From the Guidelines
The maximum daily dose of tramadol is 400mg per day for immediate-release formulations and 300mg per day for extended-release formulations, as recommended for adult patients with normal hepatic and renal function 1.
Key Considerations
- The recommended dose for immediate-release formulations is 100mg 4 times a day, while extended-release formulations should not exceed 300mg per day 1.
- 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 considered to be approximately one-tenth as potent as morphine, and doses above the recommended levels may increase the risk of adverse effects, including respiratory depression 1.
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.
- Patients should be closely monitored for signs of adverse effects, including vomiting, dizziness, and weakness, especially when compared to other opioids like hydrocodone and codeine 1.
From the FDA Drug Label
For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of tramadol hydrochloride tablets, USP can be improved by initiating therapy with a titration regimen: The total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg q.i.d.) After titration, tramadol hydrochloride tablets, USP 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day In all patients with creatinine clearance less than 30 mL/min, it is recommended that the dosing interval of tramadol hydrochloride tablets be increased to 12 hours, 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 daily dose of tramadol (tramadol hydrochloride) is:
- 400 mg/day for adults with normal renal function
- 200 mg/day for patients with creatinine clearance less than 30 mL/min
- 300 mg/day for elderly patients over 75 years old 2
From the Research
Maximum Daily Dose of Tramadol
The maximum daily dose of tramadol is a crucial aspect of its administration. According to the studies:
- The recommended maximum daily dose of tramadol is 400 mg/day 3, 4.
- This dose can be administered in divided doses, with a typical range of 50-100 mg every 4-6 hours 3.
- For extended-release formulations, the maximum daily dose is also 400 mg, but it is taken once daily 5, 6.
- It is essential to note that the dose should be individualized, and patients should be monitored for efficacy and tolerability.
Key Considerations
Some key considerations when determining the maximum daily dose of tramadol include:
- The patient's medical history and current health status
- The type and severity of pain being treated
- The patient's response to the medication and any adverse effects
- The potential for drug interactions and abuse
Pharmacokinetics and Pharmacodynamics
The pharmacokinetics and pharmacodynamics of tramadol also play a role in determining the maximum daily dose. Tramadol has a high bioavailability, with a half-life of 5-7 hours, and is metabolized by the liver 3, 4. Its dual mechanism of action, involving both mu-opioid receptors and inhibition of neuroamine reuptake, contributes to its analgesic effects 3, 4, 6.