Tramadol and Dexketoprofen (TRAMAL-D®)-A new combination in Market!
Tramadol and dexketoprofen is a new oral combination prescription medicine of two different pain killers that works together in different manners to combat moderate to severe pain. Previously approved in other countries, have now got approval in Pakistan as well by the name of Tramal-D®. So, in order to understand them thoroughly, let’s take a dive into the must know facts of Tramadol hydrochloride and Dextroprofen:
Dextroprofen:
- Dexketoprofen belongs to the class of NSAIDs (non-steroidal anti-inflammatory drugs) and is an R(-)-enantiomer of racemic ketoprofen having analgesic and anti-inflammatory properties.
- Dexketoprofen is used in the short-term management of mild-moderate pain including the dysmenorrhoea, musculoskeletal pain & toothache.
- As a member of NSAID class, it also works by reducing prostaglandin level.
- Onset of action is 30 minutes and half-life is 4-6 hours.
- Metabolized via liver through the process of glucouronidation.
- Excreted through kidneys.
- ADRs includes: Nausea, vomiting, diarrhea, indigestion, dizziness, skin rashes, and dry mouth etc. However, sever toxicity can leads to bleeding episodes, anemia and thrombocytopenia.
- Mostly available in tablets form having potency of 25mg. Though the spray formulation has also been licensed in some countries.
- It is also available in combination with other drugs like acetaminophen and thioclochicoside etc. but these combinations aren’t available in Pakistan at this time.
Tramadol hydrochloride:
- Tramadol is a centrally-acting opioid agonist & SNRI (serotonin/norepinephrine reuptake inhibitor) used for the management of moderate to severe pain in adults.
- Have 1/10th of the potency of Morphine.
- Tramadol exists as a racemic mixture consisting of 2 pharmacologically active enantiomers.
- Metabolised by liver via N- and O- demethylation and conjugation. One of the most active metabolites of tramadol is O-desmethyl-tramadol (M1) which is catalyzed by CYP2D6.
- Tramadol has a half-life of 5-6 hours while its active metabolite (M1) has a half-life of 8 hours.
- Metabolites are excreted via kidneys.
- Can be taken with or without food as food doesn’t affect its absorption.
- Most common side effects include: dizziness, headache, constipation, dry mouth, sweating, and low energy.
- Possess a risk of dependence, tolerance and abuse.
- Approved by a lot of countries including US-FDA, as opposite to the Dexketoprofen, which is not FDA approved however, has been approved by various countries of Asia, and Europe.
- Tramadol mostly comes in combination with acetaminophen. However, other combination like tramadol + celecoxib/diclofenac sodium, and tramadol + Dexketoprofen have also been approved.
- Available as tablets, capsule, suppositories and injection.
Tramadol and Dexketoprofen:
When both tramadol and dexketoprofen comes together, they act synergistically to treat moderate to severe pain where the use of single agent is ineffective. The combination of tramadol and dexketoprofen provide central as well as peripheral analgesia to the patient. As per researches, the most effective analgesia is achieved via fixed dose-combination of 75mg of tramadol + 25 mg of dexketoprofen and that’s the reason Tramal-D® has also the same dose combination. While recommending this combination to the patients the side effect profiles of tramadol and dexketoprofen and the abusive potential of tramadol should be kept in mind.
References:
Moore, R. A., McQuay, H. J., Tomaszewski, J., Raba, G., Tutunaru, D., Lietuviete, N., Galad, J., … Bertolotti, M. (2016). Dexketoprofen/tramadol 25 mg/75 mg: Randomised double-blind trial in moderate-to-severe acute pain after abdominal hysterectomy. BMC Anesthesiology, 16(1), 9. https://doi.org/10.1186/s12871-016-0174-5
DrugBank. (n.d.-a). DB09214 — Dexketoprofen. In DrugBank database. Retrieved July 10, 2025, from https://go.drugbank.com/drugs/DB09214
DrugBank. (n.d.-b). DB00193 — Tramadol. In DrugBank database. Retrieved July 10, 2025, from https://go.drugbank.com/drugs/DB00193
Disclaimer: This article is for informational purpose only and does not substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting any medication. Always use such medication on the prescription of a registered medical professional
