The Tramadol Blog

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Tramadol

2009-03-06T06:11:00.000-08:00

Tramadol is used to treat pain.

Nausea, vomiting or constipation may occur with this medicine. Your doctor may be able to prescribe medicines to take with tramadol to help with these side effects.
Tramadol may cause drowsiness. Make sure your reactions are normal before driving, operating machinery or doing any other jobs which could be dangerous if you were not fully alert.

About tramadol
Type of medicine
Analgesic
Used for
Pain

Also called
Zamadol, Zydol, Dromadol SR, Larapam SR, Mabron, Zamadol 24hr, Zamadol SR, Zydrol SR, Zydol XL

Available as
Capsule, tablet, soluble tablet, orodispersible tablet, injection
Tramadol is used to relieve severe pain; it works on the nerves and brain to reduce the pain you feel.

Before taking tramadol

Before taking tramadol make sure your doctor or pharmacist knows:
If you are pregnant, trying for a baby or breast-feeding
If you suffer from liver problems
If you suffer from kidney problems
If you suffer from respiratory (breathing) problems
If you suffer from prostate problems
If you suffer from thyroid problems
If you suffer from epilepsy
If you suffer from blood pressure problems
If you have recently suffered a serious head injury
If you have been constipated for more than a week, with or without tummy pain and bloatedness
If you have a problem with drug or alcohol addiction
If you suffer from phaeochromocytoma (a tumour near the adrenal glands)
If you are taking or have recently stopped taking antidepressants

How to take tramadol

Take Tramadol exactly as directed by your doctor.
Soluble tablets should be dissolved in water before taking as directed.
The orodispersible (melt in the mouth) tablets will dissolve quickly in the mouth or can be dissolved in half a glass of water, stirred and drunk immediately
Modified release forms that release drug slowly over time to give a more even effect should not be broken, crushed or chewed otherwise they may release the drug too quickly and cause side effects.

Getting the most from your treatment

Alcohol will increase any feelings of drowsiness. Avoid alcoholic drinks.
Can tramadol cause problems?
Along with their useful effects all medicines can cause unwanted side effects, which usually improve as your body adjusts to the new medicine. Speak with your doctor or pharmacist if any of the following side effects continue or become troublesome.

Common side-effects

What can I do if I experience this

Feeling or being sick

Drink plenty of liquid. Stick to simple foods such as dry toast. If vomiting continues to be a problem speak to your doctor.

Constipation

Try to eat a well balanced diet containing plenty of fibre and drink 6-8 glasses of water each day. If constipation continues to be a problem speak to your pharmacist or doctor.

Diarrhoea

Drink plenty of water to replace lost fluids. If diarrhoea continues to be a problem speak to your pharmacist or doctor.

Dry mouth

Try chewing sugar-free gum, sucking pieces of ice or sugar-free sweets. If this becomes troublesome speak to your pharmacist or doctor.

Headache, dizziness, a fast or fluttering heartbeat, seeing or hearing things that aren't real, mood changes, confusion, pins and needles, sexual problems or skin rashes, difficulty urinating (passing water)
Speak with your doctor.

How to store tramadol

Keep all medicines out of the reach of children.
Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Keep all medicines out of the sight and reach of children.

Make sure that the person prescribing this medicine knows about any other medicines that you are taking. This includes medicines you buy and herbal and homeopathic medicines.
If you buy any medicines check with a pharmacist that they are safe to take with your other medicines.

Before taking this medicine tell your doctor if you have ever had an allergic reaction after taking any medicine.

Never take more than the prescribed dose. If you suspect that you or someone else has taken an overdose of this medicine go to the accident and emergency department of your local hospital at once. Always take the container with you, if possible, even if it is empty.

If you are having any treatment like an operation or dental treatment tell the person carrying out the treatment which medicines you are taking.

Always read the printed information leaflet that comes with your medicine.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Never keep out of date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Tramadol Correspondence

