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What is Tramadol?

Tramadol is an opioid pain medication. It is available in the market with the brand name Ultram among others.

It is also available in combination with acetaminophen (paracetamol) or as longer-acting formulations.

On a dosage to dosage basis, it has about one-tenth of the potency of morphine and is equally potent to pethidine and codeine.

What are the uses of Tramadol?

It is useful in relieving moderate to moderately severe pain.

It is useful for managing severe pain enough to require an opioid analgesic and for which alternative treatments are inadequate. It is also available in injection along with oral tablets/ capsules and liquid.

There is moderate evidence of its use as a second-line treatment for fibromyalgia as a secondary painkiller.

How does Tramadol work?

Tramadol is a medicine that works in the brain to change how your body responds to pain and how your body feels.

It starts its work of relieving the pain within an hour when you take the immediate-release formulation within an hour.

Its painkilling effects last about 6 hours.

What to know before using Tramadol?

You should resist taking this medicine if you are allergic to it or if you have:

  • Breathing problems or asthma (severe)
  • Stomach or bowel obstruction, including paralytic ileus
  • If you have recently used sedatives, tranquilizers, alcohol, or narcotic medications
  • If you have used an MAO inhibitor within the last two weeks

MAO inhibitors include linezolid, methylene, isocarboxazid, blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine.

Do not give Tramadol to a child younger than 12 years old. In Ultram ER’s case, one should not give it to anyone younger than 18 years old.

If someone younger than 18 years old and recently had surgery to remove tonsils or adenoids, then they must not take this medicine.

Avoid giving Tramadol to children between 12-18 who have conditions that may cause breathing problems.

There are chances of seizures if you take this medicine without asking the doctor about your risk of stroke, which may be higher if you ever had a head injury, epilepsy, or other seizure disorder.

The seizure risk due to this medicine is also higher if you use certain antidepressants, muscle relaxants, opioids, or other medications.

Your baby could become drug dependent if you use this drug during pregnancy. It can cause life withdrawal symptoms in the baby after its birth. Babies dependent on habit-forming medicine may need medical treatment for several months.

Tell your doctor if you are expecting or plan to conceive. If you are breastfeeding, ask your doctor before taking Tramadol.

To ensure Tramadol is safe for you, tell the doctor if you ever had:

  • Sleep apnea
  • Breathing problem
  • Liver or kidney disease
  • Problem with gallbladder, pancreas, or thyroid
  • Urination problems
  • A stomach disorder
  • Mental illness (or suicide attempt)

Tramadol dosage

This medicine is available in strengths of 50 mg, 100 mg/24 hours, 200 mg/24 hours, 300 mg/24 hours, 100 mg, 150 mg/24 hours.

Usual adult dosage for pain (17 years or older)

  • 50 to 100 mg orally every 4-6 hours
  • For the patients who do not require rapid onset of analgesic effect: initial dosage- 25 mg/day orally; titrate in 25 mg increments every three days to reach a dose of 25 mg four times a day; increase the quantity by 50 mg as tolerated every three days.
  • Maximum amount- 400 mg per day

Usual adult dose for chronic pain

  1. ER: 18 Years or older (tramadol-naive)- 100 mg orally once a week
  • Individually titrate in 100 mg increments every five days to an effective dose
  • Maximum dose- 300 mg/day
  1. For patients currently receiving Tramadol IR: Calculate 24 hour IR requirement and begin with a total daily ER dosage rounded down to the next lowest 100 mg/day increment orally.
  2. Conversion from other opioids:
  • 100 mg/day ER orally
  • Individually titrate in 100 mg increments every five days to an effective dose
  • Maximum dose- 300 mg/day

Take Tramadol as per the doctor’s prescription and follow all the directions on your prescription label.

Resist taking all other around-the-clock narcotic pain medications when you start taking Tramadol.

Use a dosing syringe or a medicine dose-measuring device to measure the liquid medicine carefully.

Do not crush or open an extended-release capsule or tablet (ConZip, Ultram ER). To avoid exposure to a potentially fatal dose, swallow the whole tablet/capsule.

Never inhale the powder of the tablet or mix it into a liquid to inject the drug into your vein. It may lead to death.

It is normal to use Tramadol ER tablet, and the tablet shell may pass into your bowel movement (stool).

A sudden stop to the use of medicine may lead to unpleasant withdrawal symptoms. Take your doctor’s help to stop the use of this medicine.

Tramadol side effects

Seek medical help if you have signs of an allergic reaction to Tramadol. Allergic reaction include hives, difficult breathing, swelling in face or throat, or a severe skin reaction involving fever, sore throat, a red or purple skin rash that spreads and cause blistering and peeling, burning in your eyes and skin pain.

Tramadol can slow your breathing, just like other narcotic medicines. Too much weakness in breathing may lead to death.

An attendant should give you naloxone or ask for medical help if you have slow breathing with long pauses, you are hard to wake up, or have blue colored lips.

Call for medical help if you have:

  • Noisy breathing, shallow breathing
  • Sighing, sleep apnea
  • A slow heart rate
  • Weak pulse
  • A light-headed feeling
  • Seizures
  • Missed menstrual periods
  • Sexual problems, loss of interest in sex, impotence
  • Nausea, vomiting, loss of appetite
  • Dizziness, worsening tiredness, or weakness

It may cause serotonin syndrome also. Agitation, hallucinations, fever, sweating, shivering, rapid heart rate, muscle stiffness, loss of coordination, nausea, vomiting, or diarrhea are symptoms of serotonin syndrome.

Serious aftereffects are more likely to occur in older adults and those who are malnourished or overweight.

Long term use of this medication may affect fertility in men or women.

Common side effects of Tramadol may include:

  • Headache
  • Itching
  • Nausea
  • Vomiting
  • Constipation
  • Stomach ache
  • Dizziness
  • Drowsiness
  • Tiredness

You may report your side effects to FDA at 1-800-FDA- 1088.