tramadol

[marjaba]

I have been taking a very small dose of Tramadol for RLS for about 5 years, since I noticed it's good effects after taking some for pain after skin surgery. I asked my doctor at the time about it and he thought it was better than what he was going to suggest. He left and I have a new doctor who continues the prescription, but I don't think realizes I take it for RLS not pain. Two questions: Can long-time use at this small dose (25mg) cause any problems, and are doctors now not allowed to prescribe Tramadol for RLS, or is it up to the doctor?

[Rustsmith]

Long term use of tramadol should not present a problem as far as RLS goes. RLS does not seem to cause any tolerance with the use of opioids, probably because we use a far smaller dose than the doses used to treat pain.

As for doctors not being allowed to prescribe tramadol for RLS, that depends upon where you are. In the US, it is up to the doctor. Many doctors do not like to prescribe any form of opioid for any reason (even very good ones). That is why the RLS Foundation has been pushing the FDA to add RLS to their list of "carve out" meds that opioids can be "safely" prescribed for. Tramadol is also very different from the other opioids. It is Sch 4, where most of the other opioids are Sch 2. Due to the way that tramadol is metabolized, it is almost impossible to become addicted or to overdose on it (which is why it is Sch 4). Tramadol's major drawback as far as RLS goes is that it is also an anti-depressant. That means that it can dull your emotions and even more important, it means that getting off of it requires a slow reduction in the dose (although you are low already). Stopping too abruptly can cause Antidepressant Withdrawal Syndrome, which is a miserable condition that lasts for months or years. I was abruptly taken off of 200mg/day four years ago and am still suffering the aftereffects of that doctor's stupidity.