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What is Like all opioids, tramadol acts as an analgesic drug by stimulating mu opioid receptors. Apa from this, the additional mechanism of action of tramadol is? and explain in detail?
Ans. A. Serotonin and nor-adrenaline reuptake inhibition* Tramadol differs from other traditional opioid medications in that it doesn't just act as a m-opioid agonist, but also affects monoamines by modulating the effects of neurotransmitters involved in the modulation of pain such as serotonin and norepinephrine which activate descending pain inhibitory pathways.* Tramadol's effects on serotonin and norepinephrine mimic the effects of other SNRI antidepressants such as duloxetine and venlafaxine.* Tramadol exists as a racemic mixture consisting of two pharmacologically active enantiomers that both contribute to its analgesic propey through different mechanisms and are also themselves metabolized into active metabolites: (+)-tramadol and its primary metabolite (+)-O-desmethyl-tramadol (M1) are agonists of the m opioid receptor while (+)-tramadol inhibits serotonin reuptake and (-)-tramadol inhibits norepinephrine reuptake.* These pathways are complementary and synergistic, improving tramadol's ability to modulate the perception of and response to pain.