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    Tramadol acts on the opioid receptors through its major active metabolite desmetramadol, which has as much as 700-fold higher affinity for the MOR relative to tramadol.[11] Moreover, tramadol itself has been found to possess no efficacy in activating the MOR in functional activity assays, whereas desmetramadol activates the receptor with high intrinsic activity (Emax equal to that of morphine).[48][11][66] As such, desmetramadol is exclusively responsible for the opioid effects of tramadol.[67] Both tramadol and desmetramadol have pronounced selectivity for the MOR over the DOR and KOR in terms of binding affinity.[49][44][46]
    It is difficult to say if it will be „safe“ for you individually over an extended period of time. Patients react differently to medications. According to medical references, the most common adverse effects occurring in greater than 10% of studied patients taking tramadol include the following: flushing, dizziness, headache, somnolence, insomnia, pruritus (itching), constipation, nausea, vomiting, dyspepsia (upset stomach) and weakness. These are not all of the possible side effects associated with the use of tramadol. The recommendation is made for you to talk to your physician regarding the questions and concerns that you have about using tramadol for an extended period of time. Jen Marsico, RPh
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