From the Guidelines
The maximum recommended dose of tramadol is 400 mg per day for adults with normal hepatic and renal function, with a typical division into smaller doses of 100 mg four times a day for immediate-release formulations or 300 mg once daily for extended-release formulations. This recommendation is based on the most recent and highest quality study available, which suggests that exceeding this dose increases the risk of serious side effects, including respiratory depression, seizures, and serotonin syndrome 1.
Key Considerations
- Elderly patients, those with renal or hepatic impairment, and patients taking certain medications may require lower maximum doses, often 300 mg daily or less, to reduce the risk of seizures and other adverse effects 1.
- Tramadol is an opioid analgesic that works by binding to mu-opioid receptors and inhibiting the reuptake of serotonin and norepinephrine, providing pain relief for moderate to moderately severe pain 1.
- Patients should be aware that tramadol can cause physical dependence, and the medication should be tapered gradually when discontinuing after prolonged use to avoid withdrawal symptoms.
Important Safety Information
- Tramadol should be used with caution or avoided in patients taking other serotonergic or monoamine oxidase inhibitors (MAOI)-like medications due to the risk of serotonin syndrome 1.
- The medication is less potent than other opioids and is considered to be approximately one-tenth as potent as morphine 1.
From the FDA Drug Label
Adults (17 years of age and over) ...not to exceed 400 mg/day In all patients with creatinine clearance less than 30 mL/min, ...with a maximum daily dose of 200 mg. For elderly patients over 75 years old, total dose should not exceed 300 mg/day.
The maximum dose of tramadol is 400 mg/day for adults with normal renal function, 200 mg/day for patients with creatinine clearance less than 30 mL/min, and 300 mg/day for elderly patients over 75 years old 2.
From the Research
Tramadol Dosage
- The maximum dose of tramadol is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, it is mentioned that tramadol can be well tolerated in older patients, but has risks of cognitive and classic opioid side effects 5.
- The study on pharmacotherapy for spine-related pain in older adults suggests that tramadol can be used, but with caution and at the lowest therapeutic doses 5.
- Another study compares the efficacy of tramadol hydrochloride/acetaminophen combination with non-steroidal anti-inflammatory drugs for perioperative pain after total knee arthroplasty, but does not provide information on the maximum dose of tramadol 6.
- There is no direct information on the maximum dose of tramadol in the provided studies, and it is recommended to consult the prescribing information or a healthcare professional for specific dosage guidelines.
Key Considerations
- Tramadol is an effective analgesic that works through a combined mechanism of weak mu receptor binding and the inhibition of serotonin and norepinephrine reuptake 3.
- The combination of opioids, including tramadol, with other medications such as acetaminophen or non-steroidal anti-inflammatory drugs, can produce synergistic analgesic effects 4.
- Tramadol has a favorable adverse-effect profile, but can have risks of cognitive and classic opioid side effects, particularly in older patients 5.