From the Guidelines
Tramadol is contraindicated in patients with severe renal or hepatic impairment, and its use should be avoided in patients with renal impairment due to the risk of accumulation of the parent drug or active metabolites, as recommended by the most recent guideline from 2023 1. The contraindications of tramadol are multifaceted and primarily centered around its potential for adverse interactions and its pharmacokinetic properties.
- Tramadol should not be used in patients with hypersensitivity to the drug or its components.
- It is also contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or who have taken them within the past 14 days due to the risk of serotonin syndrome, as noted in the guidelines from 2019 1.
- Patients with severe respiratory depression, acute or severe bronchial asthma in unmonitored settings, known or suspected paralytic ileus, and severe renal or hepatic impairment should avoid tramadol, as highlighted in the study from 2013 1.
- Additionally, tramadol should be used with extreme caution in patients with head injury, increased intracranial pressure, or seizure disorders, as it lowers the seizure threshold.
- Tramadol is also contraindicated during pregnancy, particularly near delivery, as it can cause neonatal withdrawal syndrome.
- Caution is warranted in elderly patients and those with a history of substance abuse, considering the potential for drug interactions and the central nervous system effects of tramadol, which binds to μ-opioid receptors and inhibits reuptake of serotonin and norepinephrine. The most recent and highest quality study from 2023 1 emphasizes the importance of modifying opioid use in patients with renal or hepatic impairment, recommending avoidance of tramadol in such cases due to its elimination characteristics.
From the FDA Drug Label
Tramadol hydrochloride tablets, USP should not be administered to patients who have previously demonstrated hypersensitivity to tramadol, any other component of this product or opioids. Tramadol hydrochloride tablets, USP are contraindicated in any situation where opioids are contraindicated, including acute intoxication with any of the following: alcohol, hypnotics, narcotics, centrally acting analgesics, opioids or psychotropic drugs. The contraindications of tramadol are:
- Hypersensitivity to tramadol, any other component of the product, or opioids
- Situations where opioids are contraindicated
- Acute intoxication with:
- Alcohol
- Hypnotics
- Narcotics
- Centrally acting analgesics
- Opioids
- Psychotropic drugs 2
From the Research
Contraindications of Tramadol
- Tramadol is contraindicated in patients with a history of hypersensitivity to the drug 3
- It is also contraindicated in patients with acute or severe bronchial asthma, or those with status asthmaticus 3
- Patients with known or suspected gastrointestinal obstruction, or those at risk of paralytic ileus, should not use tramadol 4
- Tramadol is not recommended for patients with a history of seizures or those with a risk of seizure, such as those with a history of head trauma, or those taking other medications that lower the seizure threshold 5, 6
- Patients with severe renal impairment or those on dialysis should use tramadol with caution, as the drug and its metabolites are mainly excreted via the kidneys 4
- Tramadol is not recommended for patients with severe hepatic impairment, as the drug is metabolized by the liver and may accumulate to toxic levels 4
Special Precautions
- Tramadol should be used with caution in patients with a history of substance abuse or dependence, as the drug can be habit-forming 7
- Patients taking tramadol should be monitored for signs of serotonin syndrome, a potentially life-threatening condition caused by excessive levels of serotonin in the body 5
- Tramadol should be used with caution in patients taking other medications that affect the central nervous system, such as sedatives, hypnotics, or other opioids, as the risk of adverse effects may be increased 4, 7