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Ultracet: tramadol/acetaminophen combination analgesia

同性質的藥物同用有加成作用synergism，以前是將codeine與acetaminophen合用，不知道哪一個天才發現Tramadol 與acetaminophen用37.5 與 325的比率合用，可以增強止痛作用，並且減少噁心嘔吐的副作用於是有ultracet複合劑型的出現，現在外科醫師已經將此運用在外傷或者手術後疼痛了，看來疼痛也一步一步遭臨床科蠶食鯨吞了。



A double-blind placebo-controlled comparison of tramadol/acetaminophen and tramadol in patients with postoperative dental pain.Pain. 2004 Jun;109(3):250-7.

Tramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study.Clin Ther. 2003 Apr;25(4):1123-41.


Tramadol 及其活性代謝物 ( M1 ) 都鍵結於中樞神經系統的 μ 類鴉片劑受體，藉由阻斷神經傳導物質的釋放而產生止痛效果，屬弱效鴉片類止痛劑，其止痛效果可經由其活性代謝物 M1 媒介，同時，tramadol 亦能於神經突觸抑制血清素 ( 5 - HT ) 及正腎上腺素 ( NE ) 的再吸收，從而增加這些抑制痛覺神經傳導物質在神經突觸中的濃度，其作用機轉和 amitriptyline 等三環類抗憂鬱劑 ( TCA ) 相似但相對較弱。
Acetaminophen 能阻斷中樞神經系統中一氧化氮 ( NO ) 的製造，而 NO 是一種高度擴散性的氣體，會加強傳入神經對來自傷害感受器的輸入信號的敏感性，從而降低痛覺閥值，使神經系統更敏感於傳入的痛覺信號，acetaminophen 能藉由阻斷 NO 的製造，而阻斷輸入神經的敏感性，使其對痛覺較不敏感。

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2009年12月7日 星期一 at 清晨6:22

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