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In the liver, tramadol is O-demethylated by cytochrome P450 (CYP2D6) to form the active metabolite O-desmethyltramadol, which exerts its full analgesic effect [98]

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Results Four studies comprising 219 patients pre-treatment and 216 post-treatment were included

Phase 2 trial in type 2 diabetes (Lancet 2023) showed similar additive benefit for the combination

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