Tramadol-Associated Constipation
Tramadol can cause constipation as an opioid-related adverse effect [1].
Comparative evidence suggests that tramadol may have a lower risk of constipation than some other opioids, but constipation still occurs with tramadol therapy [2], [3].
Evidence That Tramadol Causes Constipation
- Constipation is listed among adverse events considered typical for tramadol in randomized osteoarthritis trials [1].
Comparative Constipation Risk Versus Other Opioids
- In a retrospective cohort study of hospitalized non-cancer pain patients, tramadol was associated with a lower risk of severe constipation compared with codeine (HR 0.80, 95% CI 0.64 to 1.00) [2].
- In a population-based propensity-matched cohort study, tramadol versus codeine showed no significant difference in risk of constipation [3].
Clinical Implications
- Constipation should be anticipated during tramadol therapy, and symptoms should be treated promptly to prevent complications [1].
When Constipation Requires Urgent Assessment
- Urgent evaluation is indicated for constipation with red-flag features such as severe or worsening abdominal pain, vomiting, inability to pass gas, or signs of bowel obstruction (general clinical principle for severe constipation) [1].