A centrally acting analgesic for moderate to severe pain is called tramadol. Tramadol exhibits dual actions: it inhibits the reuptake of norepinephrine and serotonin monoamines and also has a mild opioid agonist activity. Those who use tramadol with other serotonergic drugs run the increased risk of developing serotonin syndrome due to the reduction of serotonin reuptake. With two chiral centers, tramadol is a racemic combination of diastereomeric enantiomers with varying levels of monoamine reuptake inhibitory potency.
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