TRAMADOL
(Ultram, Ralivia)Standard Prescription
tramadol__mg PO Q__H (PRN) (__mg/kg/dose)
tramadol ER__mg PO daily
tramadol ER__mg PO daily
Dosages
Immediate-release formulation:
Children: 1 to 2 mg/kg/dose (max starting dose: 50 mg) PO Q4-6H PRN (max: 8 mg/kg/day or 400 mg/day).
Adolescents and adults: 50 to 100 mg PO Q4-6H PRN (max: 400 mg/day)
Extended-release formulation:
Adolescents and adults: Initial: 100 mg PO daily. Increase if needed by 100 mg/dose Q5 days to a max of 300 mg PO daily.
Doses of the extended release product are given ONCE daily. Mechanism of Action
Tramadol is an intermediate opioid analgesic with norepinephrine and serotonin effects. It is a synthetic opioid analgesic; weak u-opioid receptor agonist and weak inhibitor of serotonin and norepinephrine reuptake.
Forms Supplied
Immediate release tablet: (Ultram) 50 mg
suspension (BCCH): 5 mg/mL
Extended-release tablet: (Ralivia) 100 mg
suspension (BCCH): 5 mg/mL
Extended-release tablet: (Ralivia) 100 mg
Comments
Has a ceiling effect: if maximum doses are ineffective, change to an opioid for severe pain.
May be prescribed by any physician.
Tolerability improved by gradual dose titration. Withdrawal symptoms may develop if abruptly discontinued.
Consider alternate opioid in renal and hepatic impairment.
Tramadol is converted to active metabolites (main metabolite via CYP2D6) and therefore CYP polymorphisms (i.e. fast and slow metabolizers) and drug interactions can affect efficacy and toxicity.
Serotonin syndrome reported with concurrent use of serotonergic drugs. Contraindicated if MAO inhibitors used within 14 days.
Seizures reported with concurrent TCAs, SSRIs, opioids, tramadol doses above the recommended maximum, and drugs and conditions that lower seizure threshold.
Establish analgesia with immediate-release product and convert to extended release product if appropriate.
May be prescribed by any physician.
Tolerability improved by gradual dose titration. Withdrawal symptoms may develop if abruptly discontinued.
Consider alternate opioid in renal and hepatic impairment.
Tramadol is converted to active metabolites (main metabolite via CYP2D6) and therefore CYP polymorphisms (i.e. fast and slow metabolizers) and drug interactions can affect efficacy and toxicity.
Serotonin syndrome reported with concurrent use of serotonergic drugs. Contraindicated if MAO inhibitors used within 14 days.
Seizures reported with concurrent TCAs, SSRIs, opioids, tramadol doses above the recommended maximum, and drugs and conditions that lower seizure threshold.
Establish analgesia with immediate-release product and convert to extended release product if appropriate.
References
44, 87, 96, 108
Last Edited
2019-08-31 06:07:39