Tramadol is a pain medicine similar to an opioid and is classified as a synthetic opioid. It acts in the central nervous system (CNS) to relieve pain.

General Information

Tramadol is an FDA-approved medication for pain relief. It has specific indications for moderate to severe pain. It is considered a class IV drug by the FDA and has been since July of 2014. Due to possible misuse disorder potential, limitations to its use should be for pain that is refractory to other pain medication, such as non-opioid pain medication. There are two forms of tramadol: extended-release and immediate release. This activity outlines the indications, mechanism of action, methods of administration, important adverse effects, contraindications, toxicity, and monitoring, of tramadol so providers can direct patient therapy where it is indicated as part of the interprofessional team.

Dosage and Administration

Tramadol is typically started at a low dose and gradually increased until pain is under control. Dosage should be individualized based on pain severity, therapy response, prior treatment experience and risk factors of addiction, abuse and misuse.

Usual Adult Dose for Pain:

Adults (17 years or older): 50 to 100 mg orally every 4 to 6 hours as needed for pain
-For patients not requiring rapid onset of analgesic effect: Initial dose: 25 mg orally once a day; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days
Maximum dose: 400 mg per day.

Usual Adult Dose for Chronic Pain:

Extended-Release (ER):
18 years or older (tramadol-naive): 100 mg orally once a day
-Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions
-Maximum Dose: 300 mg/day

For patients CURRENTLY receiving Immediate-Release (IR) Tramadol:
Initial Dose: Calculate 24-hour IR requirement and initiate with a total daily ER dose rounded down to the next lowest 100 mg increment orally once a day

Conversion from other Opioids: Discontinue all other around the clock opioid drugs prior to initiating therapy
-Initial dose: 100 mg ER orally once a day
-Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions
-Maximum Dose: 300 mg/day.

How should I take?

Take tramadol exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Never use tramadol in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to take more of this medicine. Never share tramadol with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law. Stop taking all opioid medications when you start taking tramadol. Tramadol can be taken with or without food, but take it the same way each time. Swallow the capsule or tablet whole to avoid exposure to a potentially fatal overdose. Do not crush, chew, break, open, or dissolve. Measure liquid medicine with the supplied syringe or a dose-measuring device (not a kitchen spoon). Never crush or break a tramadol tablet to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death. You may have withdrawal symptoms if you stop using tramadol suddenly. Ask your doctor before stopping the medicine. Store at room temperature away from moisture and heat. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription. Do not keep leftover tramadol. Just one dose can cause death in someone using it accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, mix the leftover medicine with cat litter or coffee grounds in a sealed plastic bag throw the bag in the trash.

Warnings

Seizures have been reported in patients taking tramadol. Your risk of seizures is higher if you are taking higher doses than recommended. Seizure risk is also higher in those with a seizure disorder or those taking certain antidepressants or opioid medications. Tramadol should not be used if you are suicidal or prone to addiction. You should not take tramadol if you have severe breathing problems, a blockage in your stomach or intestines, or if you have recently used alcohol, sedatives, tranquilizers, narcotic medication, or an MAO inhibitor (isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others). Tramadol can slow or stop your breathing, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Keep this medicine where others cannot get to it. Tramadol should not be given to a child younger than 12 years old, or anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Ultram ER should not be given to anyone younger than 18 years old. Taking tramadol during pregnancy may cause life-threatening withdrawal symptoms in the newborn. Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

What should I know!

Do not drink alcohol. Dangerous side effects or death could occur. Avoid driving or hazardous activity until you know how tramadol will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.