Codeine and tramadol

Codeine is a prodrug metabolized by ortho-demethylation to morphine. Approximately 8 per cent of the Caucasian population are poor metabolizers, and this percentage is increased by medications such as fluoxetine. Absorption by the intramuscular route is variable, with a fivefold difference in peak blood concentration and a ninefold variation in minimum effective analgesia concentration. Codeine is not a suitable analgesic for the critical care patient.

Tramadol is an atypical opioid which is an agonist for p receptors and inhibits uptake of serotonin and norepinephrine (noradrenaline), producing less sedation and respiratory depression.

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