2009-03-06T06:10:00.001-08:00

"I been depressed ever since I was a child. I was always the melancholy, non-aggressive type child that kept mostly to himself. Coming from a Cuban family this was a liability. I was not sociable and outgoing like the rest of my family. I was labeled anti-social and snobbish. I would constantly criticize myself for not being like my siblings. I wanted so desperately to live my life, but I was so down that I enjoyed very little. As I grew older the depression got worse. I was put on Prozac at 22. It was how that drug made me feel that motivated me to attempt suicide. Heretofore it had always been something at the back of my mind. But I do believe that the Prozac altered my thinking in such a way that it became a very real possibility.
After that attempt several other attempts came along. I was put on just about every anti-depressant/amti-anxiolytic that any psychiatrist could think of. I read self-books and attended therapy sessions. My response was always that I am not a negative thinker, but I FEEL negative, down, and depressed despite what happens around me. It was an internal thing.
The anti-depressants worked for very short periods. My body quickly adapted to them, and I would go right back to being very depressed. My depression went from sadness and feelings to not feeling anything. I felt emotionally dead for years. It was during this time that the emotional death feeling led to exhaustion and sheer fatigue. On most days I felt like lying down on the floor out of exhaustion.
I got a severe cold one year, and couldn't get rid of a hacking cough. I was prescribed a cough suppressant with Vicodin. I had no idea what Vicodin was, but I needed to get rid of this cough.
After taking the cough syrup I felt so incredibly different! I felt alive for the first time in my life! It was amazing! The effect would last me the entire day!
My thinking cleared up to the point that I was able to do math calculations off the top of my head faster than ever before in my life. I had the desire to work, and excel myself. My body was finally inline with the positive thoughts that I had intellectually accepted, but could never physically express.
Unfortunately, the cough syrup ran out and I ended up being the same person I was before. However, I resolved to find another solution. I researched neurotransmitters, and found your site. I read about opiates and was so disappointed that something that could finally help me was labeled as the stuff of addicts.
My wife ended up in the hospital, and was prescribed Vicodin. She gave them to me since she didn't really need them. One pill professor, just one pill, gave me a mood boast that lasted over eight hours!
I would take one pill a day for three days, and then stop for another three days. My depression would return during the "off" days, but I would gladly have three good days instead of all bad days.
Since psychiatrists will not prescribe opiates as anti-depressants I went back to the psychiatrist when the Vicodin ran out. Did I try to score ot off the street? No. Did I try to hurt myself to get more? No. Did I down all thrity pills in a few days? No. I took what I needed and went from there.
The psychiatrist started on his usual anti-depressant combinations. After 6months I wasn't any better. I told him that I felt emotionally dead and tired. "Take this. Then come back in 6 weeks." Ok….but life keeps going during the 6 weeks. If I feel dead I have to wait another 6 weeks to feel otherwise?
There had to be an alternative. Last year I found one. I went to an online pharmacy and bought Ultram. This opiate affects me like Effexor, but provides opiate stimulation. It has changed my life. I am more positive at work. I am more productive. I am more loving and outgoing. Yet technically, I am a criminal. I should be on Prozac and depressed. I should not enjoy my life UNTIL science can come up with a legal solution. Really? I don't think so. I'm 32 years old now. Will a "cure" for my condition be found when I am near death after my entire quality of life has been spent?
I applaud you for being bold enough and smart enough to tell the world that depression is more than just serotonin or norephenephrine. Thank you for your research, and I look forward to you changing the medical view of depression."

GENERIC NAME: tramadol

2009-03-06T06:08:00.000-08:00

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.

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Tramadol

2009-03-05T04:10:00.000-08:00

Tramadol is a centrally acting analgesic (pain reliever) that is readily soluble in water. It is used to relieve moderate to moderately severe pain. It affects chemicals and receptors in the body that are associated with pain and may be used to treat pain caused by surgery and chronic conditions such as RSD (CRPS). It works by decreasing the body's sense of pain. It comes in tablet form and may be taken with or without food. Also marketed as Ultram.

Side effects reported for the drug include agitation, anxiety or nervousness, blurred vision, constipation, diarrhoea, dizziness, drowsiness, dry mouth, flushing, headache, indigestion or heartburn, itching, mood changes, muscle tightness, sweating, uncontrollable shaking hands, upset stomach, vomiting, weakness. Occasional reports have been heard of more serious side effects such as difficulties with breathing or swallowing, flu-like symptoms, hallucinations, rapid heartbeat or seizures. If any of these symptoms appear you should call your doctor immediately.

While taking Tramadol do not drink alcohol, which may dangerously affect breathing or cause liver problems. Take care when driving, operating machinery, or performing other hazardous activities. This drug can be habit-forming. Do not increase the size or frequency of your dose unless so advised by your doctor - and call your doctor if you find that you want to take more Tramadol or notice unusual changes in your mood or behaviour. Do not suddenly stop taking the medication or you are likely to experience unpleasant withdrawal symptoms.

