BMA Concise Guide to Medicine & Drugs

Tramadol

Brand names Larapam, Mabron, Maxitram SR, Tradorec XL, Tramake, Tramquel SR, Zamadol, Zeridame SR, Zydol

Used in the following combined preparation Tramacet

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Drug group Analgesic

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Tramadol is a synthetic opioid analgesic used to prevent or treat moderate to severe pain. It can be used for acute pain (following surgery, for example) and chronic pain (as in back injury or cancer).

The painkilling effect of tramadol wears off after about 4 hours, but a modified release (long-acting) form can be given to provide relief for up to 24 hours. In rare cases, tramadol can be habit-forming, and dependence may occur. However, most people who take it for a short period do not become dependent and are able to stop taking it without difficulty. Side effects of tramadol include a dry mouth, nausea, dizziness and, occasionally, vomiting. Unlike morphine-like opioids, tramadol tends not to cause constipation.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, MR/SR tablets, soluble tablets, capsules, MR/SR capsules, powder in sachets, injection.

Frequency and timing of doses Usually 1 x daily (MR/SR preparations) or up to 6 x daily (other preparations).

Adult dosage range Up to 400mg daily (by mouth); 600mg daily (injection).

Onset of effect 30–60 minutes (short-acting forms by mouth), at least 2 hours (SR preparations by mouth); 15–30 minutes (injection).

Duration of action 4 hours (short-acting); 12 or 24 hours (long-acting).

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember, and return to your normal schedule as soon as possible.

Stopping the drug If the reason for taking tramadol no longer exists, you may stop taking the drug and notify your doctor, who will advise you on how to stop taking it gradually. If you have been taking it for a long time, you may experience withdrawal effects.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if breathing difficulties, severe drowsiness, seizures, or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

Adverse effects such as tiredness and drowsiness seem more common with tramodol than with some other opioids. Other common adverse effects include nausea, vomiting, dry mouth, dizziness, and headache; constipation is less common. Discuss with your doctor if any of these symptoms are severe or if you experience confusion or hallucinations. If seizures, wheezing, or breathlessness occur, stop taking the drug and seek immediate medical attention.

INTERACTIONS

Antidepressants Tramadol may increase the risk of seizures if taken with antidepressants and antipsychotics.

Carbamazepine This drug may reduce blood levels and effects of tramadol.

Sedatives All drugs that have a sedative effect are likely to increase the sedative effects of tramadol. Such drugs include antidepressants, antipsychotics, antihistamines, and sleeping drugs.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have had a head injury.

· You have liver or kidney problems.

· You have heart or circulatory problems.

· You have a lung disorder such as asthma or bronchitis.

· You have thyroid disease.

· You have a history of epileptic seizures.

· You are taking other medicines.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may make the baby drowsy. Discuss with your doctor.

Infants and children Not recommended under 12 years.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid. Tramadol can cause drowsiness.

Alcohol Avoid. Alcohol increases the sedative effects of tramadol.

PROLONGED USE

Dependence may occur if tramadol is taken for long periods.