Tramadol is a synthetic analgesic with a
central action. It prevents neurotransmitters like serotonin and noradrenaline
from being reabsorbed. As a result, it alters the transmission of pain impulses
by activating both descending serotonergic and noradrenergic analgesia
pathways. Tramadol's analgesic effects are mediated through mu-opioid receptor
stimulation and indirect regulation of central monoaminergic inhibitory
pathways.
Anadol ® Capsule: Usual doses are 50 to 100
mg every four to six hours. For acute pain an initial dose of 100 mg is
required. For chronic painful conditions an initial dose of 50 mg is
recommended. Subsequent doses should be 50 to 100 mg administered 4-6 hourly.
The dose level and frequency of dosing will depend on the severity of the pain.
The total daily dosage by mouth should not exceed 400 mg.
Anadol® SR capsule: One SR capsule every
12 hours, for example first one in the morning and then at the same time in the
evening. The number of capsules taken at a time will depend upon severity of
pain, but it should not be taken more frequently than everey 12 hours. The
total daily dosage by mouth should not exceed 400 mg.
Anadol ® Injection: A dose of 50-100 mg
may be given every 4 to 6 hours by intramuscular or by intravenous injection
over 2 to 3 minutes or by intravenous infusion. For the treatment of
postoperative pain, the initial dose is 100 mg followed by 50 mg every 10 to 20
minutes if necessary to a maximum of 250 mg in the first hour. Thereafter,
doses are 50 to 100 mg every 4 to 6 hours up to a total daily dose of 600 mg.
Anadol® Suppository: Anadol®
suppository should be administered rectally. For adults usual dose is 100 mg
Tramadol Hydrochloride 6 hourly. In general, 400 mg Tramadol Hydrochloride (= 4
Anadol® suppository) per day sufficient. However, for the treatment of Cancer
pain and severe pain after operations much higher daily doses can be used.
In general, physician need not be
concerned about drugs interacting with Tramadol. The monoamine oxidase (MAO)
inhibitors represent the only drug class not recommended for combination with
Tramadol. Concomitant administration of carbamazepine with Tramadol causes a
significant increase in Tramadol metabolism and it requires to increase the
dose of Tramadol.
Tramadol is contraindicated in patients
having hypersensitivity to this drug. It is also contraindicated in acute
intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or
psychotropic drugs.
Commonly occurring side-effects are
dizziness/vertigo, nausea, constipation, headache, somnolence, vomiting,
pruritus, CNS stimulation, asthenia, sweating, dyspepsia, dry mouth, diarrhoea.
Less commonly occurring side-effects include malaise, allergic reaction, weight
loss, vasodilatation, palpitations, abdominal pain, anorexia, flatulence, GI
bleeding, hepatitis, stomatitis etc.
Safe use of Tramadol in pregnancy has not
been established. Tramadol has been shown to cross the placenta. There are no
adequate and well controlled studies in pregnant women. Therefore, Tramadol
should be used during pregnancy only if the potential benefit justifies the
risk to the foetus. Tramadol Hydrochloride should not be administered during
breast feeding as Tramadol and its metabolites have been detected in breast
milk.
Respiratory depression: When large doses
of tramadol are administered with anaesthetic medications or alcohol,
respiratory depression may result. Therefore, tramadol should be administered
cautiously in patients at risk for respiratory depression. Opioid dependence:
Tramadol is not recommended for patients who are dependent on opioids.
Concomitant CNS depressants: Tramadol should be used with caution and in
reduced dosages when administering to patients receiving CNS depressants such
as alcohol, opioids, anesthetic agents, phenothiazines, tranquilizers or
sedative hypnotics. Concomitant MAO inhibitors: Tramadol should be used with
great caution in patients taking MAO inhibitors, since tramadol inhibits the
uptake of norepinephrine and serotonin. Tramadol should be used with caution in
patients with increased intracranial pressure or head injury and patients with
acute abdominal conditions.
Opioid analgesics
Store below 250 C. Protect from light and
moisture. Keep out of the reach of children.
