Name: Micaela Andrea C.

Cielo Date:
Year & Section: BS Nursing
Tramadol
Generic Name Tramadol hydrochloride
Brand Name Ultram, Zydol

Classification Central nervous system (cns) agent; analgesic; narcotic (opiate) agonist
Indication Management of moderate to moderately severe pain.
Contraindication 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.
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

Availability

Route PO
Mechanism of
Centrally acting opiate receptor agonist that inhibits the uptake
Action
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.
Drug Interaction
Side Effects
Frequent (10%–4%): Headache, dizziness, rhinitis. Occasional
(3%–1%): Asthenia insomnia, nervousness, diarrhea,
constipation, nausea, dyspepsia, edema, EKG changes,
pharyngitis, cough, arthralgia, myalgia.

Rare (Less Than 1%): Syncope, hypotension, arrhythmias.

Adverse Effects

Nursing
Assessment & Drug Effects
Responsibilities
- 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.