Tramadol

FDA label

Read the full label on DailyMed ↗

Titration Increase every 3 days during titration

Renal CrCl <30 mL/min: dosing interval q12h, max 200 mg/day

Hepatic Severe impairment: 50 mg q12h

Max 400 mg/day (300 mg/day if >75 yr)

Instructions

• Do not use with other tramadol-containing products.
• Do not abruptly discontinue in physically dependent patients - taper gradually.
• Dialysis patients may receive their regular dose on the day of dialysis.

Contraindications

• Children younger than 12 years
• Post-operative management after tonsillectomy/adenoidectomy in children <18 years
• Significant respiratory depression
• Acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment
• Known or suspected GI obstruction, including paralytic ileus
• MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome

Cautions

• Serotonin syndrome (alone or with serotonergic drugs)
• Seizure risk
• Suicide risk - avoid in suicidal/addiction-prone patients
• Adrenal insufficiency
• Respiratory depression in COPD/elderly/cachectic/debilitated
• Severe hypotension
• Opioid-induced hyperalgesia
• Withdrawal on abrupt discontinuation

Adverse reactions

• Dizziness/vertigo
• Nausea
• Constipation
• Headache
• Somnolence
• Vomiting
• Pruritus

Pregnancy Prolonged use may cause neonatal opioid withdrawal syndrome; insufficient data on birth defects

Lactation Breastfeeding not recommended