Select a medication above to begin.
tramadol
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; reserve opioid analgesics for pts w/ inadequate tx alternatives; ER form not indicated for prn analgesic use; proper dosing and titration essential to decr. resp. depression risk
Medication Error Risk
ensure accuracy when prescribing, dispensing, and administering tramadol oral solution; dosing errors due to confusion between mg and mL can result in accidental overdose and death
Addiction, Abuse, and Misuse
opioid agonist Schedule IV controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately; instruct pts to not cut, break, chew, crush, or dissolve ER forms to avoid exposure to potentially fatal tramadol dose
Accidental Ingestion
accidental ingestion of even one dose, esp. by children, can result in fatal tramadol overdose
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel pts and/or caregivers w/ each Rx on serious risks, safe use, and importance of reading medication guide
Ultra-Rapid Metabolism of Tramadol and Other Respiratory Depression Risk in Children
resp. depression and death have occurred in children; some cases involved tramadol use post-tonsillectomy and/or adenoidectomy and at least one case had evidence of being a CYP2D6 ultra-rapid metabolizer; contraindicated in pts <12 yo and in pts <18 yo post-tonsillectomy and/or adenoidectomy; avoid use in pts 12-18 yo w/ risk factors that incr. sensitivity to resp. depressant effects of tramadol
CYP450 Interactions
concomitant use or D/C of concomitant CYP450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors are complex requiring careful consideration of the effects on tramadol and its active metabolite
Adult Dosing .
Dosage forms: TAB: 50 mg, 100 mg; ER TAB: 100 mg, 200 mg, 300 mg; SOL: 5 mg per mL
Special Note
- [prescribing info]
- Info: consider prescribing naloxone if risk of opioid overdose or accidental ingestion
pain, moderate-mod. severe
- [50-100 mg PO q4-6h prn]
- Start: 25 mg PO qam, may incr. by 25 mg/day q3 days to 25 mg PO q6h, then may incr. by 50 mg/day q3 days to 50 mg PO q6h prn; Max: 400 mg/day; Info: may skip initial titration if immed. onset required; use lowest effective dose, shortest effective tx duration; titrate slowly in pts 65 yo and older; max 300 mg/day in pts >75 yo; taper total daily dose by no more than 10-25% q2-4wk to D/C if prolonged or long-term use
pain, moderate-mod. severe chronic
- [100-300 mg ER PO qd]
- Start: 100 mg ER PO qd, may incr. by 100 mg/day q5 days prn; Max: 300 mg/day ER; Info: use lowest effective dose, shortest effective tx duration; may convert from IR to ER at same total daily dose, round dose down to nearest 100 mg; titrate slowly in pts 65 yo and older; do not cut/crush/chew ER tab; taper total daily dose by no more than 10-25% q2-4wk to D/C if long-term use
renal dosing
- [immediate-release form]
- CrCl <30: give usual dose q12h prn, max 200 mg/day
- HD: give usual dose q12h prn, max 200 mg/day; no supplement after dialysis; PD: give usual dose q12h prn, max 200 mg/day; supplement not defined
- [extended-release form]
- CrCl <30: avoid use
- HD/PD: avoid use
hepatic dosing
- [immediate-release form]
- severe impairment: 50 mg q12h prn
- [extended-release form]
- Child-Pugh Class C: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.