cautiously in patients with a history of seizure disorders or those taking seizure-threshold lowering drugs 4
- Tramadol should be avoided or used with caution in patients with hepatic or renal insufficiency, and dose adjustment may be necessary in these patients 4