Tramadol

Tramadol hydrochloride is an opioid analgesic. It also has noradrenergic and serotonergic properties that may contribute to its analgesic activity. Tramadol is used for moderate to severe pain.

Pronunciation

Tramadol 50mg

Generic Name 藥名	HA Code 藥物代碼	Classification藥物分類
Tramdol 50 mg	TRAM01	DD

Mechanism of Action

Pain relief

Opioid analgesic, Seretonin norepinerphrine reuptake inhibitor

Equivalent doses of opioid analgesics

Analgesic/Route	Dose
Codeine: PO	100 mg
Diamorphine: IM, IV, SC	3 mg
Dihydrocodeine: PO	100 mg
Morphine: PO	10 mg
Morphine: IM, IV, SC	5 mg
Oxycodone: PO	6.6 mg
Tramadol: PO	100 mg

Dosage

Tramadol hydrochloride is given orally, intravenously, or rectally as a suppository.

Oral	Initially 50 mg PRN, then adjust according to response. Maximum 400mg /day
Modify release fomulation	100-150 mg QD PRN, maximum 400 mg.
Moderate to severe acute pain	Initially 100 mg, then 50-100mg q4-6h, maximum 400 mg

Moderate to severe chronic pain :
Oral	50 to 100 mg every 4 to 6 hours. The total oral daily dosage should not exceed 400 mg.
Rectal	100mg up to 4 times daily.

Doses in children

In the UK, tramadol hydrochloride is licensed for the management of moderate to severe pain in children 12 years and older; usual adult doses may be given.

Administration in hepatic or renal impairment

• A dosage interval of 12 hours is recommended in severe hepatic impairment.
• The dosage interval should also be increased to 12 hours in patients with a creatinine clearance of less than 30 mL/min.

Side Effects

Euphoria, nausea and vomiting, respiratory depression, constipation and cough suppression, increased fall risk in elderly patients

For Opioid Analgesic in general

The commonest adverse effects are nausea, vomiting, constipation, drowsiness and confusion.

Large doses of opioids produce respiratory depression and hypotension, with circulatory failure and deepening coma. Death may occur from respiratory failure.

Treatment of Adverse Effects

1. Constipation can be treated with laxatives such as senna tables and lactulose.
2. Nausea and vomiting can be alleviated by metoclopramide.
3. Intensive supportive therapy may be required to correct respiratory failure and shock. Naloxone is used for rapid reversal of the severe respiratory depression and coma.

Pharmacokinetics

Oral bioavailability	Tramadol is readily absorbed after oral doses but is subject to some first-pass metabolism.Mean absolute bioavailability is about 70 to 75% after oral dose and 100% after intramuscular injection.
Onset of action
Metabolism	Tramadol is excreted mainly in the urine. Tramadol crosses the placenta, and distributes into breast milk.
Elimination half-life	The elimination half-life is about 6 hours.

Drug Management=

Efficiency

Pain control

Safety

mental status, blood pressure, respiratory drive, and misuse / overuse.

Drug Interaction

Increase risk of serotonin syndrome when used with SNRI, TCA, linezolid.

Caution

History of epilepsy or seizures excessive bronchial secretion. Tolerance and dependence

Contraindication

Acute intoxication with: Alcohol, other opioid, other analgesic, hypnotics. Uncontrolled epilepsy