Tramadol Hydro Chloride

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

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Relief of moderate to moderately severe pain

Contraindications and cautions

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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 Oral

Onset 1 hr

Peak 2 hr

Metabolism: Hepatic; T1/2: 6–7 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects

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CNS: Sedation, dizziness or vertigo, headache, confusion, dreaming, sweating, anxiety, seizures CV: Hypotension, tachycardia, bradycardia

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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

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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

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

Teaching points

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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.