Tramadol

Indications
 Oral
Moderate to severe pain
Adult: As conventional tablet: 50-100 mg every 4-6 hr. Max: 400 mg daily. As extended-release tablet: 50-100 mg once or twice daily. Max: 300 mg daily.
Elderly: Lower initial dose. Max: 300 mg daily (>75 yr).
Max Dosage: 400 mg daily.
CrCl (ml/min)Dosage Recommendation
10-<30As conventional tablet: increase dosage interval to 12 hr; max: 200 mg/day.
<10Contraindicated.
Hepatic impairment: As conventional tablet: Increase dosage interval to 12 hr in severe impairment e.g. 50 mg bid in hepatic cirrhosis. As extended-release tablet: Contraindicated in Child Pugh Class C.
Parenteral
Moderate to severe pain
Adult: IM/IV inj over 2-3 min/IV infusion: 50-100 mg given every 4-6 hr.
Elderly: Lower initial dose. Max: 300 mg daily (>75 yr).
CrCl (ml/min)Dosage Recommendation
10-<30Increase dosage interval to 12 hr.
<10Contraindicated.
Hepatic impairment: Severe: Increase dosage interval to 12 hr.
Parenteral
Postoperative pain
Adult: IM/IV inj over 2-3 min/IV infusion: Initially, 100 mg followed by 50 mg every 10-20 min if necessary up to 250 mg for the 1st hr. Maintenance: 50-100 mg every 4-6 hr. Max: 600 mg daily.
Elderly: Lower initial dose. Max: 300 mg daily (>75 yr).
CrCl (ml/min)Dosage Recommendation
10-<30Increase dosage interval to 12 hr.
<10Contraindicated.
Hepatic impairment: Severe: increase dosage interval to 12 hr.
Rectal
Moderate to severe pain
Adult: 100 mg suppository up to 4 times daily.
Elderly: Lower initial dose. Max: 300 mg daily (>75 yr).
CrCl (ml/min)Dosage Recommendation
<30Increase dosage interval to 12 hr.
<10Contraindicated.
Hepatic impairment: Severe: Increase dosage interval to 12 hr.

Special Populations: A dosage interval of 12 hrs is recommended in severe hepatic impairment.

Incompatibility: Incompatible with injections of diazepam, diclofenac sodium, indometacin, midazolam, piroxicam, phenylbutazone, aciclovir, clindamycin and lysine aspirin if mixed in the same syringe.
Contraindications
 Suicidal patients, acute alcoholism; head injuries; raised intracranial pressure; severe renal impairment; lactation.
Warnings / Precautions
 Hypothyroidism; adrenocortical insufficiency; renal or hepatic impairment; history of epilepsy or increased risk of seizures; inflammatory or obstructive bowel disease; myasthaenia gravis; respiratory depression; prostatic hyperplasia. Pregnancy.
Adverse Reactions
 Sweating, dizziness, nausea, vomiting, dry mouth, fatigue, asthenia, somnolence, confusion, constipation, flushing, headache, vertigo, tachycardia, palpitations, miosis, insomnia, orthostatic hypotension, seizures, CNS stimulation e.g. hallucinations.
Potentially Fatal: Respiratory depression.
Overdose Reactions
 Symptoms: Miosis, vomiting, cold and clammy skin, respiratory depression, lethargy, flaccid skeletal muscle, coma, seizures, bradycardia, hypotension, cardiac arrest, cardiac collapse and death. Management: Treatment is supportive and ensure adequate ventilation. Although naloxone will reverse some, but not all, symptoms of tramadol overdosage, there is an increased risk of seizures which has to be taken into consideration. Haemodialysis is unlikely to be helpful.
Drug Interactions
 Possible increase in anticoagulation with warfarin. Increased risk of seizures with SSRI, TCA. Increased risk of serotonin syndrome with mirtazapine, venlafaxine, SSRI and MAOI; tramadol should not be given to patients receiving MAOIs or within 14 days of their discontinuation. Reduced analgesic efficacy of tramadol with carbamazepine, 5-HT3-receptor antagonist e.g. ondansetron. Increased respiratory and CNS depression with CNS depressants e.g. alcohol, opioids, anaesthetic agents, narcotics, phenothiazines, tranquilisers or sedative hypnotics.
See Below for More tramadol Drug Interactions
Mechanism of Actions
 Tramadol inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to mu-opiate receptors in the CNS.
Onset: Oral (conventional tablet): 1 hr.
Duration: Oral (conventional tablet): 3-6 hr.
Absorption: Readily absorbed from the GI tract (oral).
Distribution: Widely distributed. Crosses the placenta and enters breast milk.
Metabolism: Extensive hepatic first-pass metabolism; converted to O-desmethyltramadol (active) by N- and O-demethylation via the cytochrome P450 isoenzymes CYP3A4 and CYP2D6 and glucuronidation or sulfation.
Excretion: Via urine (as metabolites); 6 hr (elimination half-life).
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 20-25°C (68-77°F). Parenteral: Do not store above 30°C.
ATC Classification
 N02AX02 - tramadol ; Belongs to the class of other opioids. Used to relieve pain.
Storage
 Oral: Store at 20-25°C (68-77°F). Parenteral: Do not store above 30°C.
Available As
  • Tramadol 1 mg
  • Tramadol 100 mg
  • Tramadol 15 mg
  • Tramadol 2 mg
  • Tramadol 200 mg
  • Tramadol 25 mg
  • Tramadol 37.5 mg
  • Tramadol 40 mg
  • Tramadol 50 mg
  • Tramadol 50mg

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    2 Responses to Tramadol

    1. atanu maiti March 20, 2013 at 5:04 pm #

      Is tramdol safe in lactation?

      Reply
      • March 20, 2013 at 6:08 pm #

        The excretion of tramadol into milk is low and even lower amounts of the active metabolite, O-desmethyltramadol, are excreted. With usual maternal dosage, the amount excreted into breastmilk is much less than the dose given to newborn infants for analgesia. A study in breastfed newborn infants found no adverse effects attributable to tramadol. Tramadol is unlikely to adversely affect nursing infant and is acceptable to use during breastfeeding.

        Reply

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