Tramadol

What is Tramadol

Tramadol is a centrally-acting analgesic with a unique, dual mechanism of action.

It is a mu-opioid receptor agonist and a weak inhibitor of norepinephrine and serotonin reuptake.

Tramadol exists as a racemic mixture of the trans isomer. Important differences in binding, activity, and metabolism are associated with the two enantiomers.

Tramadol is a synthetic analog of codeine; however, tramadol has a lower affinity for opioid receptors than codeine.

Tramadol has less potential for abuse or respiratory depression than other opiate agonists, but both may occur. Drug abuse and overdose, seizures, serotonin syndrome, suicides, and anaphylactoid reactions have been associated with tramadol use/misuse. 

Indications

  • arthralgia
  • diabetic neuropathy
  • moderate pain
  • osteoarthritis
  • postherpetic neuralgia
  • postoperative shivering
  • severe pain

For the treatment of moderate pain or moderately severe pain

Side Effects

  1. abdominal pain
  2. adrenocortical insufficiency
  3. agitation
  4. amenorrhea
  5. amnesia
  6. anaphylactoid reactions
  7. anemia
  8. angioedema
  9. anorexia
  10. anxiety
  11. arthralgia
  12. asthenia
  13. ataxia
  14. back pain
  15. blurred vision
  16. bradycardia
  17. bronchospasm
  18. cataracts
  19. chills
  20. cholecystitis
  21. cholelithiasis
  22. confusion
  23. constipation
  24. cough
  25. cystitis
  26. dental pain
  27. depression
  28. diaphoresis
  29. diarrhea
  30. dizziness
  31. drowsiness
  32. dyspepsia
  33. dysphagia
  34. dysphonia
  35. dyspnea
  36. dysuria
  37. ecchymosis
  38. elevated hepatic enzymes
  39. emotional lability
  40. euphoria
  41. fatigue
  42. fetal death
  43. fever
  44. flatulence
  45. flushing
  46. gastroesophageal reflux
  47. GI bleeding
  48. gonadal suppression
  49. gout
  50. hallucinations
  51. headache
  52. hearing loss
  53. hematuria
  54. hepatic failure
  55. hepatitis
  56. hot flashes
  57. hyperglycemia
  58. hyperkinesis
  59. hypertension
  60. hypertonia
  61. hypoesthesia
  62. hyponatremia
  63. hypotension
  64. impaired cognition
  65. impotence (erectile dysfunction)
  66. increased urinary frequency
  67. infection
  68. infertility
  69. influenza
  70. insomnia
  71. irritability
  72. lethargy
  73. libido decrease
  74. malaise
  75. menstrual irregularity
  76. migraine
  77. miosis
  78. muscle cramps
  79. myalgia
  80. myocardial infarction
  81. nasal congestion
  82. nausea
  83. neonatal opioid withdrawal syndrome
  84. night sweats
  85. orthostatic hypotension
  86. pallor
  87. palpitations
  88. pancreatitis
  89. paresthesias
  90. peripheral edema
  91. peripheral vasodilation
  92. pharyngitis
  93. physiological dependence
  94. proteinuria
  95. pruritus
  96. psychological dependence
  97. pulmonary edema
  98. pulmonary embolism
  99. QT prolongation
  100. rash
  101. respiratory depression
  102. restlessness
  103. rhinitis
  104. rhinorrhea
  105. seizures
  106. serotonin syndrome
  107. SIADH
  108. sinus tachycardia
  109. sinusitis
  110. sneezing
  111. Stevens-Johnson syndrome
  112. stomatitis
  113. suicidal ideation
  114. syncope
  115. thrombocytopenia
  116. tinnitus
  117. torsade de pointes
  118. toxic epidermal necrolysis
  119. tremor
  120. urinary retention
  121. urticaria
  122. vertigo
  123. visual impairment
  124. vomiting
  125. weakness
  126. weight loss
  127. withdrawal
  128. xerostomia
  129. yawning

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • accidental exposure
  • acute abdomen
  • acute intoxication of CNS depressants
  • adenoidectomy
  • adrenal insufficiency
  • alcoholism
  • asthma
  • biliary tract disease
  • breast-feeding
  • children
  • coadministration with other CNS depressants
  • constipation
  • depression
  • diarrhea
  • driving or operating machinery
  • ethanol ingestion
  • ethanol intoxication
  • geriatric
  • GI disease
  • GI obstruction
  • head trauma
  • hepatic disease
  • hypothyroidism
  • ileus
  • increased intracranial pressure
  • infants
  • infertility
  • labor
  • lactase deficiency
  • MAOI therapy
  • myxedema
  • neonatal opioid withdrawal syndrome
  • neonates
  • neuromuscular disease
  • obesity
  • obstetric delivery
  • opiate agonist hypersensitivity
  • pancreatitis
  • phenylketonuria
  • polysorbate 80 hypersensitivity
  • potential for overdose or poisoning
  • pregnancy
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • reproductive risk
  • respiratory depression
  • seizure disorder
  • seizures
  • sleep apnea
  • substance abuse
  • suicidal ideation
  • tonsillectomy
  • ulcerative colitis

