Prescribing of tramadol in patients with osteoarthritis is associated with a doubled mortality rate compared to patients prescribed NSAIDs, a UK study shows.
The increased mortality rate for tramadol was similar to that seen for codeine for which tramadol is often seen as a safer alternative analgesic.
The study, published in JAMA, compared all-cause mortality in patients aged over 50 years with initial prescriptions of tramadol, naproxen, diclofenac, celecoxib, etoricoxib or codeine for their osteoarthritis.
It comprised almost 89,000 patients with either knee, hip or hand osteoarthritis.
The Hazard Ratios (HR) for one-year mortality associated with tramadol compared to naproxen was 1.71, diclofenac 1.88, celecoxib 1.70 and etoricoxib 2.04.
There was no statistically significant difference in all-cause mortality between tramadol and codeine (HR 0.94).
Tramadol (opioid) nearly doubles the risk of mortality in patients with #osteoarthritis– despite the residual confounding, another reason not to take opiates https://t.co/slk1BCozt1
— David Hunter (@ProfDavidHunter) March 18, 2019
The study concluded non-opioid therapy was preferable for the management of osteoarthritis pain.
And strategies to minimise the adverse effects of other drugs, such as co-prescribing proton pump inhibitors with NSAIDS to minimise gastrointestinal effects, might help.
“Tramadol is a weak opioid agonist and has been considered a potential alternative to NSAIDs and traditional opioids because of its assumed relatively lower risk of serious cardiovascular and gastrointestinal adverse effects than NSAIDs, as well as a lower risk of addiction and respiratory depression compared with other opioids,” the study authors said.
“Studies, including the present study, have shown that tramadol prescription among patients with osteoarthritis has been increasing since 2000.”
The researchers noted that patients receiving tramadol were older, had a higher BMI and a higher co-morbidity burden than other patients, which might have influenced the results.
“Thus, the present findings should be interpreted with caution, and future studies are needed.”