From the Guidelines
Tramadol should be used with caution and at a maximum daily dose of 400 mg for adults with normal hepatic and renal function, due to its potential for adverse effects and lower potency compared to other opioids. The medication works by binding to opioid receptors in the brain and inhibiting the reuptake of serotonin and norepinephrine, providing pain relief through multiple mechanisms 1. The typical adult dosage ranges from 50-100 mg every 4-6 hours as needed for pain, with a maximum daily dose of 400 mg (or 300 mg for elderly patients or those with certain medical conditions) 1.
Key Considerations
- Tramadol is available in immediate-release and extended-release formulations, with the latter typically taken once daily 1.
- Common side effects include dizziness, nausea, constipation, headache, and drowsiness 1.
- It carries risks of dependence, addiction, and respiratory depression, though generally less than stronger opioids 1.
- Tramadol should not be combined with alcohol, other central nervous system depressants, or certain antidepressants due to potentially dangerous interactions 1.
- A Cochrane review of tramadol (with or without acetaminophen) concluded that limited evidence supports the use of tramadol for treatment of cancer pain and that tramadol is likely not as effective as morphine in this setting 1.
Special Populations
- Lower doses are recommended for older adults (75 years and older) and those with hepatic and/or renal dysfunction to reduce the risk of seizures 1.
- Tramadol is less potent than other opioids and is considered to be approximately one-tenth as potent as morphine 1.
- One nonrandomized, observational study in patients with cancer found comparable analgesic efficacy of high-dose tramadol (ie, $300 mg/d) and low-dose morphine (ie, #60 mg/d), but observed higher rates of constipation, neuropsychological symptoms, and pruritus in patients receiving low-dose morphine 1.
Monitoring and Safety
- It's essential to take tramadol exactly as prescribed, not to suddenly stop taking it after long-term use (as withdrawal symptoms may occur), and to store it securely away from others, especially children 1.
- Tramadol and tapentadol should be used with caution or avoided in patients taking other serotonergic or monoamine oxidase inhibitors (MAOI)-like medications (eg, TCAs, SSRIs, and MAOIs) due to risk of serotonin syndrome 1.
From the FDA Drug Label
Tramadol hydrochloride tablets, USP are indicated for the management of moderate to moderately severe pain in adults. The primary use of tramadol is for the management of moderate to moderately severe pain in adults.
- Key points:
- Indication: management of moderate to moderately severe pain
- Population: adults 2
From the Research
Tramadol Overview
- Tramadol is a mild opioid agonist and norepinephrine and serotonin reuptake inhibitor, used for the treatment of moderate to moderately severe pain 3.
- It is a centrally acting weak μ-opioid receptor analgesic and is a racemic mixture of (+)-tramadol and (-)-tramadol enantiomers 4.
Uses of Tramadol
- Tramadol is recommended for the treatment of chronic pain, either alone or in conjunction with nonselective NSAIDs and COX-2 inhibitors 3.
- It is used for the management of acute pain, including postoperative pain, pain associated with labor, and acute myocardial infarction 5.
- Tramadol is also used for the treatment of moderate to severe pain in patients who have not responded to previous oral therapy, or in patients who have contraindications to COX-2 inhibitors and nonselective NSAIDs 3.
Benefits and Safety Profile
- Tramadol has a favorable adverse-effect profile and is likely to have an important role in the management of chronic pain syndromes 6.
- It has a lower incidence of adverse events compared to immediate-release tramadol, and is not associated with gastrointestinal, renal, or cardiovascular complications 3.
- Tramadol does not show much serious adverse effects without any dependency potential in therapeutic doses, as seen in other opioids like morphine 4.