Pharmacology Book

http://www.fpnotebook.com/

Tramadol

Aka: Tramadol, Ultram
  1. Mechanism
    1. Opiate Analgesic (Codeine analog)
    2. Weak mu-receptor binding
    3. Inhibits Norepinephrine and Serotonin reuptake
    4. Reported low abuse and addiction potential
  2. Contraindications
    1. See Drug Interactions below
    2. Seizure disorder or increased Seizure risk factors
    3. Acute Intoxication (Alcohol, hypnotics, Opioids or psychotropic agents)
    4. Breastfeeding women
    5. All children under age 12 years old
    6. Children ages 12 to 18 years old with additional risks
      1. Tonsillectomy or adenoidectomy
      2. Obesity
      3. Sleep Apnea
    7. References
      1. FDA Drug Safety Communication (4-20-2017)
        1. https://www.fda.gov/Drugs/DrugSafety/ucm549679.htm
  3. Precautions
    1. Weak Analgesic, with abuse potential and risk of death in ultrarapid CYP2D6 metabolizers
    2. Other agents are preferred: NSAIDs, Acetaminophen, short acting Morphine, Hydrocodone, Oxycodone
  4. Classification
    1. Reclassified as FDA Schedule IV Opioid (US, August 2014)
  5. Efficacy: Relatively weak Opioid
    1. One-thirtieth the potency of Morphine (very weak mu receptor agonist)
    2. Equivalent effect to Tylenol with codeine (Tylenol #3)
    3. Less effective than Hydrocodone with Acetaminophen (Vicodin 5/500)
      1. Turturro (1998) Ann Emerg Med 32(2): 139-43 [PubMed]
  6. Dosing
    1. Usual dose: 50-100 mg every 4-6 hours
  7. Dosing: Maximum dose per day
    1. Healthy patient: 400 mg/day
    2. Over age 75 years: 300 mg/day
    3. Renal Insufficiency (Creatinine Clearance <30 ml/min)
      1. Reduce dosing frequency to every 12 hours
      2. Do not exceed 200 mg per day
  8. Disadvantages
    1. More expensive and lower efficacy than other Opioids
    2. SNRI properties with risk of Serotonin Syndrome when combined with other agents (see below)
    3. Risk of abuse and is Schedule 4 FDA Controlled substance, similar to Hydrocodone as of 2014
      1. Tramadol Overdose has been associated with deaths (especially when combined with Alcohol)
    4. References
      1. Orman and Hayes in Herbert (2016) EM:Rap 16(2): 1-2
  9. Adverse Effects
    1. Most common
      1. Nausea
      2. Constipation
      3. Somnolence
    2. Serious adverse effects
      1. Serotonin Syndrome
      2. Seizures
      3. Anaphylactoid reaction
      4. Abuse potential
      5. Hypoglycemia
        1. Uncommon (<1 per 1000 per year)
        2. Typically occurs in first 10 days of starting
        3. Fournier (2015) JAMA Intern Med 175(2):186-93 +PMID:25485799 [PubMed]
      6. Respiratory Depression in Children
        1. Seen with Ultrafast CYP2D6 metabolizers
        2. Avoid Tramadol use in children
        3. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm463499.htm
  10. Drug Interactions
    1. CYP 2D6 Inhibitors
      1. Block metabolism of Tramadol to active ingredient
        1. Increased adverse effects and decreased efficacy when used in combination with Tramadol
        2. Unique to Tramadol (other Opioids do not have some interaction)
      2. Paroxetine (Paxil)
      3. Fluoxetine (Prozac)
    2. Opioids
      1. Avoid use with other Opiates (no benefit)
    3. Serotonin Syndrome (try to avoid combination with other serotonergic agents)
      1. MAO inhibitors (absolute contraindication)
      2. Linezolid (Zyvox)
      3. Selective Serotonin Reuptake Inhibitors (SSRI)
      4. Serotonin Norepinephrine Reuptake Inhibitors (SNRI)
      5. Tricyclic Antidepressants
    4. Seizures
      1. Opioids
      2. Bupropion
      3. Selective Serotonin Reuptake Inhibitors (SSRI)
      4. Tricyclic Antidepressants
      5. Antipsychotic Medications
    5. Warfarin
      1. Tramadol may increase INR
      2. Recheck INR three days after starting Tramadol
    6. References
      1. (2012) Presc Lett 19(3): 17 [PubMed]
Medication Costs
tramadol (on 5/17/2017 at Medicaid.Gov Pharmacy Drug pricing)
TRAMADOL ER 100 MG TABLET Generic $1.73 each
TRAMADOL ER 200 MG TABLET Generic $3.07 each
TRAMADOL ER 300 MG TABLET Generic $3.84 each
TRAMADOL HCL 50 MG TABLET Generic $0.02 each
TRAMADOL HCL ER 100 MG TABLET Generic $1.72 each
TRAMADOL HCL ER 200 MG TABLET Generic $2.42 each
TRAMADOL HCL ER 300 MG TABLET Generic $3.07 each
TRAMADOL-ACETAMINOPHEN 37.5-325 MG TAB Generic $0.18 each
ultram (on 2/22/2017 at Medicaid.Gov Pharmacy Drug pricing)
ULTRAM 50 MG TABLET Generic $0.02 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Tramadol (C0040610)

Definition (CHV) a pain relieving drug
Definition (NCI) A synthetic codeine analogue, Tramadol has central analgesic properties with effects similar to opioids, such as morphine and codeine, acting on specific opioid receptors. Used as a narcotic analgesic for severe pain, it can be addictive and weakly inhibits norepinephrine and serotonin reuptake. (NCI04)
Definition (MSH) A narcotic analgesic proposed for severe pain. It may be habituating.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D014147
SnomedCT 108507005, 386858008
LNC LP18112-0, MTHU003394
English Tramadol, Cyclohexanol, 2-((dimethylamino)methyl)-1-(3-methoxyphenyl)-, cis-(+-)-, Tramadol [Chemical/Ingredient], TRAMADOL, traMADol, tramadol, Tramadol (product), Tramadol (substance)
Swedish Tramadol
Czech tramadol
Finnish Tramadoli
French Zamudol, Tramadol
Russian TRAMADOL, ТРАМАДОЛ
Japanese トラマール, クリスピン, トラマドール塩酸塩, 塩酸トラマドール, トラマドール
Polish Tramadol
Spanish tramadol (producto), tramadol (sustancia), tramadol, Tramadol
German Tramadol
Italian Tramadolo
Portuguese Tramadol
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Ultram (C0724054)

Definition (CHV) brand name of a painkiller drug
Definition (CHV) brand name of a painkiller drug
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D014147
English Ultram, Ortho Brand of Tramadol Hydrochloride, ultram, ultram [brand name]
Sources
Derived from the NIH UMLS (Unified Medical Language System)


You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree