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Tramadol belongs to a group of drugs called opioid analgesics. They work by acting on sites in the central nervous system to block the transmission of pain signals.
Tramadol is used for the treatment and prevention of moderate to severe pain
 BRAND NAMES
- International: Tramal
- Canada: Ralivia
- Italy: Contramal, Unitrama
- U.S.: Conzip, Ryzolt PI, Ultram PI, Ultram ER PI
 MECHANISM OF ACTION
Tramadol is a centrally acting synthetic opioid analgesic.
Tramadol's analgesia derives from relatively weak µ-opioid receptor agonism plus norepinephrine and serotonin reuptake inhibition.
- Tramadol is indicated for the management of moderate to moderately severe chronic pain in adults.
- Post-operative pain
- Imediate-Release products: 50-100 mg every 4-6 hours. Do not exceed 400 mg/day.
- Extended-Release products: tramadol ER should be initiated at a dose of 100 mg once daily and titrated up as necessary by 100 mg increments every five days to relief of pain and depending upon tolerability. Tramadol ER should not be administered at a dose exceeding 300 mg per day.
- Moderate to severe pain: 50-100 mg every 4–6 hours.
- Post-operative pain: Initial: an initial bolus of 100mg is administered, then 50 mg every 10-20 minutes if needed, up to 250 mg for the first hour. Maintenance: 50-100 mg 4-6 hrly. Maximum: 600 mg/day.
- Hypersensitivity to tramadol
- Acute intoxication with alcohol, hypnotics, centrally-acting analgesics, opioids, or psychotropic drugs. Tramadol may worsen central nervous system and respiratory depression in these patients
 WARNINGS AND PRECAUTIONS
- Administer with caution in patients at risk for respiratory depression. In these patients alternative non-opioid analgesics should be considered
- May impair alertness or ability to drive
- Tramadol can be abused and may be subject to criminal diversion
- Seizures have been reported in patients receiving tramadol within the recommended dosage range.
- Potentially life-threatening serotonin syndrome may occur with the use of tramadol (See interactions)
- Decreased effect:
- Increased effect:
- Serotonin Syndrome Risk: particularly with concomitant use of serotonergic drugs such as SSRIs, SNRIs, TCAs, MAOIs, and triptans, with drugs which impair metabolism of serotonin (including MAOIs), and with drugs which impair metabolism of tramadol (CYP2D6 and CYP3A4 inhibitors). Serotonin syndrome may include mental-status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).
 PREGNANCY AND LACTATION
- Pregnancy Category C (US). Tramadol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Neonatal seizures, neonatal withdrawal syndrome, fetal death and still birth have been reported during post-marketing
- Nursing mothers: Tramadol is not recommended for obstetrical preoperative medication or for postdelivery analgesia in nursing mothers because its safety in infants and newborns has not been studied.
 SIDE EFFECTS
Possible side effects: Dizziness, nausea, vertigo, constipation, headache, somnolence, vomiting, pruritis, CNS stimulation (a composite of nervousness, anxiety, agitation, tremor, spasticity, euphoria, emotional lability and hallucinations) and asthenia