Mortality was higher with tramadol than with nonsteroidal anti-inflammatory drugs.
The opioid agonist tramadol often is prescribed for patients with osteoarthritis pain because it is thought to be safer than opioids or nonsteroidal anti-inflammatory drugs (NSAIDs). To assess tramadol’s safety, researchers used a U.K. general practice database to identify about 89,000 patients (mean age, 70) with knee, hip, or hand osteoarthritis who were taking tramadol, naproxen, diclofenac, celecoxib, etoricoxib (Arcoxia; not FDA-approved), or codeine. Patients with cancer or histories of opioid-use disorder were excluded. In general, patients taking tramadol were older, weighed more, had longer duration of osteoarthritis, and were more likely to have several comorbidities than were patients taking other analgesics. Five cohorts were created (matched by sociodemographic and medication variables and comorbidities) to compare tramadol patients with patients taking the other analgesics.
In the five cohorts, mortality among patients taking tramadol ranged from 24 to 36 per 1000 person-years. Mortality for patients taking one of the four NSAIDs was consistently lower (13–19/1000 person-years), whereas mortality among codeine users and tramadol users was similar.