Comparative Pharmacology
Head-to-head clinical analysis: SYNALGOS DC A versus ULTRAM.
Peer-Reviewed Evidence
Head-to-head clinical analysis: SYNALGOS DC A versus ULTRAM.
SYNALGOS-DC-A vs ULTRAM
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
SYNALGOS-DC-A contains dihydrocodeine, which is a semisynthetic opioid agonist; aspirin, a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes; and caffeine, a central nervous system stimulant. Dihydrocodeine binds to mu-opioid receptors in the central nervous system to produce analgesia. Aspirin irreversibly acetylates COX-1 and COX-2, reducing prostaglandin synthesis. Caffeine enhances analgesia via adenosine receptor antagonism and possibly by increasing drug absorption.
Tramadol is a centrally acting synthetic opioid analgesic that binds to μ-opioid receptors and inhibits norepinephrine and serotonin reuptake.
1-2 capsules orally every 4-6 hours as needed for pain; each capsule contains dihydrocodeine bitartrate 16 mg, acetaminophen 356.4 mg, and caffeine 30 mg.
50-100 mg orally every 4-6 hours as needed for pain; maximum 400 mg/day (for extended-release: 100 mg once daily, titrated up to 300 mg once daily).
None Documented
None Documented
Propoxyphene: 6-12 hours; norpropoxyphene: 30-36 hours; clinical context: prolonged with hepatic impairment, age >60 years, and renal dysfunction; accumulation of norpropoxyphene may cause cardiotoxicity
Tramadol: ~6 hours; M1 metabolite (O-desmethyltramadol): ~7 hours; prolonged in renal/hepatic impairment
Renal: ~70-80% as free and conjugated propoxyphene; norpropoxyphene is renally eliminated; biliary: 10-20%; fecal: <10%
Renal: ~90% (tramadol and metabolites; conjugated metabolites are major), Fecal: ~10%
Category C
Category C
Opioid Analgesic
Opioid Analgesic