Tramadol Hydrochloride Uses, Dosage, Side Effects

Tramadol Hydrochloride

(tra′mad-ol)

ConZip, Rybix, Ryzolt, Ultram, Ultram ER, Zydol

Classifications: ANALGESIC; NARCOTIC (OPIATE AGONIST)

Therapeutic: NARCOTIC ANALGESIC

Prototype: Morphine sulfate

Pregnancy Category: C

Controlled Substance: Schedule IV (in some states)

AVAILABILITY

Tablet; orally disintegrating tablet; extended release tablet; extended release capsule

ACTION & THERAPEUTIC EFFECT

Centrally acting opiate receptor agonist that inhibits the uptake of norepinephrine and serotonin, suggesting both opioid and nonopioid mechanisms of pain relief. May produce opioid-like effects, but causes less respiratory depression than mor- phine. Effective agent for control of moderate to moderately severe pain.

USES

Management of moderate or moderately severe pain.

CONTRAINDICATIONS

Hypersensitivity to tramadol or other opioid analgesics including anaphylactoid reaction; severe respiratory depression; severe or acute asthmas; patients on MAO Inhibitors; substance abuse; suicidal; alcohol intoxication; lactation. Extended release: Do not administer to patients with severe hepatic impairment.

CAUTIOUS USE

Debilitated patients; chronic respiratory disorders; respiratory depression; liver disease; renal impairment; myxedema, hypothyroidism, or hypoadrenalism; GI disease; acute abdominal conditions; increased ICP or head injury, increased intracranial pressure; history of seizures; older adults: pregnancy (category C); children younger than 16 y. Extended release: Do not use in children younger than 18 y.

ROUTE & DOSAGE

Pain

Adult: PO immediate release: 25 mg daily, titrated up to dose of 100 mg/day (max: 400 mg/day)

PO Extended release: 100 mg qd may titrate up q5d

PO Disintegrating tablet: 50–100 mg q4–6h may increase q3d to 200 mg/day

Renal Impairment Dosage Adjustment

CrCl less than 30 mL/min: Decrease to 50–100 mg q12h

Hepatic Impairment Dosage Adjustment

Cirrhosis: Decrease to 50–100 mg q12h

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ADMINISTRATION

Oral

• Extended release tablets should be swallowed whole. They should not be crushed or chewed.
• Store at 15°–30° C (59°–86° F).

ADVERSE EFFECTS (≥1%)

CNS: Drowsiness, dizziness, vertigo, fatigue, headache, somnolence, restlessness, euphoria, confusion, anxiety, coordination disturbance, sleep disturbances, seizures. CV: Palpitations, vasodilation. GI: Nausea, constipation, vomiting, xerostomia, dyspepsia, diarrhea, abdominal pain, anorexia, flatulence. Body as a Whole: Sweating, anaphylactic reaction (even with first dose), withdrawal syndrome (anxiety, sweating, nausea, tremors, diarrhea, piloerection, panic attacks, paresthesia, hallucinations) with abrupt discontinuation, flushing. Skin: Rash. Special Senses: Visual disturbances. Urogenital: Urinary retention/frequency, menopausal symptoms.

DIAGNOSTIC TEST INTERFERENCE

Increased creatinine, liver enzymes; decreased hemoglobin; proteinuria.

INTERACTIONS

Drug: Carbamazepine significantly decreases tramadol levels (may need up to twice usual dose). Tramadol may increase adverse effects of MAO INHIBITORS. TRICYCLIC ANTIDEPRESSANTS, cyclobenzaprine, PHENOTHIAZINES, SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIs), MAO INHIBITORS may enhance seizure risk with tramadol. May increase CNS adverse effects when used with other CNS DEPRESSANTS. Herbal: St. John’s wort may increase sedation.

PHARMACOKINETICS

Absorption: Rapidly absorbed from GI tract; 75% reaches systemic circulation. Onset: 30–60 min. Peak: 2 h. Duration: 3–7 h. Distribution: Approximately 20% bound to plasma proteins; probably crosses blood– brain barrier; crosses placenta; 0.1% excreted into breast milk. Metabolism: Extensively in liver by cytochrome P450 system. Elimination: Primarily in urine. Half-Life: 6–7 h.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Assess for level of pain relief and administer prn dose as needed but not to exceed the recommended total daily dose.
• Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression.
• Withhold drug and notify prescriber if S&S of hypersensitivity occur.
• Assess bowel and bladder function; report urinary frequency or retention.
• Use seizure precautions for patients who have a history of seizures or who are concurrently using drugs that lower the seizure threshold.
• Monitor ambulation and take appropriate safety precautions.

Patient & Family Education

• Exercise caution with potentially hazardous activities until response to drug is known.
• Do not exceed the total number of mg prescribed for a 24 h period.
• Understand potential adverse effects and report problems with bowel and bladder function, CNS impairment, and any other bothersome adverse effects to prescriber.

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Ditulis oleh Unknown pada tanggal Tuesday, October 27, 2015