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 serotonin;
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 psychotropic drugs.
• Use cautiously with pregnancy, lactation, seizures, concomitant use of CNS
depressants or MAOIs, renal or hepatic impairment.

Available forms
Tablets—50 mg

Dosages
ADULTS
50–100 mg PO q 4–6 hr; do not exceed 400 mg/day.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
50 mg PO q 12 hr. Do not exceed 200 mg/day.
> 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, sweating,
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; lactation;
seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic
impairment; 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 and kidney
function tests

Interventions
• Control environment (temperature, lighting) if sweating or CNS effects occur.

Teaching points
• Limit use in patients with past or present history of addiction to or dependence on
opioids.
• These side effects may occur: Dizziness, sedation, drowsiness, impaired visual
acuity (avoid driving or performing tasks that require alertness); nausea, loss of
appetite (lie quietly, eat frequent small meals).
• Report severe nausea, dizziness, severe constipation.

Adverse effects in Italic are most common; those in Bold are life-threatening.