Tramadol hydrochloride

Generic Name : tramadol hydrochloride Brand Name: Ultram Classification: Analgesic, centrally acting Pregnancy Category C

Dosage & Route

Available forms : Tablets50 mg ADULTS

Patients who require rapid analgesic effect: 50100 mg PO q 46 hr; do not exceed 400 mg/day. Patients with moderate to moderately severe chronic pain: Initiate at 25 mg/day in the morning and titrate in 25-mg increments q 3 days to reach 100 mg/day. Then, increase in 50 mg-increments q 3 days to reach 200 mg/day. After titration, 50100 mg q 46 hr; do not exceed 400 mg/day. Patients with cirrhosis: 50 mg q 12 hr. Patients with creatinine clearance < 30 ml/min: 50100 mg PO q 12 hr. Maximum 200 mg/day.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC OR RENAL IMPAIRMENT

> 75 yr: Do not exceed 300 mg/day.

Therapeutic actions
Tramadol inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to mu-opiate receptors in the CNS.

Indications

Relief of moderate to moderately severe pain

Adverse effects
Sweating, dizziness, nausea, vomiting, dry mouth, fatigue, asthenia, somnolence, confusion, constipation, flushing, headache, vertigo, tachycardia, palpitations, miosis, insomnia, orthostatic hypotension, seizures, CNS stimulation e.g. hallucinations. Potentially Fatal: Respiratory depression.

Contraindications
Suicidal patients, acute alcoholism; head injuries; raised intracranial pressure; severe renal impairment; lactation.

Nursing considerations
Assessment

History: Hypersensitivity to tramadol; pregnancy; acute intoxication with alcohol, opioids, psychotropic drugs or other centrally acting analgesics; lactation; seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic impairment; past or present history of opioid addiction Physical: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP; bowel sounds, normal output; LFTs, renal function tests

Interventions

Control environment (temperature, lighting) if sweating or CNS effects occur. WARNING: Limit use in patients with past or present history of addiction to or dependence on opioids.

Teaching points

You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals). Report severe nausea, dizziness, severe constipation.