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The bioactivation of tramadol by CYP2D6 is a crucial source of variability as a result of drug interaction. The analgesic efficacy of tramadol is usually considerably lessened by CYP2D6 inhibitors, for example some SSRIs or terbinafine [114, 115].In apply, morphine or hydromorphone at lowered doses look like the ideal oral opioid selections in indi