tramadol hydrochloride

CLINICAL USE

Analgesic

DOSE IN NORMAL RENAL FUNCTION

Oral: 50–100 mg up to 4 hourly; maximum 400 mg daily IM/IV: 50–100 mg every 4–6 hours; total daily dose 600 mg

PHARMACOKINETICS

Molecular weight : 299.8

%Protein binding : 20

%Excreted unchanged in urine : 90

Volume of distribution (L/kg) : 163–243 litres

half-life – normal/ESRD (hrs) : 6/11

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : 50–100 mg every 8 hours initially and titrate dose as tolerated

<10 : 50 mg every 8 hours initially and titrate dose as tolerated

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Unknown dialysability. Dose as in GFR <10 mL/min

HD : Dialysed. Dose as in GFR

<10 : mL/ min

HDF/high flux : Dialysed. Dose as in GFR

<10 : mL/ min

CAV/VVHD : Dialysed. Dose as in GFR=10– 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anticoagulants: enhances effect of coumarins

Antidepressants: possibly increased serotonergic effects with duloxetine; possible CNS excitation or depression with MAOIs and moclobemide – avoid concomitant use with MAOIs; increased risk of CNS toxicity with SSRIs or tricyclics

Anti-epileptics: effect reduced by carbamazepine

Antivirals: concentration possibly increased by ritonavir

Atomoxetine: increased risk of convulsions

Dopaminergics: use selegiline with caution Sodium oxybate: enhanced effect of sodium oxybate – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

IV, IM, oral

Rate of Administration

Slow bolus or continuous

IV infusion

/PCA

Comments

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OTHER INFORMATION

Tramadol is a centrally acting opioid agonist which also acts on inhibitory pain pathways .

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