Tramadol is a centrally acting analgesic that is used in the treatment of moderate to moderately severe pain. Tramadol is a synthetic analog of the phenanthrene alkaloid codeine, is an opioid and also a prodrug. Common brand names of Tramadol are Amaryll, Cetodol, Clomadol, Dolcet, Dolmal, Dolotral, Dolpaz, Doltrahex, Gesidol, Mardol, Microdol, Milador, Mosepan, Pengesic, Peptrad, Plazadol, Siverol, Tracaine, Tradomal, Tradonal, Tramadin, Tramal, Tramid, Tramkor, Tramundin, Unitral, Vistra, and Vitral. Tramadol is classified as an Analgesic.
Indication for Tramadol
Tramadol is used to treat moderate to moderately sever pain.
Routes and Dosage of Tramadol
Moderate to Moderately Severe Pain
PO: ADULTS, ELDERLY: 50-100mg every 4-6 hours. Maximum <75 years old: 400mg per day. Maximum >75 years old: 300mg per day.
Renal Function Impairment (Creatinine clearance <30mL per minute)
Alert: Dialysis patients can receive their regular dose on day of dialysis.
PO: ADULTS, ELDERLY: Increase dosing interval to 12 hours. Maximum daily dose: 200mg.
Hepatic Function Impairment
PO: ADULTS, ELDERLY: 50mg every 12 hours.
Action of Tramadol
Tramadol binds to µ-opiate receptors and inhibits reuptake of norepinephrine and serotonin. It reduces intensity of pain stimuli incoming from sensory nerve endings, altering pain perception and emotional response to pain.
Side Effects and Adverse Reactions of Tramadol
Side Effects of Tramadol
- Dizziness or vertigo
- Nausea and Vomiting
- Constipation
- Headache
- Somnolence
- Pruritus
- CNS Stimulation
- Asthenia
- Diaphoresis
- Dyspepsia
- Dry mouth
- Diarrhea
- Malaise
- Vasodilation
- Anorexia
- Flatulence
- Rash
- Visual disturbance
- Urinary retention or frequency
- Menopausal symptoms
Adverse Reactions of Tramadol
- Respiratory depression
- Seizures
- Prolonged duration of action and cumulative effect may occur in patients with impaired hepatic or renal function.
Nursing Considerations for Clients Taking Tramadol
- Assess onset, type, location, and duration of pain.
- Effect of medication is reduced if full pain recurs before next dose.
- Assess drug history especially carbamazepine, CNS depressant medication, MAOIs.
- Review past medical history, especially epilepsy or seizures.
- Assess renal or hepatic function laboratory values.
- Give without regards to meals
- Monitor pulse and blood pressure.
- Assist with ambulation if dizziness or vertigo occurs.
- Dry crackers or cola may relieve nausea.
- Palpate bladder for urinary retention.
- Monitor pattern of daily bowel activity and stool consistency.
- Sips of tepid water may relieve dry mouth.
- Assess for clinical improvement and record onset of relief from pain.
Patient Teachings for Clients Taking Tramadol
- May cause dependence.
- Avoid alcohol and over-the-counter medications.
- May cause drowsiness, dizziness, and blurred vision.
- Avoid tasks requiring alertness and motor skills until response to drug is established.
- Inform physician if severe constipation, difficulty in breathing, excessive sedation, seizures, muscle weakness, tremors, chest pain, and palpitations occur.
