Tramadol

General

• Type: Opioid
• Dosage Forms: PO, IM, IV, PR; immediate and extended release formulations; combination formulations with acetaminophen (Tramacet)
• Common Trade Names: Ultram, Ryzolt, Zytram

Adult Dosing

General

• Moderate to severe pain:
  • 50-100mg PO q4-6h PRN

• Chronic severe pain:
  • 100-300mg ER PO daily

Pediatric Dosing

• Not Currently recommended

Special Populations

• Pregnancy Rating: C
• Lactation Risk Categories: Probably safe
• Renal Dosing
  • Adult: CrCL < 30: given q12h, max 200mg/day
  • Pediatric: none
• Hepatic Dosing
  • Adult: cirrhosis: 50mg q12h, max 100mg/day
  • Pediatric: not defined

Contraindications

• Allergy to class/drug
• Asthma, acute
• Respiratory depression
• Severe hepatic impairment
• Severe renal impairment
• Acute alcohol intoxication

Adverse Reactions

Serious

• Respiratory Depression
• Suicidal ideation
• Seizures
• Anaphylaxis
• Serotonin syndrome
• Stevens-Johnson syndrome

Common

• Nausea
• Rash
• Headache
• Fatigue
• Xerostomia
• Constipation
• Tremor
• Insomnia

Pharmacology

• Half-life: 6.3 - 7.9 hour
• Metabolism: Liver
• Excretion: urine
• Mechanism of Action:exact mechanism unknown, binds to mu opioid receptors and weakly inhibits NE/Serotonin reuptake