Tramadol is called Ultram in the U.S, it appears on the site under that name, but I've never heard it called that in England. I've been taking Tramadol for three years, and although it helped with the pain initially the side effects are dramatic. It now no longer helps the pain, but my body is completely addicted, so I'm attempting to come off them slowly. They make me tired a lot of the time, faint, nauseous, very dehydrated, I have to sleep for much longer periods, sleep is unpleasant and interrupted, and I get viruses very easily. I think it could be advisable to take Tramadol in very acute periods of RSD, but not long term. Lucy - Oxford, England

I have been taking Pregabelin (Lyrica) for a number of weeks now, along with Tramadol. I am very aware that when I take a full dose of both drugs together I feel a very strange almost "spaced out" feeling. I feel unsteady on my feet and find it difficult to walk a few yards without having to hold on to something to steady myself. If I reduce the Pregabelin dose it is a bit better. I would be interested to hear from anyone with similar experiences when using both drugs. Andy - Taunton, Somerset, UK

Like Andy from Taunton I was given Tramadol on top of the highest dose of Pregabalin and had the same symptoms. I have now come off of Tramadol and am seeking a new pain killer to take over from it. I was so bad at the start of taking both drugs I could not move from a chair or open my eyes without a feeling my brain was swimming, I have had chronic in my elbows for 6 years and have forgotten what a pain free life is. MSB - UK

Having had a traumatic amputation of my lower leg I was given Tramadol. 8 months on I am well and truly hooked. Any lower dose of Tramadol gives me sweats anxiousness, loss of temper, loss of patience, flu-like joint pain and hyper alertness. The pain specialists advised me at the time that it was not addictive but It most definitely is a dependancy inducing drug. I am going to try to come off again but I fear I will have to take a couple of weeks off work to try and come off without shouting at a customer or getting into trouble! Don - Scotland

I start taking Tramadol in 1997 for fractures in my lower back and was on it for 2 years. At the time the doctor said it was not addictive. It slowly stopped working and the doctor kept trying me on other painkillers, but every time I came off Tramadol and started taking other drugs I would get ill with flu-like symptoms, my bones would ache, I was nauseous and my head would feel it was going to explode. After the 3rd attempt of coming off I realised what was wrong: I was hooked. The doctor said it was not the Tramadol and I just had a sensitive stomach. I stopped taking them and was really ill for about 5 days, then I and had flu for a few weeks, but after that I was fine. Next I went onto Vioxx until it was banned. Now I have been put back on to Tramadol, which I have been taking for the past 2 months. I am going to go and see my doctor next week and ask to be put on something else. My advice to anyone taking Tramadol is - yes it is good but don't take it for any longer than necessary! Leander - Nottingham,

UKI am so grateful for your experiences on here. I was searching the web looking in the early hours of the morning convinced I was losing my mind. I was prescribed Tramadol by a GP for pain related to my spina bifida. At first I was very drousy and sleepy, but since then I have been unable to sleep at all - other than the odd hour here and there. This has now gone on for 6 weeks. I decided to come off the drug as my GP told me it was highly addictive and he wouldn't recommend longer than 2 months use. I reduced the dose for a few days and then stopped. Since then I've had terrible night panic attacks, anxiety attacks, I am either boiling hot sweaty or freezing cold, I feel sick 24/7 and had terrible headaches. I feel 'uneasy' in my skin (I can't even put that feeling into words). Reading all your experiences helped me to see that it's the drug and not me, which was a relief. I pray these withdrawal symptoms go soon. I wish I'd never started with Tramadol. Amanda Leicester UK

I was prescribed Tramadol 3 years ago. At first the pain relief was great, but slowly the pain started to return. Everytime I started to reduce the dose, the pain would increase. If I missed a dose, I would start to suffer withflu-like symtoms, which would go away as soon as I took Tramadol. I decided to stop taking the drug completely and then felt terrible for a few days - I ached all over, felt sick, headaches. But for the first time in years, I did not wake up with a hangover in the morning! I feel this drug is highly addictive and, if taken long term, causes more pain than it relieves. Steve - London, England

I medicated myself with Tramadol which is easily accessable a few miles south of me in Tijuana, MX without prescription for around $20 for 50 tablets. I created an expensive habit but I have decided I don't like myself this way. My 4 hour habit makes me quick to irritation with my children, no motivation, constipation! I AM ADDICTED and I am smart enough to recognize it. I took my last 5 pills 48 hours ago and last night was the worst experience of my life. Sleeplessness, agitation, thoughts of suicide, diorrhrea, chills, skin crawls, heat flashes and sweats and that was just at night. During the day, I feel weak, tired, and truly fearful of another night like that. Natalie - San Diego, California, USA

