- tramadol hydrochloride
- Ultram, Zydol
- Central nervous system (cns) agent;
- Narcotic (opiate) agonist
- Pregnancy Category: C
- Centrally acting opiate receptor agonist that inhibits the uptake of norepinephrine and serotonin, suggesting both opioid and nonopioid mechanisms of pain relief. May produce opioid-like effects, but causes less respiratory depression than morphine.
- Effective agent for control of moderate to moderately severe pain.
- 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.
- Management of moderate to moderately severe pain.
- Hypersensitivity to tramadol or other opioid analgesics; patients on MAO inhibitors; patients acutely intoxicated with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs; substance abuse; patients on obstetric preoperative medication; abrupt discontinuation; alcohol intoxication; pregnancy (category C); lactation; children 75 y.
Route & Dosage
- Adult: PO 50–100 mg q4–6h prn (max: 400 mg/d), may start with 25 mg/d if not well tolerated, and increase by 25 mg q3d up to 200 mg/d
- Geriatric: PO 50–100 mg q4–6h prn (max: 300 mg/d), may start with 25 mg/d if not well tolerated, and increase by 25 mg q3d up to 200 mg/d
- Clcr <30 mL/min: decrease to 50–100 mg q12h
- Cirrhosis decrease to 50–100 mg q12h
- Note: Dosage reduction is recommended for patients with renal insufficiency and hepatic impairment.
- Store at 15°–30° C (59°–86° F).
- CNS: Drowsiness, dizziness, vertigo, fatigue, headache, somnolence, restlessness, euphoria, confusion, anxiety, coordination disturbance, sleep disturbances, seizures.
- CV: Palpitations, vasodilation.
- GI: Nausea, constipation, vomiting, xerostomia, dyspepsia, diarrhea, abdominal pain, anorexia, flatulence.
- Body as a Whole: Sweating, anaphylactic reaction (even with first dose), withdrawal syndrome (anxiety, sweating, nausea, tremors, diarrhea, piloerection, panic attacks, paresthesia, hallucinations) with abrupt discontinuation.
- Skin: Rashes
- Special Senses: Visual disturbances.
- Urogenital: Urinary retention/frequency, menopausal symptoms.
Diagnostic Test Interference
- Increased creatinine, liver enzymes; decreased hemoglobin; proteinuria.
- Drug: Carbamazepine significantly decreases tramadol levels (may need up to twice usual dose). Tramadol may increase adverse effects of mao inhibitors. tricyclic antidepressants, cyclobenzaprine, phenothiazines, selective serotonin-reuptake inhibitors (ssris), mao inhibitors may enhance seizure risk with tramadol. May increase CNS adverse effects when used with other cns depressants.
- Herbal: St. John’s wort may increase sedation.
- Absorption: Rapidly absorbed from GI tract; 75% reaches systemic circulation. Onset: 30–60 min. Peak: 2 h.
- Duration: 3–7 h.
- Distribution: Approximately 20% bound to plasma proteins; probably crosses blood–brain barrier; crosses placenta; 0.1% excreted into breast milk.
- Metabolism: Metabolized extensively in liver by cytochrome P450 system.
- Elimination: Excreted primarily in urine. Half-Life: 6–7 h.
Assessment & Drug Effects
- Assess for level of pain relief and administer prn dose as needed but not to exceed the recommended total daily dose.
- Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression.
- Discontinue drug and notify physician if S&S of hypersensitivity occur.
- Assess bowel and bladder function; report urinary frequency or retention.
- Use seizure precautions for patients who have a history of seizures or who are concurrently using drugs that lower the seizure threshold.
- Monitor ambulation and take appropriate safety precautions.
- Control environment (temperature, lighting) if sweating or CNS effects occur.
- WARNING: Limit use in patients with past or present history of addiction to or dependence on opioids.
Patient & Family Education
- Exercise caution with potentially hazardous activities until response to drug is known.
- Understand potential adverse effects and report problems with bowel and bladder function, CNS impairment, and any other bothersome adverse effects to physician.
- Do not breast feed while taking this drug.
- You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals).
- Report severe nausea, dizziness, severe constipation.