Tramadol Prescription Quantity for 30-Day Supply
For a standard 30-day supply of tramadol (Ultram), you should prescribe 120 tablets of immediate-release formulation (50mg tablets taken QID) or 60 tablets for extended-release formulation (100mg tablets taken BID). 1
Dosing Recommendations
Immediate-Release Formulation:
- Initial dose: 50mg every 4-6 hours as needed
- Typical maintenance dose: 50mg QID (4 times daily)
- Maximum daily dose: 400mg per day 2, 1
- Quantity for 30-day supply: 120 tablets (50mg tablets)
Extended-Release Formulation:
- Initial dose: 100mg once daily or twice daily
- Maximum daily dose: 300mg per day 2
- Quantity for 30-day supply: 30-60 tablets (depending on once or twice daily dosing)
Special Population Considerations
Elderly Patients (>75 years):
- Maximum daily dose should not exceed 300mg/day 2, 1
- Consider prescribing 90 tablets for a 30-day supply (50mg TID)
Patients with Renal Impairment:
- For CrCl <30 mL/min: Increase dosing interval to 12 hours
- Maximum daily dose: 200mg 2, 1
- Quantity for 30-day supply: 60 tablets (50mg BID)
Patients with Hepatic Impairment:
- Reduce dose to 50mg every 12 hours 2
- Quantity for 30-day supply: 60 tablets
Titration Considerations
- For patients not requiring rapid onset of analgesia, start with lower doses and titrate up
- Initial titration: 50mg daily, increasing by 50mg every 3 days as tolerated
- Target dose: 200mg/day (50mg QID) 1
- This approach results in fewer discontinuations and increased tolerability 1
Important Prescribing Notes
- Include breakthrough dosing instructions if appropriate
- Consider prescribing adjunct medications for specific pain types (e.g., neuropathic pain) 3, 2
- Avoid prescribing with MAOIs due to risk of adverse interactions 2
- Monitor for serotonin syndrome if patient is on other serotonergic medications 2
By following these guidelines, you can appropriately prescribe the correct quantity of tramadol tablets for a 30-day supply while ensuring safe and effective pain management for your patient.