The results of the trial reported by Salem et al. in the Journal of Sexual Medicine showing tramadol, an agonist of mu-opioid receptors, to be promising in the treatment of premature ejaculation (PE) were impressive [1],I note, however, that tramadol HCL has been defined as an anti-inflammatory drug in this article for which I can find no supportive evidence. In Australia, it is defined as a narcotic analgesic and hence may cause drug dependence [2]. The revised 2001 U.S. product package of Ortho-McNeil, manufacturers of Ultram (tramadol), in doses of 100, 200 and 300 mg, indicates, "use of this drug is for management of moderate to severe pain." It further states, "tramadol, like other opioids, may induce psychic and physical dependence of the morphine type (mu opioid). Dependence and abuse including drug-seeking behavior and talcing illicit actions to obtain the drug are not limited to those patients with a prior history of opioid dependence."McDiarmid et al. state that tramadol carries a low risk of substance abuse and withdrawal syndrome based on a case report surveillance program (U.S. Food and Drug Administration MedWatch) [3], A trial in a chronic pain population of 11,352 enrolled subjects in which 8,139 completed the trial, 68.2% being female, identified the rate of abuse with tramadol (2.7%) was not significantly greater than nonsteroidal anti-inflammatory drugs (NSAIDs) (2.5%) but less than oxycodone (4.9%). However, the authors have admitted there is little known about NSAID abuse [4].
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