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
- Constipation can be treated with laxatives such as senna tables and lactulose.
- Nausea and vomiting can be alleviated by metoclopramide.
- 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
FAQ
How should I take the tablet?
Follow the doctor's prescription, Take with or without food Take the medication with plenty of water Can be crushed
What should I avoid while taking?
Avoid abrupt withdrawal
What happen if I overdose?
Emergency situation, called 999 immediately Antidote: Naloxone
What happen if I miss a dose?
Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
