"Angel" or "devil"?

Author: drink more than music

On March 3, the State Food and Drug Administration issued the “Announcement on Revising the Instructions for Tramadol Injection and Unilateral Oral”.

[Precautions] Named the drug resistance of tramadol; [Drug interaction] Adding tramadol in combination with ethanol, sedatives, analgesics or other psychotropic drugs can cause acute poisoning; and selective serotonin reuptake inhibition The combination of drugs (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, and other drugs that lower the seizure threshold can cause problems.

01

Non-opioid central analgesic-tramadol

As a non-opioid central analgesic, tramadol can also bind to μ-opioid receptors, but its affinity is very weak, equivalent to only 1/6000 of morphine.

However, with the widespread use of tramadol, the problem of addiction has gradually emerged.

02

The fast-growing "analgesic family" and the stagnant "tramadol"

The data in this article are all from the PDB drug comprehensive database, and sample drugs are selected for data analysis.

Analgesics have been strictly controlled in my country to prevent drug abuse, and prescription review is also strict.

We turned our attention back to tramadol, and it was obvious that from 2012 to 2019, the market size of tramadol did not expand, and sales were in decline for 6 out of 7 years.

All signs indicate that tramadol has not been able to open the market when the analgesic family has developed greatly.

Figure 1 Sales and change trends of "analgesic family" and tramadol over the years

Subdividing the family of analgesics and selecting representative drugs for analysis (see Figure 2), we found that dezocine has suddenly risen, and sales have soared from 392 million yuan in 2012 to 2.

The second place is Sufentanyl and Fentanyl.

The third place is oxycodone.

The top three sales accounted for about 50%-60% of the total sales.

Figure 2 Sales and change trends of "analgesic family" segmented drugs over the years

03

"Involution"-the sales dispute of tramadol

We split tramadol sales according to production companies, and selected the most representative Grunenthal GmbH, Mundi (China) and Grantai Pharmaceuticals for analysis (see Figure 3).

In Q1-Q3 of 2020, Grunenthal GmbH temporarily gained a monopoly, occupying 60% of the market share.

Figure 3 Sales of tramadol enterprises over the years

04

summary

The analgesic market has been booming in recent years and has unlimited possibilities in the future; however, due to its special addiction, there are many taboos in its promotion and clinical application.

In the analgesic family, such as dezocine, fentanyl and sufentanil, oxycodone all have good market prospects, although they are included in various control lists.

Tramadol faces a more embarrassing situation.
Its analgesic effect is worse than morphine, but not as good as dezocine.
It is highly addictive and has a longer duration of withdrawal response, making it difficult to use methadone therapy to get rid of it; but in terms of safety On the other hand, the "Announcement on Revising the Instructions for Tramadol Injection and Unilateral Oral Administration" also confirmed that it had serious adverse reactions, and it was a solid "make up for it.
"

At present, various companies have also begun to enter the game to compete for market share, and the number of competitors will continue to increase in the future.
As the "cake" is difficult to continue to grow, I am afraid it is not good news.