Tramadol

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Tramadol is a centrally acting synthetic opioid analgesic and SNRI (serotonin/norepinephrine reuptake-inhibitor) that is structurally related to codeine and morphine. Due to its good tolerability profile and multimodal mechanism of action, tramadol is generally considered a lower-risk opioid option for the treatment of moderate to severe pain. It is considered a Step 2 option on the World Health Organization’s pain ladder and has about 1/10th of the potency of morphine.

Dosage and Administration

Tramadol is typically started at a low dose and gradually increased until pain is under control. Dosage should be individualized based on pain severity, therapy response, prior treatment experience and risk factors of addiction, abuse and misuse.

Usual Adult Dose for Pain:

Adults (17 years or older): 50 to 100 mg orally every 4 to 6 hours as needed for pain
-For patients not requiring rapid onset of analgesic effect: Initial dose: 25 mg orally once a day; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days
Maximum dose: 400 mg per day.

Usual Adult Dose for Chronic Pain:

Extended-Release (ER):
18 years or older (tramadol-naive): 100 mg orally once a day
-Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions
-Maximum Dose: 300 mg/day

For patients CURRENTLY receiving Immediate-Release (IR) Tramadol:
Initial Dose: Calculate 24-hour IR requirement and initiate with a total daily ER dose rounded down to the next lowest 100 mg increment orally once a day

Conversion from other Opioids: Discontinue all other around the clock opioid drugs prior to initiating therapy
-Initial dose: 100 mg ER orally once a day
-Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions
-Maximum Dose: 300 mg/day.

Tramadol is an FDA-approved medication for pain relief. It has specific indications for moderate to severe pain. It is considered a class IV drug by the FDA and has been since July of 2014. Due to possible misuse disorder potential, limitations to its use should be for pain that is refractory to other pain medication, such as non-opioid pain medication. There are two forms of tramadol: extended-release and immediate release. This activity outlines the indications, mechanism of action, methods of administration, important adverse effects, contraindications, toxicity, and monitoring, of tramadol so providers can direct patient therapy where it is indicated as part of the inter professional team.

Tramadol side effects

Tramadol oral tablet may cause drowsiness. You should not drive, use heavy machinery, or perform any dangerous activities until you know how this drug affects you. Tramadol may also cause other side effects.

More common side effects

The more common side effects of tramadol can include:

  • dizziness
  • headache
  • drowsiness
  • nausea and vomiting
  • constipation
  • lack of energy
  • sweating
  • dry mouth
  • itching

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Serotonin syndrome. Symptoms can include:
    • fast heart rate
    • high blood pressure
    • body temperature that’s higher than normal
    • reflexes that are stronger than normal
    • lack of coordination (control of your movements)
    • nausea and vomiting
    • diarrhea
    • agitation
    • hallucinations (seeing or hearing things that aren’t real)
    • coma
  • Serious breathing problems. Symptoms can include:
    • slowed breathing rate
    • very shallow breathing (little chest movement with breathing)
    • fainting, dizziness, or confusion
  • Physical dependence and withdrawal when stopping the drug. Symptoms can include:
    • feeling irritable, anxious, or restless
    • trouble sleeping
    • increased blood pressure
    • fast breathing rate
    • fast heart rate
    • dilated (large) pupils
    • teary eyes
    • runny nose
    • yawning
    • nausea, vomiting, and a loss of appetite
    • diarrhea and stomach cramps
    • sweating
    • chills
    • muscle aches, back pain, or joint pain
  • Adrenal insufficiency. Symptoms can include:
    • long-lasting tiredness
    • muscle weakness
    • pain in your abdomen
  • Androgen deficiency. Symptoms can include:
    • tiredness
    • trouble sleeping
    • decreased energy
  • Seizures
  • Addiction or misuse of this drug

 Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

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