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What is tramadol?

Tramadol is a narcotic-like pain reliever.

Tramadol is used to treat moderate to severe pain.

The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an as-needed basis for pain.

Tramadol may also be used for purposes not listed in this medication guide.

Important information

You should not take tramadol if you have used alcohol, sedatives, tranquilizers, or narcotic medications within the past few hours.

Tramadol can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take tramadol in larger amounts, or for longer than prescribed. Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose.

Seizures (convulsions) have occurred in some people taking this medicine. Tramadol may be more likely to cause a seizure if you have a history of seizures or head injury, a metabolic disorder, or if you are taking certain medicines such as antidepressants, muscle relaxers, narcotic, or medicine for nausea and vomiting

Tramadol dosing information

Usual Adult Dose for Pain:

For mild to moderate severe chronic pain not requiring rapid onset of analgesic effect:

Initial dose: 25 mg every morning

Titration: increase in 25 mg increments as separate doses every 3 days to reach 100 mg per day taken as 25 mg 4 times per day. Then the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg per day taken as 50 mg 4 times per day.

Maintenance: After titration, tramadol 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg per day.

For the management of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time: Extended-Release Tablets:

Initial Dose: 100 mg once daily and titrated up as necessary by 100 mg increments every five days to relief of pain and depending upon tolerability. Maximum Dose: Extended-release tablets should not be administered at a dose exceeding 300 mg per day.

For patients in whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial dose:

Dose: 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours, not to exceed 400 mg per day.

Tramadol Extended-Release (ER):

Patients not currently treated with tramadol immediate-release (IR):

Initial dose: 100 mg once daily and titrated up as necessary by 100 mg increments every 5 days to relief of pain and individualized according to patient need and tolerability.

Maximum dose: 300 mg per day

Patients currently on tramadol IR (immediare release) :

Calculate the 24-hour tramadol IR dose:

Initial dose: Round down to the next lowest 100 mg increment. The dose may subsequently be individualized according to patient need and tolerability.

Maximum dose: 300 mg per day

Due to limitations in flexibility of dose selection with tramadol ER, some patients maintained on immediate release products may not be able to convert.

Usual Geriatric Dose for Pain:

For patients over 65 years:

Dose selection should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy.

For patients over 75 years:

Maximum dose of regular oral tablets: 300 mg per day in divided doses