Recommended Dosage for Intravenous (IV) Tramadol Administration
For adult patients, the recommended intravenous dosage of tramadol is 50-100 mg every 4-6 hours as needed, with a maximum daily dose of 400 mg for patients with normal hepatic and renal function. 1
Pediatric Dosing
- For children, the recommended IV dosage is 1-1.5 mg/kg, titrated to effect for breakthrough pain in the post-anesthesia care unit (PACU) 2
- For breakthrough pain management on the ward (with adequate monitoring), children should receive 1-1.5 mg/kg every 4-6 hours 2
Adult Dosing Considerations
- Tramadol is rapidly absorbed with onset of action occurring within 1 hour of administration 1
- Peak analgesic effect is reached in approximately 2-3 hours after administration 1
- The mean terminal plasma elimination half-life is approximately 6.3 ± 1.4 hours 1
- Tramadol is extensively metabolized in the liver, with approximately 30% excreted unchanged in urine 1
Special Populations
Hepatic Impairment
- Metabolism of tramadol is reduced in patients with advanced cirrhosis 1
- For patients with cirrhosis, dosage adjustment is recommended due to longer elimination half-lives (13 hours for tramadol) 1
- Lower doses should be used in patients with hepatic dysfunction to reduce the risk of seizures 2
Renal Impairment
- Impaired renal function results in decreased rate and extent of excretion of tramadol and its active metabolite 1
- For patients with creatinine clearance less than 30 mL/min, dosage adjustment is recommended 1
- Only a small amount (less than 7%) of tramadol is removed during dialysis 1
Elderly Patients
- Lower doses are recommended for older adults (75 years and older) to reduce the risk of seizures 2
Mechanism of Action
- Tramadol is a centrally acting synthetic opioid analgesic with a dual mechanism of action 1, 3:
- Binds to μ-opioid receptors in the central nervous system
- Inhibits reuptake of norepinephrine and serotonin
Safety Considerations
- Tramadol should be used with caution or avoided in patients taking serotonergic medications (SSRIs, TCAs, MAOIs) due to risk of serotonin syndrome 2
- Common adverse effects include dizziness, nausea, dry mouth, and sedation 4
- Unlike other opioids, tramadol has lower risk of respiratory depression and constipation 5, 6
- Tramadol has lower abuse potential compared to traditional opioids 5, 3
Clinical Pearls
- Tramadol is approximately one-tenth as potent as morphine 2
- For cancer pain management, tramadol may be less effective than morphine but can be useful for moderate pain 2
- Nausea is dose-dependent and more likely to occur with high loading doses; reducing the initial dose can improve tolerability 3
- Tramadol can be administered without regard to food as food does not significantly affect its absorption 1
Common Pitfalls to Avoid
- Exceeding the maximum recommended daily dose of 400 mg in adults with normal renal and hepatic function 2
- Failing to adjust dosage in patients with renal or hepatic impairment 1
- Administering tramadol concurrently with other serotonergic medications without monitoring for serotonin syndrome 2
- Using high loading doses which can increase the incidence of adverse effects, particularly nausea 3