Tramadol

Tramadol

[1 vial 91 cents; one tablet 14 cents]

ADMINISTRATION ROUTES:

  • IV, PO, IM, NG

ALTERNATIVE NAMES:

  • Tramal, Tramadol

ICU INDICATIONS:

  1. Analgesia

PRESENTATION AND ADMINISTRATION:

  • IV / IM: 100mg in 2ml (solution)
    For IM injection, inject undiluted into large muscle
    For IV administration, dilute in compatible IV fluid and administer by IV injection over 2-3 minutes. Alternatively, dilute with a suitable volume of compatible IV fluid and administer over a convenient time period.
    Compatible with the following IV fluids: 0.9% normal saline 5% dextrose Glucose and Sodium Chloride Hartmanns 8.4% sodium bicarbonate
    Dilutions in compatible IV fluids are stable for 24 hours at room temperature
    Any solution not used within 24 hours of preparation should be discarded
    Store at room temperature
  • PO:
    Capsules:
    Tramadol 50mg capsules (green / yellow) Tramal 50mg capsules (green / pale yellow) Tramedo 50mg capsules (orange / white)
    Sustained Release capsules:
    Tramal SR 50mg, 100mg and 200mg SR capsules
    Oral Drops:
    Tramal oral drops 100mg/ml

DOSAGE:

  • IV / PO/ NG: 50-100mg 4-6 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]:
    <10: 50mg every 12 hours
    10-20: 50mg every 12 hours
    >20-50: 50-100mg every 12 hours
  • Dose in renal replacement therapy:
    CAPD: 50mg every 12 hours
    HD: 50-100mg every 12 hours
    CVVHDF: Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV: 2-3mg/kg stat, then 1-2mg/kg 4-6 hourly

CLINICAL PHARMACOLOGY:

  • Tramadol is a centrally acting synthetic analgesic compound. Although its mode of action is not completely understood, at least two complementary mechanisms appear applicable: binding of parent and M1 metabolite to opioid receptors and weak inhibition of reuptake of norepinephrine and serotonin.

CONTRAINDICATIONS:

  1. hypersensitivity to tramadol

WARNINGS

  • Seizure Risk: Seizures have been reported in patients receiving tramadol within the recommended dosage range. The risk of convulsions may be increased in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections).
  • Anaphylactoid Reactions: Serious and rarely fatal anaphylactoid reactions have been reported in patients receiving therapy with tramadol.

PRECAUTIONS

  • General: Administer tramadol cautiously in patients at risk for respiratory depression. In cirrhotic patients, dosing reduction is recommended. Reduce dose and / or increase dosing interval
  • Laboratory Tests: No tests additional to routine ICU tests are required
  • Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Concomitant use of tramadol increases the seizure risk in patients taking selective serotonin reuptake inhibitors and tricyclic antidepressants.
  • Synergistic with other CNS depressant drugs.
  • Post-marketing surveillance has revealed rare reports of digoxin toxicity and alteration of warfarin effect, including elevation of prothrombin times.

ADVERSE REACTIONS

  • Body as a Whole: Itch
  • Cardiovascular: Hypotension, Tachycardia
  • Gastrointestinal: Nausea, vomiting, diarrhoea, constipation, dry mouth
  • Nervous System: Anxiety, confusion, coordination disturbance, euphoria, headache, seizures

Critical Care Drug Manual

Print Friendly