TRAMADOL HYDROCHLORIDE

(tra'ma-dol)
Ultram, Zydol
Classifications: central nervous system (cns) agent; analgesic; narcotic (opiate) agonist
Prototype: Morphine sulfate
Pregnancy Category: C

Availability
50 mg tablets

Actions
Centrally acting opiate receptor agonist that inhibits the uptake of norepinephrine and
serotonin, suggesting both opioid and nonopioid mechanisms of pain relief. May produce
opioid-like effects, but causes less respiratory depression than morphine.

Therapeutic Effects
Effective agent for control of moderate to moderately severe pain.

Uses
Management of moderate to moderately severe pain.

Contraindications
Hypersensitivity to tramadol or other opioid analgesics; patients on MAO inhibitors;
patients acutely intoxicated with alcohol, hypnotics, centrally acting analgesics, opioids,
or psychotropic drugs; substance abuse; patients on obstetric preoperative medication;
abrupt discontinuation; alcohol intoxication; pregnancy (category C); lactation; children
<16 y.

Cautious Use
Debilitated patients; chronic respiratory disorders; respiratory depression; older adults;
liver disease; renal impairment; myxedema, hypothyroidism, or hypoadrenalism; GI
disease; acute abdominal conditions; increased ICP or head injury, increased intracranial
pressure; history of seizures; patients >75 y.
Route & Dosage
Pain
Adult: PO 50–100 mg q4–6h prn (max: 400 mg/d), may start with 25 mg/d if not well
tolerated, and increase by 25 mg q3d up to 200 mg/d
Geriatric: PO 50–100 mg q4–6h prn (max: 300 mg/d), may start with 25 mg/d if not well
tolerated, and increase by 25 mg q3d up to 200 mg/d

Renal Impairment
Clcr <30 mL/min: decrease to 50–100 mg q12h

Hepatic Impairment
Cirrhosis decrease to 50–100 mg q12h

Administration
Oral

• Note: Dosage reduction is recommended for patients with renal insufficiency and
hepatic impairment.
• Store at 15°–30° C (59°–86° F).

Adverse Effects ( 1%)

CNS: Drowsiness, dizziness, vertigo, fatigue, headache, somnolence, restlessness,
euphoria, confusion, anxiety, coordination disturbance, sleep disturbances, seizures. CV:
Palpitations, vasodilation. GI: Nausea, constipation, vomiting, xerostomia, dyspepsia,
diarrhea, abdominal pain, anorexia, flatulence. Body as a Whole: Sweating, anaphylactic
reaction (even with first dose), withdrawal syndrome (anxiety, sweating, nausea, tremors,
diarrhea, piloerection, panic attacks, paresthesia, hallucinations) with abrupt
discontinuation. Skin: Rash. Special Senses: Visual disturbances. Urogenital: Urinary
retention/frequency, menopausal symptoms.

Diagnostic Test Interference

Increased creatinine, liver enzymes; decreased hemoglobin; proteinuria.

Interactions
Drug: Carbamazepine significantly decreases tramadol levels (may need up to twice
usual dose). Tramadol may increase adverse effects of mao inhibitors. tricyclic
antidepressants, cyclobenzaprine, phenothiazines, selective serotonin-reuptake inhibitors
(ssris), mao inhibitors may enhance seizure risk with tramadol. May increase CNS
adverse effects when used with other cns depressants. Herbal: St. John's wort may
increase sedation.

Pharmacokinetics
Absorption: Rapidly absorbed from GI tract; 75% reaches systemic circulation. Onset:
30–60 min. Peak: 2 h. Duration: 3–7 h. Distribution: Approximately 20% bound to
plasma proteins; probably crosses blood–brain barrier; crosses placenta; 0.1% excreted
into breast milk. Metabolism: Metabolized extensively in liver by cytochrome P450
system. Elimination: Excreted primarily in urine. Half-Life: 6–7 h.

NURSING IMPLICATIONS
Assessment & Drug Effects

• Assess for level of pain relief and administer prn dose as needed but not to exceed
the recommended total daily dose.
• Monitor vital signs and assess for orthostatic hypotension or signs of CNS
depression.
• Discontinue drug and notify physician if S&S of hypersensitivity occur.
• Assess bowel and bladder function; report urinary frequency or retention.
• Use seizure precautions for patients who have a history of seizures or who are
concurrently using drugs that lower the seizure threshold.
• Monitor ambulation and take appropriate safety precautions.

Patient & Family Education

• Exercise caution with potentially hazardous activities until response to drug is

known.
• Understand potential adverse effects and report problems with bowel and bladder
function, CNS impairment, and any other bothersome adverse effects to
physician.
• Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined: generic names in

bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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