I starting taking Tramadol in December 05. It was great; immediately I no longer had any pain and on the plus side I actually felt really well. The side affect of constipation was a small price to pay and went when I decreased to just 1 tablet a day. Two days ago I decided to completely stop taking Tramadol. For the past two days I have felt like I have flu with hot sweats, chills, shakes and a general feeling that my mind is not in sinc with any movement my body makes. Worse, last night I paced the floor for hours anxious, shaking and unable to relax enough to sleep, I felt terrible. Today, feeling worse, I had to come home from work and searched the internet for informaton about Tramadol and thankfully found this website. I took a Tramadol three hours ago and already I'm starting to feel "normal" again. I'm off to the Doctors tomorrow to start slowly decreasing the dose to get off this drug before it takes over completely. I did not expect withdrawal symptons as I was told by the specialist who put me on it that I could take it as long as I wanted as it was not addictive. I disagree; there should be a warning about Tramadol! Carol - Chester, UK

I was given Ultram initially, then changed to Tramadol. I was told the only difference is that tramadol does not contain acetaminophen. I was also told it wasn't addictive, but trying to leave it on my own has been difficult. The symptoms are similar to many of you: terrible headaches, skin crawls, sleeplessness. I'm planning to take a few weeks to enter a detox center and get rid of it once and for all. Richard - Chino, California, USA

About four years ago, I was prescribed Tramadol for severe chronic pain. Previous to taking this drug, I had taken other strong pain medications and had never had any problems so I didn't expect any complications with Tramadol. Within a week of taking this drug, I noticed I felt despondent which progressed into depression over the years. However, since I had no clue that the Tramadol was the cause, I kept taking it.I developed more severe symptoms like muscle tightness which was debilitating; the tightness affected my sleep and my ability to relax. I had headaches all over my skull and my brain felt like it was swimming or bouncing around inside. Then anxiety, insomnia and fatigue drove me to the point where I couldn't work and I started to believe I had mental problems! I had an alarming sensation of crawling under my skin and sought medical help. I had a MRI which showed I had previously had a minor stroke. However, my doctors were aware of this before I was placed on Tramadol.I was also chronically constipated and bloated. If I took Tramadol at night, I would stay awake all night and the next day. My skin and mouth were chronically dry. The fact that I had a minor stroke before I was placed on tramadol could have exacerbated my symptoms. I found that it changed my moods and I became irritable and confused. My anxiety never went away. Although I was using it for pain it actually increased the pain slightly before it soothed it which is quite strange. However this is my own particular experience.I am now going through detox and sincerely hope I will recover since the side effects were so severe. More importantly, the information leaflet which accompanies this drug states it does have the ability to do these things to a person; only I took no notice of it. C.R - Croydon, Surrey,

UKI have been taking Tramodol, together with Lyrica, for nerve damage but now the doctors have taken me off Tramodol. I have been suffering from anxiety, heat, cold shivers, flu-like symptoms, etc. Today is the second day and I feel much worse. Can anyone tell me how many days shall I have to suffer like this to come off it completely? I thought that the Lyrica was taking care of my discomfort. Now I am upset to know that I am addicted like this. I was told that Tramodol was not a narcotic. Joan - Sun City West, Arizona, USA

Thanks so much for putting this page on the internet. I recently broke two bones in my hand and the Surgeon and GP both prescribed Tramadol. At first it was great, no pain whatsoever after taking it. I've been taking it the past two weeks and I realised that it was likely Tramadol was a Heroin/Morphine derivative, if not that it must have been in the same family of drugs. Last night I stopped taking Tramadol since I felt there was little need for it now.I was taking two 50mg tablets twice a day, sometimes two at night and one for when I felt the pain. Since I've stopped taking Tramadol I've noted I've been having SEVERE headaches, feeling insanely hot, suddenly cold and what seems like mood changes (I suddenly started crying!).Hoping theres not long left of these withdrawal symptoms. What's worse is my Mother takes these for her Arthiritis and has a cabinet full of them! Must stay strong! Abdul - London, UK

I have been on tramadol 7 years. At this very moment I am in the middle of stopping them; I am now on hour 41 and to be honest I dont think I can go for much longer. This is the worst feeling in my whole life and I am 40. I can't sleep, I feel violently sick, I have headache, I can't stand still and I am so tired I feel like giving in and taking the rest of the box. Like most people I was misinformed and did not know they were addictive. So my advice is, no matter how bad you are, do not take these tablets. They will ruin your life. I hope this helps somebody out there. AT - Blackpool, Lancashire, UK

