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.
Capsule or Tablet: 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.
Sustained Release Capsule or Tablet: One
SR capsule or tablet 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 every 12 hours.The total daily dosage by mouth should not exceed 400 mg.
Injection: A dose of 50-100 mg may be
given every 4 to 6 hours by intramuscular 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.
Suppository: Tramadol suppository should
be administered rectally. For adults usual dose is 100 mg Tramadol
Hydrochloride 6 hourly. In general, 400 mg Tramadol Hydrochloride (4 Tramadol
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, there are no medicines that
interact with Tramadol that doctors should be concerned about. Monoamine oxidase
(MAO) inhibitors are the only pharmacological class that should not be used in
conjunction with Tramadol. The combination of carbamazepine and Tramadol
induces a considerable increase in Tramadol metabolism, necessitating an
increase in Tramadol dosage.
People who are hypersensitive to tramadol
should avoid using it. Intoxication with alcohol, hypnotics, centrally acting
analgesics, opioids, or psychotropic medications is also contraindicated.
Dizziness/vertigo, nausea, constipation,
headache, somnolence, vomiting, pruritus, CNS stimulation, asthenia, sweating,
dyspepsia, dry mouth, and diarrhoea are all common adverse effects. Malaise,
allergic reaction, weight loss, vasodilatation, palpitations, abdominal pain,
anorexia, flatulence, GI bleeding, hepatitis, stomatitis, and other less common
side effects include malaise, allergic reaction, weight loss, vasodilatation,
palpitations, abdominal pain, anorexia, flatulence, GI bleeding, hepatitis,
stomatitis, and others.
Tramadol has not been proven to be safe
during pregnancy. It has been proven that tramadol crosses the placenta. In
pregnant women, there are no sufficient and well-controlled trials. Tramadol
should therefore only be used during pregnancy if the possible benefit
outweighs the risk to the fetus. Because tramadol and its metabolites have been
found in breast milk, Tramadol Hydrochloride should not be given to a nursing
mother.
Respiratory depression: When large doses
of tramadol are used together with narcotic drugs or alcohol, it can cause
respiratory depression. Therefore, patients at risk of respiratory depression
should use tramadol with caution.
Opioid dependence: Tramadol is not
recommended for patients who are dependent on opioids.
Concomitant central nervous system
depressants: Tramadol should be used with caution and dose reduced when
administered to patients receiving central nervous system depressants (such as
alcohol, opioids, anesthetics, phenothiazines, sedatives, or
sedative-hypnotics).
Concomitant MAO inhibitors:
Patients taking MAO inhibitors should use tramadol with caution, as tramadol
inhibits norepinephrine and serotonin uptake.
Tramadol should be used with
caution in patients with elevated intracranial pressure or head trauma and
patients with acute abdomen.
Opioid analgesics
Keep below 30°C temperature, away from
light & moisture. Keep out of the reach of children.
