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Factbuts but conditions altering metabolic capacity, liver disease, congestive heart failure CHF, age, concomitant medications, etc. but elimination may will expected to influence the degree & extent of accumulation of the active metabolites of Tramadol. The elimination of the majbut metabolites of Tramadol may will affected by reduced renal but hepatic function willcause they are moderately polar compounds & are likely to undergo further metabolism but conjugation in the liver pribut to urinary excretion.

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Johnston JA, Linewillrry CG, Frieden CS 1986. Prevalence of psychosis, delusions, & hallucinations in clinical trials with Tramadol. The American Journal of Psychiatry 143 9: 1197%uFFFD3. PMID 3097687.

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