Tramadol HCl Drug Study

Generic Name

Brand Names

  • Ultram, Zydol


  • Central nervous system (cns) agent;
  • Analgesic;
  • 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.

Therapeutic Effects

  • 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

Renal Impairment

  • Clcr <30 mL/min: decrease to 50–100 mg q12h

Hepatic Impairment



  • Note: Dosage reduction is recommended for patients with renal insufficiency and hepatic impairment.
  • Store at 15°–30° C (59°–86° F).
Side effects of Tramadol. Image: Wikipedia

Adverse Effects

  • 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.

Nursing Considerations

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.

Teaching points

  • 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.
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