Since 1993 tramadol (Tramal?, Tramagetic?) is available in the Netherlands and since 2003 tramadol is also available in combination with paracetamol (Zaldiar?). Tramadol is a centrally acting analgesic, which is indicated for acute and chronic pain, such as pain due to surgery or trauma, and malignant diseases. Tramadol is a racemate of two enantiomers. The cis-enantiomer binds to the μ-opiatereceptor and inhibits the serotonin-reuptake. The trans-enantiomer inhibits the norepinephrine-reuptake and stimulates *2-receptors. Nausea, vomiting, constipation, sweating, dry mouth and headache are the most frequently occurring adverse drug reactions. Respiratory depression may occur only when high dosages of tramadol are used or when concomitant drugs with centrally inhibiting effects are used. Tramadol has almost no effect on the gastrointestinal motility.
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