Class: Opioid Analgesic
Dosage Forms. Tablet: 50 mg; Tablet, Disintegrating: 50 mg; Tablet, Extended Release: 100 mg, 200 mg, 300 mg; Capsule, Variable Release: 100 mg (25 mg immediate release, 75 mg extended release), 200 mg (50 mg immediate release, 150 mg extended release); 300 mg (50 mg immediate release, 250 mg extended release)
Common FDA Label Indication, Dosing, and Titration.
1. Pain, chronic, moderate to severe: Immediate release and disintegrating tablet, 50 mg po prn, may titrate to 200 mg/d
2. Pain, chronic, moderate to severe: Extended release, initial, 100 mg po daily, may titrate to 300 mg/d
Off-Label Uses. None
MOA. Tramadol is a mu agonist and a weak inhibitor of serotonin and norepinephrine reuptake. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation.
Drug Characteristics: Tramadol
Medication Safety Issues: Tramadol
Drug Interactions: Tramadol
Adverse Reactions: Tramadol
Efficacy Monitoring Parameters. Relief of pain.
Toxicity Monitoring Parameters. Excessive drowsiness; decreased breathing, severe constipation, chest pain, dizziness. Monitor vital signs.
Key Patient Counseling Points. Use a stool softener and stimulant or laxative for preventing constipation if used chronically. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants.
Do not use immediate release in patients with phenylketone sensitivity. To take the disintegrating tablets, peel back the foil on the blister pack and remove the tablet. Do not push the tablet through the foil. Do not chew or crush the tablet. Place the tablet on tongue and wait for the tablet to dissolve completely. After the tablet dissolves, swallow it with or without water. Extended-release products must not be crushed or chewed, but may be taken with or without food, and always the same way to avoid variability in absorption.
Clinical Pearls. Tolerance and physical dependence may occur with chronic use; avoid abrupt discontinuation. Tramadol-related deaths have been reported in patients with histories of emotional disturbances; suicidal ideation/attempts; or tranquilizer, alcohol, and other CNS-active drug misuse. Controlled substance in some states.