Adult Dosing
Moderate to moderately severe chronic pain
- TABS
- Recommended dose: 50-100 mg PO q4-6 hrs PRN; Max: 400 mg/day
- Gradual titration: 25 mg/day PO initially; then increase 25 mg/day PO q3 days to 25 mg PO qid; then increase 50 mg/day PO q3 days to 50 mg PO qid; Max: 400 mg/day; 300 mg/day if >75 yrs
- Rapid titration: 50–100 mg PO q4–6 hrs; Max: 400 mg/day; 300 mg/day if >75 yrs
- Extended Release TABS
- Recommended dose:100-300 mg PO daily
- Gradual titration:100 mg PO daily, increase 100 mg/day PO q5 days PRN; Max: 300 mg/day
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment: (Based on CrCl)
- <30 mL/min:
- TABS: Increase dosing interval to q12 hrs. Max: 200 mg/day
- Extended Release TABS: Contraindicated
- Hemodialysis: No supplement
Hepatic Dose Adjustment
- Cirrhosis:
- TABS: 50 mg PO q12 hrs. Max 100 mg/day
- Extended Release TABS (Child-Pugh Class C): Contraindicated
See Supplemental Patient Information
- Seizures have been reported in patients receiving tramadol within the recommended dosage range. The risk is increased with doses above the recommended range
- Concomitant use of SSRI's/tricyclic antidepressants/opioids increase the risk of seizures and may develop a potentially life-threatening serotonin syndrome
- Do not administer therapy in patients who are suicidal or addiction-prone. Overdosage may cause central nervous system depression, respiratory depression and death
- Serious and rarely fatal anaphylactoid reactions have been reported in patients receiving tramadol
- This drug should not be administered to patients who have previously demonstrated hypersensitivity to tramadol, any other component of this product or opioids
- Non-opioid analgesics should be used instead of tramadol in patients at risk for respiratory depression
- Respiratory depressant effects of therapy include carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure. Therefore cautiously administer therapy in patients with increased intracranial pressure or head injury
- Do not drive or operate a car because therapy may impair the mental and physical abilities required for the performance of such task
- Abrupt withdrawal of therapy may cause anxiety, sweating, insomnia, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, piloerection, and rarely hallucinations
- Therapy may cause drug abuse, dependence or addiction
- Therapy may complicate the clinical assessment of patients with acute abdominal conditions
- Not recommended for obstetrical pro or post delivery analgesia or in nursing mothers
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Hx of epilepsy
- Risk factors for seizures
- Elderly patients > 75 yrs
- Co-administration of MAO inhibitors
- Co-administration of CNS depressants
- Hx of opioid dependence
- Head injury
- Increased ICP
- Psychiatric disorder
- Patients at risk for respiratory depression
- Patients who are suicidal or addiction-prone
- Acute abdomen
- Concomitant alcohol use
Supplemental Patient Information
- Do not drive or operate a car because therapy may impair the mental and physical abilities required for the performance of such task
Pregnancy Category:C
Breastfeeding: Unlikely to adversely affect healthy, full-term infants and acceptable to use during breastfeeding; monitor premature infants for increased sleepiness, difficulty breastfeeding, breathing difficulties or limpness. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 16 May 2011). Manufacturer advises caution.
US Trade Name(s)
- Ryzolt
- Ultram
- Ultram ER
- Conzip
- Rybix ODT
US Availability
tramadol hydrochloride (generic)
- TABS: 50 mg
- Extended Release TABS: 100, 150, 200, 300 mg
Ryzolt
- Extended Release TABS: 100, 200, 300 mg
Ultram
Ultram ER
- Extended Release TABS: 100, 200, 300 mg
Conzip
- Extended Release CAPS: 100, 150, 200, 300 mg
Rybix ODT
Canadian Trade Name(s)
Canadian Availability
Ralivia
Tridural
Zytram XL
- ETABS: 150, 200, 300, 400 mg
UK Trade Name(s)
- Dromadol
- Tramquel
- Zamadol
- Zamadol 24hr
- Zamadol Melt
- Zeridame
- Zydol
- Zydol XL
UK Availability
tramadol hydrochloride (generic)
Dromadol
Tramquel
- CAPS: 50, 100, 150, 200 mg
Zamadol
- CAPS: 50 mg
- ECAPS: 50, 100, 150, 200 mg
Zamadol 24hr
- ETABS: 150 200, 300, 400 mg
Zamadol Melt
Zeridame
Zydol
- CAPS: 50 mg
- ODT: 50 mg
- ETABS: 50, 100, 200, 300 mg
Zydol XL
- ETABS: 150, 200, 300, 400 mg
Australian Trade Name(s)
- Tramahexal SR
- Tramal
- Tramedo
- Tramedo SR
Australian Availability
tramadol hydrochloride (generic)
- CAPS: 50 mg
- ETABS: 100, 150, 200 mg
Tramahexal SR
Tramal
- ETABS: 50, 100, 150, 200 mg
Tramedo
Tramedo SR
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Ultram ER 200 MG TB24 [Bottle] (JANSSEN PHARMACEUTICALS)
30 mg = $224.99
90 mg = $619.95 - Ultram ER 100 MG TB24 [Bottle] (JANSSEN)
30 mg = $144.99
90 mg = $413.95 - Ryzolt 200 MG TB24 [Bottle] (PURDUE PHARMA L.P.)
30 mg = $213.98
90 mg = $599.21 - Ultram ER 300 MG TB24 [Bottle] (JANSSEN)
30 mg = $298
90 mg = $858 - Ultram 50 MG TABS [Bottle] (JANSSEN)
30 mg = $62.99
100 mg = $194.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
