Class
- Opioid Analgesic (Schedule IV Controlled Substance in some regions)
Indications
- Moderate to moderately severe pain (acute or chronic)
- Pain relief after surgery or injury
- Neuropathic pain (off-label use)
Mechanism of Action
- Binds to opioid receptors in the brain to reduce pain perception.
- Inhibits reuptake of serotonin and norepinephrine, modulating pain signals.
Dosage and Administration
Immediate-Release (IR) Tablets
- Starting dose: 50–100 mg every 4–6 hours as needed.
- Maximum dose: 400 mg/day.
Extended-Release (ER) Tablets
- For chronic pain requiring long-term management.
- Starting dose: 100 mg once daily; titrate up to 300 mg/day based on response.
- Swallow whole; do not crush or chew.
Pediatric Use
- Not recommended for children under 12 years.
- Contraindicated in post-operative pain management in children under 18 following tonsillectomy or adenoidectomy.
Geriatric Use
- Start at the lower end of the dosing range due to decreased renal or hepatic function.
Forms Available
- Immediate-release tablets: 50 mg.
- Extended-release tablets/capsules: 100 mg, 200 mg, 300 mg.
- Oral drops or solution.
- Injectable formulations (hospital use).
Brand Names and Manufacturers
- Ultram (Janssen Pharmaceuticals).
- ConZip (Vertical Pharmaceuticals).
- Generic versions widely available.
Contraindications
- Hypersensitivity to tramadol or any of its components.
- Severe respiratory depression or acute asthma.
- Concurrent use of monoamine oxidase inhibitors (MAOIs).
- History of seizures or conditions predisposing to seizures.
- Children under 12 or post-operative use in children under 18.
Precautions
- Risk of addiction, abuse, and misuse, even at prescribed doses.
- Use with caution in patients with a history of substance abuse.
- May cause serotonin syndrome when combined with other serotonergic drugs.
- Increased risk of seizures in patients with epilepsy or head injuries.
- Avoid alcohol and CNS depressants to reduce risk of sedation and respiratory depression.
- Use with caution in renal or hepatic impairment; dosage adjustment required.
Side Effects
Common
- Nausea, vomiting.
- Dizziness, drowsiness.
- Constipation.
- Dry mouth.
- Headache.
Less Common
- Sweating, itching.
- Weakness, fatigue.
- Insomnia.
Rare but Serious
- Respiratory depression.
- Serotonin syndrome (confusion, rapid heart rate, high fever, muscle rigidity).
- Seizures.
- Severe allergic reactions (rash, swelling, difficulty breathing).
Drug Interactions
Increased Risk of Side Effects
- CNS depressants (e.g., alcohol, benzodiazepines): Enhanced sedation and respiratory depression.
- Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs): Risk of serotonin syndrome.
Reduced Effectiveness
- Carbamazepine: Reduces tramadol levels.
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): Decrease tramadol’s pain-relieving effects.
Avoid
- MAOIs within 14 days of tramadol use (risk of hypertensive crisis).
Monitoring Parameters
- Pain relief and functional improvement.
- Signs of misuse, abuse, or addiction.
- Respiratory function, especially in elderly or those with lung conditions.
- Symptoms of serotonin syndrome or seizures.
Patient Counseling Points
- Take tramadol exactly as prescribed; do not increase the dose without consulting your doctor.
- Do not combine with alcohol or sedatives.
- Swallow extended-release tablets whole to avoid overdose.
- Report severe side effects, such as difficulty breathing, confusion, or rapid heartbeat.
- Avoid driving or operating machinery until you know how the medication affects you.
- Keep tramadol in a secure place to prevent misuse by others.
- Dispose of unused medication properly to prevent accidental ingestion.
FAQs About Tramadol
Q1: Is tramadol a strong painkiller?
- Tramadol is considered a moderate-strength opioid, effective for moderate pain but less potent than morphine.
Q2: How long does tramadol take to work?
- Immediate-release: Pain relief begins within 1 hour.
- Extended-release: Takes several hours but provides longer-lasting effects.
Q3: Can tramadol be addictive?
- Yes, it has potential for addiction and misuse; follow your doctor’s instructions carefully.
Q4: What should I do if I miss a dose?
- Take it as soon as you remember unless it’s close to the next scheduled dose; do not double doses.
Q5: Can tramadol cause withdrawal symptoms?
- Yes, abrupt discontinuation can lead to withdrawal symptoms such as restlessness, irritability, and sweating. Taper off under medical supervision.
Q6: Can tramadol be used for long-term pain management?
- Yes, but only under close medical supervision due to risks of dependence and tolerance.
Q7: Is tramadol safe during pregnancy?
- Generally not recommended; may cause withdrawal symptoms in newborns if used late in pregnancy.
Q8: Can tramadol cause seizures?
- Yes, especially at high doses or in individuals with a history of seizures.
Q9: What’s the difference between tramadol and other opioids?
- Tramadol also works on serotonin and norepinephrine pathways, unlike traditional opioids like morphine.
Q10: Is tramadol suitable for neuropathic pain?
- It is sometimes used off-label for neuropathic pain, though other medications may be more effective.
Q11: How should I store tramadol?
- Store at room temperature in a secure location out of reach of children and pets.
Q12: Can tramadol be used in elderly patients?
- Yes, but at lower doses due to increased sensitivity to side effects like sedation and respiratory depression.
Q13: Is tramadol a controlled substance?
- Yes, it is classified as a controlled substance in many countries due to its potential for abuse.
Q14: Can tramadol be taken with ibuprofen or paracetamol?
- Yes, it is often combined with non-opioid painkillers for enhanced pain relief, but consult your doctor first.
Q15: What should I do in case of an overdose?
- Seek immediate medical attention. Symptoms include extreme drowsiness, slow breathing, seizures, or loss of consciousness.
