Comparative Pharmacology
Head-to-head clinical analysis: BUTRANS versus ULTRAM ER.
Peer-Reviewed Evidence
Head-to-head clinical analysis: BUTRANS versus ULTRAM ER.
BUTRANS vs ULTRAM ER
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Buprenorphine is a partial mu-opioid receptor agonist and a weak kappa-opioid receptor antagonist. It binds with high affinity to mu-opioid receptors, producing analgesic and opioid effects with a ceiling effect on respiratory depression.
Tramadol is a centrally acting synthetic opioid analgesic that binds to μ-opioid receptors and inhibits serotonin and norepinephrine reuptake.
Apply one BUTRANS (buprenorphine) transdermal system to a clean, dry, non-irritated, and non-hairy area of the chest, back, flank, or upper arm. Initial dose: 5 mcg/h for opioid-naïve patients; titrate based on pain control and tolerability. Maximum dose: 20 mcg/h. Replace every 7 days. Rotate application sites.
100 mg orally once daily initially, titrate up to 100 mg twice daily as needed; maximum 200 mg/day.
None Documented
None Documented
Terminal half-life: 4-6 hours in healthy adults; prolonged to 12-18 hours in elderly or renal impairment
The terminal elimination half-life of tramadol is approximately 6.3 hours (range 5-9 hours), while its active metabolite M1 has a half-life of about 7.4 hours. Clinically, this supports dosing every 24 hours for the extended-release formulation.
Renal: 60-70% as unchanged drug and metabolites; biliary/fecal: 20-30%
Renal excretion of tramadol and its metabolites accounts for approximately 90% of total elimination. About 10% is excreted unchanged, 30% as O-desmethyltramadol (M1), and the remainder as other minor metabolites. Biliary/fecal excretion is minimal (<10%).
Category C
Category C
Opioid Analgesic
Opioid Analgesic