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However, two more recent studies failed to find a releasing effect of tramadol at respective concentrations up to 10 and 30 μM.[72][71][64] In addition to serotonergic activity, tramadol is also a norepinephrine reuptake inhibitor.[41][42] It is not a norepinephrine releasing agent.[73][74][75][64] Tramadol does not inhibit the reuptake or induce the release of dopamine.[73][64]
Tramadol’s use in pregnancy is generally avoided as it may cause some reversible withdrawal effects in the newborn.[16] A small prospective study in France found that, while there was an increased risk of miscarriages, there were no major malformations reported in the newborn.[16] Its use during lactation is also generally advised against, but a small trial found that infants breastfed by mothers taking tramadol were exposed to about 2.88% of the dose the mothers were taking. There was no evidence of this dose having a harmful effect on the newborn.[16]
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