section name header

Pronunciation

TRA-ma-dol audio

Indications

REMS

Action

Therapeutic Effects:

Pharmacokinetics

Absorption: Immediate-release — 75% absorbed after oral administration; Extended-release (Ultram) — 85–90% (compared with immediate-release).

Distribution: Crosses the placenta; enters breast milk.

Metabolism/Excretion: Mostly metabolized by the liver (primarily by CYP2D6 and CYP3A4); primarily metabolized by CYP2D6 to active metabolite with analgesic activity (M1); CYP2D6 enzyme system exhibits genetic polymorphism; 7% of population may be poor metabolizers and may have significantly concentrations of tramadol and concentrations of M1 metabolite. 1–10% of Whites, 3–4% of Blacks, and 1–2% of East Asians may be ultra–rapid metabolizers of CYP2D6 and have significantly concentrations of M1 metabolite. 30% eliminated unchanged in the urine.

Half-life: Tramadol — 6–8 hr, ER — 7.9 hr; active metabolite — 7–9 hr; both are in renal or hepatic impairment.

Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: vasodilation.

Derm: pruritus, sweating.

EENT: visual disturbances.

Endo: hypoglycemia.

F and E: hyponatremia.

GI: constipation, nausea, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, vomiting.

GU: fertility, menopausal symptoms, urinary retention/frequency.

Neuro: hypertonia , SEIZURES, dizziness, headache, somnolence, anxiety, confusion, coordination disturbance, euphoria, malaise, nervousness, sleep disorder, stimulation, weakness.

Resp: RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA AND SLEEP-RELATED HYPOXEMIA).

Misc: physical dependence, psychological dependence, tolerance.

Interactions

Drug-Drug:

Drug-Natural Products:

Route/Dosage

Immediate-release

Renal Impairment

Hepatic Impairment

Extended-release

Implementation

US Brand Names

ConZip, Qdolo, Ultram, Ultram ER

Canadian Brand Names

Durela, Ralivia, Tridural, Zytram XL

Contr. Subst. Schedule

Schedule IV (C-IV)

Classifications

Therapeutic Classification: analgesics (centrally acting), opioid analgesics

Availability

(Generic available)

Time/Action Profile

(analgesia)

ROUTEONSETPEAKDURATION
PO1 hr2–3 hr4–6 hr
ERunknown12 hr24 hr

Assessment

Lab Test Considerations: Toxicity and Overdose:

Patient/Family Teaching

Evaluation/Desired Outcomes

Pill Image

tramadol_hcl_195_8991.jpg

Code

NDC Code*