Deco dives while on meds

[WetWillie]

I take Tramadol as well for back and joint pain. I was advised not to take with 24hours of diving as it has a side effect of impacting your breathing rate?

 

[Duke Dive Medicine]

I take Tramadol as well for back and joint pain. I was advised not to take with 24hours of diving as it has a side effect of impacting your breathing rate?

Willie,

Respiratory depression is a listed side effect of tramadol.

Best,
DDM

 

[DocVikingo]

I take Tramadol as well for back and joint pain. I was advised not to take with 24 hours of diving as it has a side effect of impacting your breathing rate?

Hi Willie,

Respiratory depression is a listed side effect of tramadol.

Given a typical regimen of oral tramadol, the incidence of respiratory depression in the general population is 0.5% or less (1/2% or less; 1 user in 200 or less).

Given a typical regimen of oral tramadol, the incidence of respiratory depression in individuals without breathing abnormalities, concomitant meds or intercurrent illnesses that may adversely affect respiration, or other complicating factors is less than 0.5%, likely well less.

In the absence of SCUBA-related CO2 toxicity, which is easily prevented, there is no compelling reason to expect that recreational diving would meaningfully contribute to respiratory depression.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[WetWillie]

Sorry i was not more clear. The effect is decreased breath rate, the doctor i spoke with said since breathing is critical to diving it would be best to avoid this med 24 hours before diving. I apologize, i tend to think of every dive now as a decompression dive

this was not based on specific evidence, just a general feeling of avoidance and minimizing possible risk.

Also note i only take as needed for pain, i do not take on a regular basis.

 

[TSandM]

I think Doc Vikingo was trying to reassure you that, in people without other reasons for breathing issues, Tramadol is unlikely to have enough impact on your breathing rate to cause problems while diving, at least when taking in low doses.

I'd be much more concerned about sedative effects, especially since they would likely be additive with narcosis on deep dives. And, of course, with the underlying problem for which the Tramadol was being taken.

 

[DocVikingo]

Doc, I'd submit that using hyperoxic mixes also falls into the category of seizure risk factors, as you point out below.Best regards,
DDM

Hey DDM,

I concur, but still believe the risk is tiny.

Regards,

Doc

---------- Post added April 6th, 2012 at 06:20 AM ----------

Sorry i was not more clear. ...this was not based on specific evidence, just a general feeling of avoidance and minimizing possible risk....Also note i only take as needed for pain, i do not take on a regular basis.

Hey Willie,

No, you were clear & correct. I just wanted to put the issue in a quantitative perspective.

If tramadol is not taken on diving days, there should be no reason for concern regarding drug-related respiratory depression during SCUBA.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

---------- Post added April 6th, 2012 at 06:26 AM ----------

And, of course, with the underlying problem for which the Tramadol was being taken.

Hey Willie

Agree w/TSandM. Given this brief medical hx --> http://www.scubaboard.com/forums/diving-medicine/416333-ivc-contraindication-diving.html#post6293704, yours is not a simple matter and needs expert, hands on, evaluation and monitoring.

Best of luck.

Regards,

DocVikingo

 

[Duke Dive Medicine]

I'll reiterate my concerns about the possibility of potentiation of seizures when breathing elevated partial pressures of O2 while taking tramadol. DocV mentioned CO2 toxicity; I agree that it's usually easy to prevent, but it's always a possibility in diving, and hypercapnia itself increases the risk for seizures. I do not think it is advisable to take tramadol while diving, especially while breathing hyperoxic mixes.

 

[Duke Dive Medicine]

Hey DDM,

I concur, but still believe the risk is tiny.

Hi Doc,

Can you define tiny, and elaborate on what you think an acceptable risk for seizure underwater is?

Best,
DDM

 

[LakerPride]

I have not contacted DAN yet but I will, that pesky work/school thing is keeping me busy. I think the simple answer will be on the day of my deep dives and days I use mixes to avoid taking the Tramadol. I can easily handle a day without it, not to mention while I'm in the water I feel fine, it's gravity that hurts!

 

[jimmy71]

He has not posted a response from DAN, what I can tell you what they told me when I asked about the various meds I have taken while diving. These meds are usually related to sinuses or motion sickness. The short response was that few/no meds have been studied scientifically in the diving setting. The knowledge and advice is related to the known mechanism of action/side effects and assumed interactions at depth.

So while everyone is effected differently by medications, the risks are assumed but logical.

Ultram has sedating effects = can/will increase the narcotic effects of nitrogen.

Ultram lowers the seizure threshold (ie increases the risk/likelihood of seizures) = assumed increases your risk of a seizure when at an elevated PPO2 or CNS toxicity

As DocVik pointed out, resp depression is a bit of a stretch.

Once again all of this is assumed and an extrapolation of understanding. I can promise you there have been no documented studies on the effect of Ultram in the hyperbaric settings, but I have not looked.

My 2 cents

---------- Post added April 6th, 2012 at 11:10 AM ----------

Please keep in mind that the increased risk of seizures from ultram is not really related to the increased CO2, but is believed to be caused by its effects on serotonin. All the breathing in the world will not change this effect.

The shift in CO2 would also effect your seizure threshold, but the effect would be assumed to be min.

So many assumptions! Remember what they say about assumptions. They make and ASS out of U and MPTIONS.