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Anti-inflammatory and antioxidant effects

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Synthesis of nicotinamide adenine dinucleotide (NAD + ) The figure illustrates the biosynthetic pathways that produce NAD + from the various dietary precursors: tryptophan, nicotinic acid, nicotinamide, and nicotinamide riboside

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]