I have been on Tramadol since 1997 and didn't realise I was addicted until I ran out. I was climbing the walls and had to go to A&E for an emergency supply. That was two years ago and I am now weaned down to 100 mg twice a day and about to reduce by 50mg. It has been a long slow haul. A few times I stopped, thinking that my dose wss low enough, but I can only stand a week before the sweats, chills, headaches and aching bones make me start again. I will get off them even if it takes 10 years. Lindsay -Halifax, West Yorkshire, UK

Oral tramadol in postoperative pain

2009-03-05T04:05:00.000-08:00

Clinical bottom line:

Tramadol is an effective analgesic in postoperative pain. A single 100 mg oral dose of tramadol is equivalent to 1000 mg paracetamol. A dose of 100 mg had an NNT of 4.6 (3.6-6.4) for at least 50% pain relief over 4-6 hours in patients with moderate to severe pain compared with placebo.
At doses of 50 and 100 mg incidence of adverse effects (headache, nausea, vomiting, dizziness, somnolence) was similar to comparator drugs. In dental trials there was increased incidence of vomiting, nausea, dizziness and somnolence.

Tramadol (tramadol hydrochloride) has been in use in Europe since the 1970s for a range of pain conditions, and in the US since the late 1980s. It is a weak opioid receptor agonist with a number of other properties including serotonin release and inhibition of noradrenaline uptake. Tramadol is produced as a racemic mixture.

Systematic review
Moore RA, McQuay HJ. Single-patient data meta-analysis of 3453 postoperative patients: Oral tramadol versus placebo, codeine and combination analgesics. Pain 1997; 69:287-294.
Date review completed: 1995
Number of trials included: 18
Number of patients: 3453 (1486 tramadol / 695 placebo)
Control group: oral placebo

Main outcomes: pain relief at 6 hours (TOTPAR), Number-needed-to-treat (NNT) (with 95% confidence intervals) and relative benefit (with 95% confidence intervals).
Inclusion criteria were single oral dose, randomised, placebo-controlled, double-blind trials of tramadol in acute postoperative pain with sufficient data to calculate the area under the curve for pain relief (TOTPAR). Baseline pain was moderate to severe. The 6 hour TOTPAR was calculated for each patient, and the data were converted to the percent of maximum total pain relief from categorical pain scales (%maxTOTPAR), and then to dichotomous information to generate a number-needed-to-treat for at least 50% pain relief. Relative benefit was calculated to provide an assessment of how much more likely an individual given a particular treatment is to have at least 50% pain relief than someone given no treatment. Adverse effects frequency data were used to calculate numbers-needed-to-harm and relative risk.
Dental trials and postsurgical trials were also analysed separately to establish whether this had an effect on the NNTs and relative benefits of the drug conditions. Comparisons with codeine and combination analgesics were also made.

Findings
The meta-analysis was carried out on nine postsurgical pain trials and nine dental extraction trials. All trials showed a significantly superior analgesia to placebo, with a clear dose response for tramadol (higher doses associated with higher benefit and lower NNTs). Tramadol 100 mg had an NNT of 4.6 (3.6-6.4).

Table: Oral tramadol in acute postoperative pain. Data for all analgesics in the review

Improved on Active
Improved on Control
Relative benefit (95%CI)
NNT (95%CI)
codeine 60
99/649
63/656
1.6 (1.2 - 2.1)
16.7 (11 - 48)
tramadol 50
79/409
26/361
2.7 (1.8 - 4.1)
8.3 (6.0 - 13)
tramadol 75
90/281
37/282
2.4 (1.7 - 3.5)
5.3 (3.9 - 8.2)
tramadol 100
140/468
35/414
3.5 (2.5 - 5.0)
4.8 (3.8 - 6.1)
tramadol 150
135/279
37/282
3.7 (2.7 - 5.1)
2.9 (2.4 - 3.6)
paracetamol 650 plus propoxyphene 100
114/316
40/322
2.9 (2.1 - 4.0)
4.2 (3.3 - 5.8)
aspirin 650 plus codeine 60
76/305
17/293
4.3 (2.6 - 7.1)
5.3 (4.1 - 7.4)

With the exception of tramadol 100 mg, NNTs were lower in postsurgical pain than in dental extraction models. This was not due to differences in baseline pain intensity.

Adverse effects
The most commonly reported effects were headache, vomiting, nausea, dizziness and somnolence, though predominantly of mild intensity. In dental trials only, this was significantly different to placebo for vomiting, nausea, dizziness and somnolence, and there was a distinct dose-response, particularly in dental patients, with higher doses producing greater incidence of adverse events. Numbers-needed-to-harm for individual adverse effects with dental patients are shown in the Figure (unpublished data).

Ultram

2009-03-05T03:59:00.000-08:00

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.