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Question Posted October 27, 2005
Does anyone know if there is any research on using Tramadol in cats for short term or long term pain management?? I am having great success in using it in my canine patients and really need an alternative to NSAIDs for use in cats. Thanks!
Ashley Owens
Response 1
Dr Steagall et al presented a paper at the AVA meeting in Newmarket last month. They used Tramadol at 1 mg/kg (injectable, SQ) and tested cats with thermal and mechanical pressure stimuli - no effect. Cats might be different?!
The pharmacokinetics in cats hasn't been published yet but could be different form dogs who were really different form humans...
Sheilah Robertson
Response 2
I am also interested in the group's experiences with oral tramadol. We have been having our tramadol compounded by two local pharmacies, and upon further exploration, the formulations have lead me to question the doses and intervals we have been using for the last 6 months. One pharmacy puts the generic tramadol into an immediate release form, similar to the human product Ultram. A lot of vets had read on VIN to use 2-4mg/kg BID-TID and had been using this dose with apparent success. Based on KuKanich's paper looking at the PK in dogs, we were not sure this dose and interval was an appropriate use of the drug, and since TID to QID dosing is a bit of a problem for many of our clients, a second pharmacy has started putting the tramadol into capsules for us as an extended release by using hydroxypropylmethycellulose as the diluent. We have been using this new formulation BID and (as well as we can tell) have had good analgesia from it. Before this, we were getting break-through in some patients that were on a BID regimen, which makes sense when you think about it relative to the small amount of research that is out there.
What forms of oral tramadol are others finding to be useful? Capsules, liquid, tablets?
Is anyone else using a modified release form, or just the human form of Ultram (as is the case in the US )?
If so, what doses and intervals do you think are appropriate for each form?
Is anyone currently conducting research on the PK of tramadol in dogs or cats with these types of sustained release formulations?
We have a company in Ontario , Biovail, that just got approval from the FDA for release of a tramadol ER in the US with exclusive rights for the next three years. I talked to them last week, but unfortunately, they are not planning on releasing it in Canada , and they wouldn't tell me if they had any research on dogs that we could base dosing ischedules on. Soooo, I am back to square one.
Anyone want to collaborate on a PK study of a sustained release tramadol in dogs and cats? Our vets up here are using tramadol like it is going out of style, and it would be nice to know if we are using it appropriately or not!
Any experiences would be welcome. TIA.
Matt Read
Response 3
Dr. Read makes excellent points about using species-specific and formulation-specific PK data to guide dosing! Along those lines, does anyone have experience using tramadol orally in horses? The epidural antinociceptive effect noted by Natalini and Robinson had concurrent systemic effects; were plasma tramadol concentrations looked at in those studies (sorry, don't have the papers in front of me)? I spoke with a practitioner trying to manage laminitic pain in an older pony who wanted to try tramadol. She started the pony on 2 mg/kg tramadol orally (Ultram 50 mg tabs) twice daily, based on the conservative dose used in dogs. She reported improvement in the pony's mobility, appetite, and comfort, but this effect took 3 days to become consistent and obvious, and she felt there was still a clear decrease in effect by the next dosing point. She hasn't noticed any adverse side effects at this dose and interval, and is planning to try a q 8 hour interval at the same dose. Any insight on dose and interval in horses is welcomed as she has been pleased with this case and has several similar cases she is considering treating with tramadol. Thanks!
Kirsten Wegner
Response 4
I tried tramadol in my old arthritic cat and she became extremely dysphoric on it byt the third dose. It took her almost 24 hours to come down off it. It was a pretty unpleasant experience for both of us. This cat was also very sensitive to torbutrol so it may have just been my cat. I haven't tried it on any other cat since though I've read opinions from other practitioners on VIN that have used it and love it. I really like it in dogs.
Ebalinna M. Vaughn
Response 5
I have used tramadol in many of the arthritic cats in our practice. Having said that, about 30% have dysphoria sufficient to discontinue use.
Sharon Jensen
Response 6
I have some good clinical experience with tramadol in dogs and cats. Particularly, we have just completed studies on its use as a pre-operative analgesic in dog, and we will submit the paper soon. Also we did a study on its use in osteoarthritic in dogs and the results were very good. It is for sure that the PK is very specific, and there is no doubt in my mind that the cumulative administration in chronic use leads to a high decrease in metabolism with an extended duration of action. Matt is completely right with the difference in the formulations you have to use. We definitively prefered the extended release for its advantageous limited number of administration. In the cat (only clinical experience), we observed a 30 to 45% rate of dysphoria, maniac excitement mainly related to overdose. Particularly, at that time where I had access to injectable and various formulations of Tramadol, the occurence of such excitement in these cats, were all case where I prescribed Tramadol pills, that were not possible to precisely measure. After that, I kept use of Tramadol in some cats by injectable 1-2 mg/kg and did not notice such excitement. So, I am particularly concerned by any possible sensitivity or overdose of Tramadol in cat. Moreover, Tramadol is well recognised to demonstrate a decreased liver metabolism with accumulation of administration. Particularly in our OA study, the dogs demonstrated such better level of activity even after we switched from a daily administration for 28 days to a discontinuous (at the discretion of the owner) treatment followed for 2 subsequential months. Badly, at that time, I was not so wise to think to do blood sampling and PK evaluation.
Hoping this information could be helpful
Eric Troncy