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NERVOUS SYSTEM › ANALGESICS › OPIOIDS › Other opioids
tramadol
N02AX02
Forms & Strengths
- Oral tablet: 50 mg
- Oral tablet, extended-release: 100 mg, 200 mg, 300 mg
- Oral capsule, extended-release: 100 mg, 150 mg, 200 mg, 300 mg
- Oral solution: 5 mg/mL
Adult Dosing
- Immediate-release: 50 to 100 mg orally every 4 to 6 hours as needed; maximum 400 mg/day
- Extended-release: 100 to 300 mg orally once daily; maximum 300 mg/day
- Renal impairment (CrCl < 30 mL/min): Increase dosing interval to 50 mg every 12 hours (IR) or avoid ER
Pediatric Dosing
- Children < 12 years: Contraindicated for pain management
- Children 12 to 18 years: Contraindicated for post-operative management following tonsillectomy and/or adenoidectomy
- Safety and efficacy in pediatric patients under 12 years have not been established
Indications
- Management of moderate to moderately severe pain in adults
- Management of chronic pain requiring around-the-clock opioid therapy (extended-release formulation)
Mechanism of Action
- Centrally acting analgesic
- Weak agonist at mu-opioid receptors in the central nervous system
- Inhibits reuptake of norepinephrine and serotonin, enhancing descending inhibitory pain pathways
Contraindications
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or lack of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity to tramadol, other opioids, or any component of the formulation
- Concurrent use with monoamine oxidase inhibitors (MAOIs) or use within 14 days
Adverse Reactions
- Dizziness, vertigo, and somnolence
- Headache and CNS stimulation
- Constipation, nausea, vomiting, and dry mouth
- Sweating and flushing
- Seizures and risk of serotonin syndrome
- Respiratory depression
Drug Interactions
- Monoamine oxidase inhibitors (MAOIs): Risk of serotonin syndrome and fatal potentiation
- Serotonergic agents (SSRIs, SNRIs, TCAs, triptans): Increased risk of serotonin syndrome and seizures
- CYP3A4 and CYP2D6 inhibitors (e.g., ketoconazole, erythromycin, fluoxetine): May increase tramadol exposure and toxicity risk
- CYP3A4 inducers (e.g., carbamazepine, rifampin): May decrease tramadol efficacy
- CNS depressants (alcohol, benzodiazepines, other opioids): Risk of profound sedation, respiratory depression, coma, and death
Curated Content: Needs Vetting Before Put to Clinical Use