The use of tramadol in combination with pseudoephedrine and caffeine in sports

Abstract

In sport, the prescription of analgesics by a trained sports physician is a common clinical practice aimed at attenuating the pain derived from sport-related injuries. However, there is growing evidence that points toward the intended use of analgesics to increase exercise performance. 1 In this regard, some athletes use over-the-counter pain killers and other analgesic drugs in the absence of injury with the final aim of increasing their physical capacity through increased pain tolerance. 2 The increase in sports performance through pain reduction complies with the World Anti-Doping (WADA) Code when the analgesics used are non-steroidal anti-inflammatory drugs (NSAID) or painkillers, such as paracetamol, because these substances do not meet the criteria to

Is pain temporary and glory forever? Detection of tramadol using dried blood spot in cycling competitions

“…Although a direct causality is hard to prove, an altered alertness or dizziness may definitely increase the risk of crashes in cycling with a major concern for the safety of a peloton. The latter may also explain the concomitant use of caffeine and pseudoephedrine in addition to tramadol by cyclists to minimise side effects of the opioid and with a possible synergetic effect on nociception 7,8 . The Monitoring Program of the World Anti‐Doping Agency (WADA) indicated a prevalence of use of tramadol in‐competition of 4.3% in cycling accounting for 56% of all tramadol findings in urine (>50 ng/ml) for Olympic sports 4 .…”

Annual banned‐substance review: Analytical approaches in human sports drug testing 2019/2020

“…Whether or not tramadol, which is regulated and tested from dried blood spots since March 2019 by the Union Cycliste Internationale (UCI), 29 and caffeine should remain on the monitoring program was the subject of debates based on both anti‐doping testing figures and controlled administration studies. On the one hand, a placebo‐controlled administration study with tramadol (100 mg) demonstrated the lack of an impact of the drug on athletic or motor‐cognitive performances in cyclists, 30 while on the other hand, it was argued that the use of tramadol combined with stimulants, such as pseudoephedrine and caffeine (for which further monitoring was recommended 31 ), needs to be taken into consideration and that a harmonized control of alleged tramadol misuse in sports is required 32,33 …”

“…On the one hand, a placebocontrolled administration study with tramadol (100 mg) demonstrated the lack of an impact of the drug on athletic or motor-cognitive performances in cyclists, 30 while on the other hand, it was argued that the use of tramadol combined with stimulants, such as pseudoephedrine and caffeine (for which further monitoring was recommended 31 ), needs to be taken into consideration and that a harmonized control of alleged tramadol misuse in sports is required. 32,33 In continuation of the 12th edition of the annual bannedsubstance review, 34 literature published between October 2019 and September 2020 is evaluated (Table 2), focusing on advances in sports drug testing approaches enabled by complementary strategies, improved analytical instrumentation, and/or optimized target analyte selection.…”

The 38th Manfred Donike workshop on doping analysis

“…Also, conterminous with anti‐doping efforts, 16,17 options of tramadol testing were presented using dried blood spots (DBS), analyzed either by LC‐MS/MS 18 or PaperSpray MS/MS, 19 both meeting the requirements of adequate detection limits and specificity to determine the drug's concentration in a single drop of blood. Taken together, this compilation of papers mirrors and highlights the multifaceted nature of doping controls and related topics.…”