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 &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 299.8
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : 20
  • %Excreted unchanged in urine &nbsp &nbsp : 90

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

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp : 6/11

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : 50–100 mg every 8 hours initially and titrate dose as tolerated
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : 50 mg every 8 hours initially and titrate dose as tolerated

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp : Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/ min
  • HDF/high flux &nbsp : Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/ min
  • CAV/VVHD &nbsp &nbsp &nbsp: 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

    –

    Route

    IV, IM, oral

    Rate of Administration

    Slow bolus or continuous

    IV infusion

    /PCA

    Comments

    –

    OTHER INFORMATION

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