Tramadol Indications, Contraindications, Warning

Tramadol is an opioid pain medication used to treat moderate to moderately severe pain. When taken by mouth in an immediate-release formulation, the onset of pain relief usually occurs within an hour. It is often combined with paracetamol (acetaminophen) as this is known to improve the efficacy of tramadol in relieving pain.

Tramadol Indications

• Fibromyalgia
• Pain due to road traffic accident.
• A headache
• Severe fever
• Chest pain
• A migraine headache
• Acute pain due to trauma
• Accidental pain
• Acute abdominal pain due to gastritis/appendicitis
• Ankylosing spondylitis
• Pain due to especially musculoskeletal system
• Ankylosing spondylitis
• Pain due to especially musculoskeletal system
• Lumbago
• Low back pain
• PLID
• Polyarthralgia
• Muscles stiffness in nerve diseases
• Multiple joint pain
• Muscles stiffness in the spinal cord
• Pain caused by nonarticular rheumatism
• Periarthritis of scapulohumeral
• Indicated in the treatment of moderate to severe pain. Consider for those prone to constipation or respiratory depression. Tramadol is used to treat postoperative, dental, cancer, and acute musculoskeletal pain and as an adjuvant to NSAID therapy in patients with osteoarthritis.

Therapeutic Indications of Tramadol

• Analgesics, Opioid; Narcotics
• Tramadol hydrochloride tablets, USP are indicated for the management of moderate to moderately severe pain in adults.
• Tramadol hydrochloride extended-release tablets are indicated for the management of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time.

Contra-Indications of Tramadol

Tramadol is contraindicated in those with hypersensitivity,

• Allergy to tramadol hydrochloride or any other ingredients in the medicine;
• Allergy to medicines called opioid antagonists (e.g. codeine, morphine);
• Consumed alcohol taken another drug which affects your brain. These include:
• Some painkillers, including opioid painkillers;
• Hypnotic drugs;
• Psychotropic drugs;
• Used monoamine oxidase inhibitors (MAOIs) such as phenelzine or tranylcypromine
• Epilepsy;
• Addiction or are recovering from addiction to another medication.
• History of peptic ulcer disease,
• Gastrointestinal bleeding,
• Alcohol intolerance,
• Renal impairment,
• Cerebrovascular bleeding,
• Nasal polyps,
• Angioedema, and asthma
• Acute intoxication with alcohol,
• Hypnotics,
• Heart failure,
• Coagulation disorders,
• Renal impairment,
• Hepatic impairment.

Dosage of Tramadol

Strengths: 50 mg; 100 mg/24 hours; 200 mg/24 hours;

Pain

Immediate-release

• 50 to 100 mg orally every 4 to 6 hours as needed for pain
• Maximum dose: 400 mg per day

Chronic Pain

Immediate-Release (IR)

• Initial dose: 25 mg orally once a day; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days to reach a dose of 50 mg four times a day
• Maintenance dose: After titration, 50 to 100 mg orally as needed for pain every 4 to 6 hours
• Maximum dose: 400 mg per day

Extended-Release (ER)

• Initial dose (tramadol-naive): 100 mg orally once a day
• Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reaction
• Maximum Dose: 300 mg orally per day

Geriatric Pain

• Age: 75 years or older: Maximum dose: 300 mg per day

Geriatric, Chronic Pain

• Age: 75 years or older: Maximum dose: 300 mg per day

Pediatric Dose for Pain

17 years or older

• Immediate-release: 50 to 100 mg orally every 4 to 6 hours as needed for pain
• Maximum dose: 400 mg per day

Immediate-Release

• Initial dose: 25 mg orally once daily; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days to reach a dose of 50 mg four times a day
• Maintenance dose: After titration, 50 to 100 mg orally as needed for pain every 4 to 6 hours
• Maximum dose: 400 mg per day

Side Effects of Tramadol

The most common

• GI disorders (e.g. dyspepsia, abdominal pain, nausea, vomiting, diarrhea, flatulence, constipation,, ulcerative stomatitis, ), indigestion,
• Disturbances of the gut such as diarrhea, constipation, nausea, vomiting or abdominal pain.
• Drowsiness and lightheadedness
• Nausea and vomiting
• joint pain
• Nausea and vomiting
• Severe stomach ache
• Severe diarrhea
• Vaginal thrush
• Skin rash
• Headache
• Chest pain
• Diarrhea or loose stools
• Difficulty with breathing
• Dizziness
• Heartburn
• Muscle pain

More common

• Abdominal or stomach pain,
• Chills or fever
• Headache,
• Joint or back pain
• Muscle aching or cramping
• Muscle pains or stiffness
• Chest pressure or squeezing pain in the chest
• Excessive sweating
• feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
• sudden tingling or coldness in an arm or leg
• Constipation
• Diarrhea
• Loss of muscle coordination
• Sleepiness or unusual drowsiness
• Clumsiness or unsteadiness
• Drowsiness

Rare

• Anxiety
• change in vision
• seizures
• abnormal or fast heart rate
• tremors
• weight loss
• chest pain or tightness
• confusion
• a cough
• Agitation
• arm, back, or jaw pain
• blurred vision
• chest pain or discomfort
• convulsions
• extra heartbeats
• fainting
• hallucinations
• a headache
• irritability
• lightheadedness
• mood or mental changes
• muscle pain or cramps
• muscle spasm or jerking of all extremities
• muscle pains or stiffness
• chest pressure or squeezing pain in the chest
• discomfort in arms, shoulders, neck or upper back

Drug Interactions of Tramadol

Tramadol may interact with following drugs, supplements & may change the efficacy of drugs

• anti-emetic medications (serotonin antagonists; e.g., granisetron, ondansetron)
• antihistamines (e.g, cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• aminoglycoside antibiotics (e.g., amikacin, gentamicin, tobramycin)
• angiotensin-converting enzyme inhibitors (ACEIs; e.g., captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• beta-adrenergic blockers (e.g., metoprolol, atenolol)
• baclofen
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• celecoxib
• cilostazol
• clopidogrel
• corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• cyclosporine
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, )
• 5-ASA medications (e.g. sulfasalazine)
• glucosamine
• haloperidol
• heparin
• methotrexate
• multivitamins
• other non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, ketorolac, naproxen)
• Omega-3 fatty acids
• phenytoin
• phenobarbital
• pentoxifylline
• quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.gduloxetine, )
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• warfarin

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately

Lactation

Tramadol can increase serum prolactin.However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.A randomized study compared tramadol and naproxen for post-cesarean section pain. Patients received the drugs either on a fixed schedule or as needed. No difference in breastfeeding rates was seen among the groups.