Tramadol

Narcotic Analgesic · Opiate analogue

Indications

Severe acute and chronic pain, diagnostic measures and surgical pain.

Dosage

Adults: ORAL: 50-100 mg three to four times daily. Max 400 mg daily. INJECTION: 50-100 mg by IM or SC or IV inj or IV infusion 3-4 times daily. Max 400 mg daily. Children: Under 12 yr, not recommended. Moderate to severe pain: ORAL: 12-18 yr, 50-100 mg not more often than every 4 hr; total of more than 400 mg daily not usually required. INJECTION: 12-18 yr, 50-100 mg every 4-6 hr by IV injection over 2-3 minutes or IV infusion or IM injection. Postoperative pain: INJECTION: IV injection over 2-3 minutes: 12-18 yr, 100 mg initially then 50 mg every 10-20 minutes if necessary up to total max 250 mg (including initial dose) in first hr, then 50-100 mg every 4-6 hr, max 600 mg/day.

Administration

Continuous or intermittent in dextrose 5% or sodium chloride 0.9% or Ringer's soln or LR. Stability: Store at controlled room temperature 25°C.

Adverse Effects

Sweating, dizziness, nausea, vomiting, dry mouth and fatigue may occur, headache, somnolence, GI upset, confusion, convulsions.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Acute intoxication with alcohol, hypnotics, analgesics or other CNS-acting drugs. Uncontrolled epilepsy, severe renal or hepatic impairment, opioid withdrawal treatment. Precautions: Mild to moderate renal or hepatic impairment. History of drug abuse. Risk of tolerance and dependence. Head injury, raised intracranial pressure, shock, unexplained loss of consciousness. History of convulsions. CYP2D6 poor metabolisers. Withdraw gradually. Elderly.

Interactions

MAOIs, alcohol, CNS depressants, other antidepressants or serotonergic drugs, carbamazepine, anticoagulants, ondansetron, mixed opioid agonists/antagonists (e.g., buprenorphine, pentazocine), other drugs that lower the seizure threshold.

Advice to Patient

Take oral form with or without meals. Swallow extended release tablet whole and do not chew, crush or split tablet. Do not stop taking medication abruptly, gradually lower the dose and then stop. If you are self-administering injection of this medication, follow directions for administration and disposal of needles as prescribed. Contact prescriber if there is difficulty in breathing, severe unrelieved constipation, increased sleepiness or lack of sleep, restlessness, change in urinary or menstrual pattern, chest pain, palpitations, seizures, muscle weakness, tremors. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Avoid alcohol during therapy. Do not take OTC medications especially tranquilizers, sedatives, antihistamines, pain medications, cough preparations without consulting prescriber.

Pharmacokinetics

Onset of action: Immediate release: Within 1 hr; Peak effect: 2-3 hrs. Metabolism: Extensively hepatic. Bioavailability: Immediate release: Approx. 75%. Extended release: Approx. 85%-95% (as compared to immediate release). Half-life elimination: Immediate release: 6.3 ± 1.4 hrs; active metabolite (M1): 7.4 ± 1.4 hrs; prolonged in elderly. Extended-release: Cap: Approx. 10 hrs; active metabolite (M1): Approx. 11 hrs. Tab: Approx. 7.9 hrs; active metabolite (M1): 8.8 hrs. Time to peak, plasma: Immediate release: Approx. 2 hrs; active metabolite (M1): 3 hrs. Extended release: Approx. 4-12 hrs; active metabolite (M1): Approx. 5-15 hrs. Excretion: Urine (approx. 30% as unchanged drug; 60% as metabolites).

Brands with this active ingredient

• Adolan
• Baritral
• Calfina
• Campex
• Conzi
• Jysk
• Lamadol
• Magadol
• Maradol
• Mictra
• Namadol
• Nopa
• Pantra
• Plagesic
• Postadol

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.