Therapeutic Indications

Uses

Pain - moderate to severe
 

Dosage
Adults 

Initial dose 100 to 150mg tablet once daily. The dose may then be titrated upwards to an optimum dosage level, which controls pain while causing no or minimal tolerable side effects for a full 24 hours.

A maximum dose of 400mg daily should not be exceeded, except in special clinical circumstances.

Elderly 

In patients over 75 years, there tends to be an increase in tramadol bioavailability and the elimination half-life of tramadol was increased by 17%.
(See Dosage; Adults)

Children 

12 years and over
 

Contraindications

Acute alcohol intoxication
Children under 12 years
Risk of paralytic ileus
Within 2 weeks of discontinuing MAOIs
Acute asthma
Acute respiratory depression
Chronic obstructive pulmonary disease
Coma
Galactosaemia
Long QT syndrome
Pregnancy
Renal impairment - creatinine clearance below 10ml/minute
Severe hepatic impairment
Torsade de pointes
Uncontrolled epileptic disorder

Precautions and Warnings

Anaesthesia
Debilitation
Family history of long QT syndrome
Impaired consciousness
Patients over 75 years
Predisposition to seizures
Shock
Adrenal insufficiency
Asthma
Benign prostatic hyperplasia
Biliary tract disorder
Breastfeeding
CYP2D6 poor metaboliser genotype
CYP2D6 ultra-rapid metaboliser genotype
Electrolyte imbalance
Epileptic disorder
Excessive bronchial secretions
Gastrointestinal obstruction
Glucose-galactose malabsorption syndrome
Head trauma
History of alcohol abuse
History of drug misuse
History of seizures
History of torsade de pointes
Hypotension
Hypothyroidism
Hypoxia
Inflammatory bowel disease
Lactose intolerance
Mild hepatic impairment
Myasthenia gravis
Opioid dependence
Psychiatric disorder
Raised intracranial pressure
Renal impairment - creatinine clearance 10-30ml/minute
Respiratory depression
Sleep apnoea

Pregnancy and Lactation

Pregnancy

Tramadol is contraindicated during pregnancy.

Lactation

Use tramadol with caution during breastfeeding.

Side Effects

Abdominal discomfort
Aggravation of existing asthma
Agitation
Allergic reaction
Anaphylactic reaction
Anaphylaxis
Angioedema
Anorexia
Anxiety
Asthma
Blurred vision
Bradycardia
Bronchospasm
Cardiovascular collapse
Changes in cognitive and sensorial capacity
Changes in mental activity
Circulatory collapse
Confusion
Constipation
Convulsions
Delusions
Dependence
Diarrhoea
Difficulty in micturition
Disturbances of appetite
Dizziness
Dry mouth
Dysphoria
Dyspnoea
Dysuria
Euphoria
Flatulence
Flushing
Gastric irritation
Gastrointestinal disorder
Hallucinations
Headache
Hiccups
Hyperalgesia
Hyperhidrosis
Hyperkinesia
Hypersensitivity reactions
Hypertension
Impairment of judgement
Increases in hepatic enzymes
Insomnia
Mood changes
Muscle weakness
Muzziness
Nausea
Nervousness
Nightmares
Oedema
Orthostatic hypotension
Palpitations
Paraesthesia
Postural hypotension
Pruritus
Quincke's oedema
Rash
Respiratory depression
Retching
Sleep apnoea
Sleep disturbances
Sweating
Tachycardia
Tremor
Urinary retention
Urticaria
Vomiting
Wheezing
Withdrawal symptoms