Dolcet

tramadol hydrochloride
(tram' ah doll)
Ultram
Pregnancy Category C
Drug class
Analgesic, centrally acting
Therapeutic actions
Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and ser
otonin; causes many effects similar to the opioids dizziness, somnolence, nausea,
constipation but does not have the respiratory depressant effects.
Indication
Relief of moderate to moderately severe pain
Contraindications and cautions
Contraindicated with allergy to tramadol or opioids or acute intoxication
with alcohol, opioids, or psychoactive drugs.
Use cautiously with pregnancy, lactation, seizures, concomitant use of CN
S depressants or MAOIs, renal dysfunction, or hepatic impairment.
Available forms
Tablets 50 mg
Dosages
ADULTS
50 100 mg PO q 4 6 hr; do not exceed 400 mg/day.
Patients with creatinine clearance < 30 ml/min: 50 100 mg PO q 12 hr. Maximum 200
mg/day.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
> 75 yr: Do not exceed 300 mg/day.
Pharmacokinetics
Route Onset Peak
Oral
1 hr
2 hr
Metabolism: Hepatic; T1/2: 6 7 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
Adverse effects
CNS: Sedation, dizziness or vertigo, headache, confusion, dreaming, sweat
ing, anxiety, seizures
CV: Hypotension, tachycardia, bradycardia
Dermatologic: Sweating, pruritus, rash, pallor, urticaria
GI: Nausea, vomiting, dry mouth, constipation, flatulence
Other: Potential for abuse, anaphylactoid reactions
Interactions
Drug-drug
Decreased effectiveness with carbamazepine
Increased risk of tramadol toxicity with MAOIs
Nursing considerations
Assessment

History: Hypersensitivity to tramadol; pregnancy; acute intoxication with

alcohol, opioids, psychotropic drugs or other centrally acting analgesics; lact
ation; seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic i
mpairment; past or present history of opioid addiction
Physical: Skin color, texture, lesions; orientation, reflexes, bilateral
grip strength, affect; P, auscultation, BP; bowel sounds, normal output; liver a
nd kidney function tests