Tramadol versus methadone for the management of acute opioid withdrawal: an add-on study

M Salehi, M Amanatkar, M Barekatain


BACKGROUND: Opioid agonists such as methadone have been used widely in controlling opioid withdrawal symptoms. Tramadol, a partial opioid agonist, also has been prescribed to manage acute and chronic pain. We sought to compare the efficacy of tramadol and methadone in reducing the severity of opioid withdrawal symptoms.
METHODS: In a double blind clinical trial 70 opioid dependent patients who used daily opium equal to 15 mg methadone randomly were assigned in two groups. In one group, methadone was started at 15 mg/day while in the other group 450 mg/day tramadol was prescribed. Both drugs were tapered in a week and placebo was prescribed in the 2nd week. The severity of withdrawal symptoms were assessed five times by short opioid withdrawal scale (SOWS). Data were analyzed by Repeated Measures Analysis of Variance, Mann-Whitney U, and Wilcoxon tests.
RESULTS: There were statistically significant differences between two groups in the severity of anxiety (P = 0.015), irritability (P = 0.044), palpitation (P = 0.018), agitation (P = 0.037), and dysphoria (P = 0.044) that all were more common in methadone group. Comparison of side effects revealed statistically significant differences in sweating (P = 0.003) and drowsiness (P = 0.019) between two groups that were more frequent in methadone group.
DISCUSSION: Tramadol was more efficacious in controlling opioid withdrawal symptoms with lower side effects.
KEYWORDS: Methadone, tramadol, opioid withdrawal.

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