Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Are Tramadol And Lyrica Safe For Long Term Use?
Question: I am prescribed 100 mg Tramadol every 4 to 6 hours together with Lyrica. I a m 70 and have peripheral Neuropathy. I have no feeling in my feet but severe pain in my hip and know joints. Is this suitable for long term use.
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
For diabetic neuropathy there are several drugs, some are first line and others are 2nd or 3rd in case 1st line drugs are not enough.
Lyrica is a first line drug and according to guidelines Tramadol is a recommended 2nd line treatment when Lyrica is not effective. Now all drugs have some side effects, some more some less but none excluded, so Tramadol does as well. Most common ones are constipation, nausea and itching. As I said there are others (seizure predisposition, somnolence etc), but rarer, in everyday practice constipation has been the one bugging my patients more. So in terms of toxicity it's acceptable. However with long term high dose use there is some risk of creating dependence as it is an opioid.
All in all I would say when first line drugs fail it is a recommended choice.
Now regarding the dosage you have been given though I think I find it too high. The maximum dosage should not exceed 400mg, so should not exceed every 6 hours, every 4 hours is a little too much. Also if this is the first time you are taking it I would try a lower dosage at first (say 50 mg every 6 hours, or 100 mg every 8 hours). If that lower dose works for you (patients differ in their response), you do not have to use the highest one by all means (it merely alleviates pain not make the disease go away, so the lowest dose which achieves that the better).
Other options if you are not crazy about using Tramadol would be either trying to increase Lyrica's dose (you do not say how many mg you take twice daily - highest possible dose if no side effects is a total of 600 mg a day), or trying a different class of medication, like antidepressants some of which are also a first line drug for neuropathic pain (such as Duloxetine).
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
For diabetic neuropathy there are several drugs, some are first line and others are 2nd or 3rd in case 1st line drugs are not enough.
Lyrica is a first line drug and according to guidelines Tramadol is a recommended 2nd line treatment when Lyrica is not effective. Now all drugs have some side effects, some more some less but none excluded, so Tramadol does as well. Most common ones are constipation, nausea and itching. As I said there are others (seizure predisposition, somnolence etc), but rarer, in everyday practice constipation has been the one bugging my patients more. So in terms of toxicity it's acceptable. However with long term high dose use there is some risk of creating dependence as it is an opioid.
All in all I would say when first line drugs fail it is a recommended choice.
Now regarding the dosage you have been given though I think I find it too high. The maximum dosage should not exceed 400mg, so should not exceed every 6 hours, every 4 hours is a little too much. Also if this is the first time you are taking it I would try a lower dosage at first (say 50 mg every 6 hours, or 100 mg every 8 hours). If that lower dose works for you (patients differ in their response), you do not have to use the highest one by all means (it merely alleviates pain not make the disease go away, so the lowest dose which achieves that the better).
Other options if you are not crazy about using Tramadol would be either trying to increase Lyrica's dose (you do not say how many mg you take twice daily - highest possible dose if no side effects is a total of 600 mg a day), or trying a different class of medication, like antidepressants some of which are also a first line drug for neuropathic pain (such as Duloxetine).
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
