ADMINISTRATION ROUTES:
IV, PO, IM, NG
ALTERNATIVE NAMES:
Tramal, Tramadol
ICU INDICATIONS:
- Analgesia
PRESENTATION AND ADMINISTRATION:
IV / IM:
100 mg in 2 mL (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, Hartmann's, 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 50 mg capsules (green / yellow) Tramal 50 mg capsules (green / pale yellow) Tramedo 50 mg capsules (orange / white)
Sustained Release capsules:
Tramal SR 50 mg, 100 mg and 200 mg SR capsules
Oral Drops:
Tramal oral drops 100 mg/mL
DOSAGE:
IV / PO/ NG:
50 - 100 mg 4-6 hourly
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | 50 mg BD |
| 10-20 | 50 - 100 mg BD |
| >20 | dose as in normal renal funcion |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | 50 mg BD |
| HD | 50 mg BD |
| CVVHDF | 50 - 100 mg BD |
DOSAGE IN PAEDIATRICS:
IV:
2 - 3 mg/kg stat then 1 - 2 mg/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:
- 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 recognised 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.
Serotonin Syndrome
When co-administered with selective serotonin reuptake inbibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs), tramadol may cause serotonin syndrome. This manifests as neuromuscular excitation (clonus, myoclonus, tremor, rigidity, hyperreflexia), autonomic nervous system over-activity (fever, tachycardia, tachypoea). and altered mental state. This can be mild but may rarely be life-threatening. If suspected, tramadol and the co-administered agent should be ceased and supportive treatment provided.
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 IN ICU:
Concomitant use of tramadol increases the seizure risk in patients taking selective serotonin reuptake inhibitors (SSRIs) 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:
General:
Itch
Cardiovascular:
Hypotension, tachycardia
Gastrointestinal:
Nausea, vomiting, diarrhoea, constipation, dry mouth
Neurological:
Anxiety, confusion, coordination disturbance, euphoria, headache, seizures