Tramadol

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General

  • Type: Opioid
  • Dosage Forms: PO, IM, IV, PR; immediate and extended release formulations; combination formulations with acetaminophen (Tramacet)
  • Common Trade Names: Ultram, Ryzolt, Zytram

Adult Dosing

General

  • Moderate to severe pain:
    • 50-100mg PO q4-6h PRN
  • Chronic severe pain:
    • 100-300mg ER PO daily

Pediatric Dosing

  • Not Currently recommended

Special Populations

  • Pregnancy Rating: C
  • Lactation Risk Categories: Probably safe
  • Renal Dosing
    • Adult: CrCL < 30: given q12h, max 200mg/day
    • Pediatric: none
  • Hepatic Dosing
    • Adult: cirrhosis: 50mg q12h, max 100mg/day
    • Pediatric: not defined

Contraindications

  • Allergy to class/drug
  • Asthma, acute
  • Respiratory depression
  • Severe hepatic impairment
  • Severe renal impairment
  • Acute alcohol intoxication

Adverse Reactions

Serious

Common

  • Nausea
  • Rash
  • Headache
  • Fatigue
  • Xerostomia
  • Constipation
  • Tremor
  • Insomnia

Pharmacology

  • Half-life: 6.3 - 7.9 hour
  • Metabolism: Liver
  • Excretion: urine
  • Mechanism of Action:exact mechanism unknown, binds to mu opioid receptors and weakly inhibits NE/Serotonin reuptake