Tramadol

 

1. Generic Name & Brand Names

• Generic Name: Tramadol

• Common Brand Names:

  • Ultram® (immediate-release)

  • Ultram ER® (extended-release)

  • ConZip® (ER)

  • Ryzolt® (ER)

  • Generic/store brands (e.g., "Tramadol HCl")

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2. Dosage Forms

• Oral:

  • Immediate-release tablets (50 mg)

  • Extended-release tablets/capsules (100–300 mg)

  • Oral drops/solution (rare)

• Injectable: IV/IM (hospital use)

• No topical forms

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3. Drug Class

• Centrally-Acting Synthetic Opioid Analgesic

• Dual Mechanism:

  • Weak μ-opioid receptor agonist

  • Serotonin/Norepinephrine reuptake inhibitor (SNRI)

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4. Uses

• Moderate-Severe Acute Pain:

  • Post-surgical, injury, dental procedures

• Chronic Pain Management:

  • Osteoarthritis, neuropathic pain (off-label)

• Not for mild pain or fever

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5. Side Effects

• Common (≥10%):

  Dizziness, nausea, constipation, headache, drowsiness

• Serious (Require Immediate Help):

  • Respiratory Depression (shallow breathing)

  • Seizures (↑ risk with high doses/SNRIs)

  • Serotonin Syndrome: Agitation, fever, tremor (see [Interactions])

  • Severe Hypotension (low BP), fainting

  • Adrenal Insufficiency (fatigue, nausea)

  • Addiction/Withdrawal

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6. Warnings Before Taking

• Black Box Warning (USA):

  • Addiction/Abuse/Misuse Risk (Schedule IV controlled substance)

  • Life-threatening respiratory depression

  • Accidental ingestion by children can be fatal

• Contraindications:

  • Severe asthma/COPD

  • GI obstruction (e.g., paralytic ileus)

  • Concurrent MAOIs or serotonin-active drugs (SSRIs, SNRIs)

  • History of seizures

• Use Extreme Caution If:

  History of substance abuse, head injury, kidney/liver disease, or depression

• Pregnancy: Avoid (neonatal withdrawal risk)

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7. How to Take It

• Immediate-Release (IR):

  • 50–100 mg every 4–6 hrs (max 400 mg/day)

• Extended-Release (ER):

  • Once daily (max 300 mg/day)

• Key Rules:

  • Swallow ER tablets whole (do not crush/chew)

  • Take with food to reduce nausea

  • Never abruptly stop (taper to avoid withdrawal)

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8. Uses in Adults

• Acute Pain: ≤5–7 days (IR form)

• Chronic Pain: ER form only under ongoing medical supervision

• Avoid in elderly >75 years (↑ side effect risk)

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9. Missed Dose

• Scheduled Dosing: Take ASAP if within 1–2 hrs. If later, skip. Never double dose

• As-Needed Use: Take when pain returns (wait ≥4–6 hrs after last dose)

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10. Overdose

• Symptoms:

  Pinpoint pupils, extreme drowsiness, slow/shallow breathing, coma

• Action:

  • Call 911 immediately

  • Administer naloxone (Narcan®) if available

  • Do NOT induce vomiting

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11. Avoid While Taking

• CNS Depressants:

  Alcohol, benzodiazepines (e.g., lorazepam), sleep aids (e.g., zolpidem)

• Serotonergic Drugs:

  SSRIs (sertraline), SNRIs (venlafaxine), triptans, MAOIs (risk of serotonin syndrome)

• Other Opioids:

  Morphine, oxycodone (↑ respiratory depression)

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12. Storage

• Secure Location: Locked cabinet (high abuse potential)

• Temperature: 20–25°C (68–77°F)

• Disposal:

  • Use FDA-approved take-back programs

  • Mix with coffee grounds/cat litter in sealed bag before trash

  • Do NOT flush (except if immediate overdose risk)

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Critical Safety Notes:

⚠️ Addiction Risk: Tolerance/dependence can develop rapidly. Use lowest effective dose for shortest duration.
⚠️ Withdrawal Symptoms: Anxiety, sweating, diarrhea if stopped suddenly (taper under medical guidance).
⚠️ Drug Interactions: 300+ known interactions—always disclose all medications/supplements.
⚠️ Never Combine with Alcohol: Fatal respiratory depression risk.

Requires Prescription: Tramadol is not OTC. Regular monitoring by a prescriber is mandatory