Tramadol Hydrochloride

A to Z Drug Facts

 Action Binds to certain opioid receptors and inhibits reuptake of norepinephrine and serotonin; exact mechanism of action unknown.

 Indications Relief of moderate to moderately severe pain.

 Contraindications Acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic agents.

 Route/Dosage

ADULTS & CHILDREN ³ 16 YR: PO 50–100 mg every 4–6 hr; maximum daily dose 400 mg. ELDERLY PATIENTS > 75 YR: PO 50–100 mg every 4–6 hr, maximum daily dose 300 mg. RENAL IMPAIRMENT: CRU < 30 ML/MIN. PO 50–100 mg every 12 hr (maximum 200 mg/day). CIRRHOSIS: 50 mg every 12 hours (maximum 100 mg/day).

 Interactions

Carbamazepine: May reduce serum tramadol levels, leading to decreased effectiveness. MAO inhibitors: Risk of seizures may be increased.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Vasodilation. CNS: Dizziness/vertigo; headache; somnolence; stimulation; anxiety; confusion; oordination disturbances; euphoria; nervousness; sleep disorder; seizures. DERM: Pruritus; sweating; rash. EENT: Visual disturbances; dry mouth. GI: Nausea; diarrhea; constipation; vomiting; dyspepsia; abdominal pain; anorexia; latulence. GU: Urinary retention/frequency; menopausal symptoms; increased creatinine; roteinuria. HEMA: Decreased hemoglobin. HEPA: Elevated liver enzymes. OTHER: Asthenia; hypertonia.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Not recommended for children < 16 yr. Elderly: Patients > 75 yr-concentrations may be slightly elevated; may have less ability to tolerate adverse effects; use reduced dosage. Head trauma: Use with caution in patients with increased intracranial pressure or head trauma. Hepatic disease: Dosage adjustments may be required in patients with cirrhosis. Renal impairment: Dosage adjustments may be required. CNS depressants: Use with caution and in reduced dosage when administering to patients receiving CNS depressants. Opioid dependence: Not recommended for patients who are opioid-dependent; use caution when administering to patients who have recently received substantial amounts of opioids.

 Administration/Storage

• Can be taken without regard to meals.
• Administer medication before pain becomes severe.
• Store at room temperature, in a tightly closed container.

 Assessment/Interventions

• Obtain patient history.
• Assess degree, location and characteristics of pain before administering.
• Assess vital signs before administering medication. If patient is hypotensive or dyspneic, notify physician before administering.
• Monitor I&O and check for urinary retention.
• Assess the effectiveness of the medication in relieving pain.

 Patient/Family Education

• Instruct patient to take the prescribed dose at the recommended intervals.
• Inform patient to check with his/her healthcare provider first before taking any over-the-counter or prescription medications, including analgesics.
• Have patient report any serious side effects to the healthcare provider.
• Advise patient not to wait until pain level is high to self-medicate, because drug will not be as effective.
• Advise patient to avoid taking alcohol or other CNS depressants (g, sleeping pills).
• Advise the patient that this medication may cause drowsiness and to use caution while driving or using heavy equipment or performing other tasks requiring mental alertness.
• Advise patient to notify the healthcare provider if the pain is not relieved by the medication at the prescribed dosage.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts