Effectiveness of buprenorphine in detoxification and naltrexone in relapse prevention of tramadol-dependent patients: A case series

Tramadol hydrochloride is a centrally acting synthetic analgesic drug. Its analgesic properties are weak agonist at mu- and kappa-opioid receptors, blockade of reuptake serotonin (5-HT), and norepinephrine at synaptic cleft inhibiting pain transmission. This case series is about the treatment of nine patients who were dependent on tramadol. All patients satisfied criteria for opioid dependency International Classification of Diseases, 10th Revision diagnostic criteria. WHO treatment guidelines for opioid detoxification using Buprenorphine and relapse prevention using oral naltrexone were followed. Detoxification with buprenorphine did not alleviate all withdrawal symptoms. Craving toward tramadol and the cost of naltrexone was a reason to relapse in patients. Cost and failure to address craving lead to noncompliance with naltrexone. Partial agonists like buprenorphine and long-acting agonist like methadone should be used to detoxify and prevent relapse in patients dependent on tramadol.