Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: tramadol
BRAND NAME: Ultram
DRUG CLASS AND MECHANISM: Tramadol is a man-made (synthetic) analgesic (pain
reliever). Its exact mechanism of action is unknown but similar morphine. Like
morphine, tramadol binds to receptors in the brain (opioid receptors) that are
important for transmitting the sensation of pain from throughout the body to.
Tramadol, like other narcotics used for the treatment of pain, may be abused.
Tramadol is not a nonsteroidal antiinflammatory drug (NSAID) and does not have
the increased risk of stomach ulceration and internal
bleeding that can occur
with NSAIDs.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (immediate release): 50 mg. Tablets (extended release):
100, 200, and 300 mg.
STORAGE: Store at room temperature, 15-30°C (59-86°F). Store in a sealed
container.
PRESCRIBED FOR: Tramadol is used in the management of moderate to moderately
severe pain. Extended release tablets are used for moderate to moderately severe
chronic pain in adults who require continuous treatment for an extended period.
DOSING: The recommended dose of tramadol is 50-100 mg (immediate release
tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To
improve tolerance patients should be started at 25 mg/day, and doses may be
increased by 25 mg every 3 days to reach 100 mg/day (25 mg 4 times daily).
Thereafter, doses can be increased by 50 mg every 3 days to reach 200 mg day (50
mg 4 times daily). Tramadol may be taken with or without food.
Recommended dose for extended release tablets is 100 mg daily which may be
increased by 100 mg every 5 days but not to exceed 300 mg /day. Extended release
tablets should be swallowed whole and not crushed or chewed.
DRUG INTERACTIONS: Carbamazepine reduces the effect of tramadol by increasing
its inactivation in the body. Quinidine
(Quinaglute, Quinidex) reduces the inactivation of tramadol,
thereby increasing the concentration of tramadol by 50%-60%. Combining tramadol
with monoamine oxidase inhibitors (for example, Parnate) or selective serotonin
inhibitors [(SSRIs, for example, fluoxetine (Prozac)] may result in severe side effects such as
seizures or a condition called serotonin syndrome.
Tramadol may increase central nervous system and respiratory depression when
combined with alcohol, anesthetics, narcotics, tranquilizers or sedative
hypnotics.
PREGNANCY: The safety of tramadol during
pregnancy has not been established.
NURSING MOTHERS: The safety of tramadol in
nursing mothers has not been
established.
SIDE EFFECTS: Tramadol is generally well tolerated, and side effects are
usually transient. Commonly reported side effects include
nausea, constipation,
dizziness, headache, drowsiness, and
vomiting. Less commonly reported side
effects include itching, sweating, dry mouth, diarrhea, rash, visual
disturbances, and vertigo. Some patients who received tramadol have reported
seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating,
insomnia, rigors, pain, nausea,
diarrhea, tremors, and hallucinations.
Reference: FDA Prescribing Information
Last Editorial Review: 7/16/2007
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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