Interactions

  • Abiraterone
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Alfentanil
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Almotriptan
  • Alprazolam
  • Amifampridine
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amiodarone
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amobarbital
  • Amoxapine
  • Amphetamine; Dextroamphetamine Salts
  • Anticholinergics
  • Apalutamide
  • Apomorphine
  • Aprepitant, Fosaprepitant
  • Aripiprazole
  • Artemether; Lumefantrine
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atazanavir; Cobicistat
  • Atenolol; Chlorthalidone
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine
  • Azelastine; Fluticasone
  • Azilsartan; Chlorthalidone
  • Baclofen
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzphetamine
  • Benztropine
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Boceprevir
  • Brexpiprazole
  • Brigatinib
  • Brompheniramine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Bumetanide
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Bupropion
  • Bupropion; Naltrexone
  • Buspirone
  • Butabarbital
  • Butorphanol
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Cannabidiol
  • Capsaicin; Metaxalone
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Cariprazine
  • Carisoprodol
  • Celecoxib
  • Cenobamate
  • Ceritinib
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chlorothiazide
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Cinacalcet
  • Citalopram
  • Clemastine
  • Clobazam
  • Clonazepam
  • Clopidogrel
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Crizotinib
  • Cyclobenzaprine
  • Cyproheptadine
  • Dacomitinib
  • Dantrolene
  • Darifenacin
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desvenlafaxine
  • Deutetrabenazine
  • Dexmedetomidine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Dicyclomine
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dimenhydrinate
  • Diphenhydramine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Dolasetron
  • Doxylamine
  • Doxylamine; Pyridoxine
  • Dronabinol
  • Dronedarone
  • Droperidol
  • Duloxetine
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix
  • Elagolix; Estradiol; Norethindrone acetate
  • Elbasvir; Grazoprevir
  • Eletriptan
  • Elexacaftor; tezacaftor; ivacaftor
  • Eliglustat
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enzalutamide
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Escitalopram
  • Esketamine
  • Estazolam
  • Eszopiclone
  • Ethacrynic Acid
  • Ethanol
  • Ethotoin
  • Everolimus
  • Ezogabine
  • Fedratinib
  • Fentanyl
  • Flavoxate
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Flurazepam
  • Fluvoxamine
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fosphenytoin
  • Fostamatinib
  • Frovatriptan
  • Furosemide
  • Gabapentin
  • General anesthetics
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Haloperidol
  • Homatropine; Hydrocodone
  • Hydantoins
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Idelalisib
  • Iloperidone
  • Imatinib
  • Indacaterol; Glycopyrrolate
  • Indapamide
  • Iobenguane I 131
  • Iohexol
  • Iopamidol
  • Iopromide
  • Ioversol
  • Isavuconazonium
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isosulfan Blue
  • Istradefylline
  • Ivacaftor
  • Ketoconazole
  • Lapatinib
  • Larotrectinib
  • Lasmiditan
  • Lefamulin
  • Lemborexant
  • Letermovir
  • Levocetirizine
  • Levomilnacipran
  • Levorphanol
  • Linezolid
  • Lisdexamfetamine
  • Lithium
  • Lofexidine
  • Loop diuretics
  • Lopinavir; Ritonavir
  • Lorazepam
  • Lorcaserin
  • Lorlatinib
  • Loxapine
  • Lumacaftor; Ivacaftor
  • Lumacaftor; Ivacaftor
  • Lumateperone
  • Lurasidone
  • Maprotiline
  • Melatonin
  • Mepenzolate
  • Meperidine
  • Meperidine; Promethazine
  • Mephobarbital
  • Meprobamate
  • Mesoridazine
  • Metaxalone
  • Methadone
  • Methamphetamine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
  • Methohexital
  • Methscopolamine
  • Methyclothiazide
  • Methylene Blue
  • Metoclopramide
  • Metolazone
  • Metyrapone
  • Midazolam
  • Milnacipran
  • Mirabegron
  • Mirtazapine
  • Mitotane
  • Molindone
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Nabilone
  • Nalbuphine
  • Nalmefene
  • Naloxone
  • Naltrexone
  • Naproxen; Sumatriptan
  • Naratriptan
  • Nefazodone
  • Netupitant, Fosnetupitant; Palonosetron
  • Nilotinib
  • Non-Ionic Contrast Media
  • Olanzapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Ondansetron
  • Opiate Antagonists
  • Oritavancin
  • Orphenadrine
  • Osilodrostat
  • Oxazepam
  • Oxybutynin
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Palbociclib
  • Paliperidone
  • Palonosetron
  • Panobinostat
  • Paroxetine
  • Pazopanib
  • Peginterferon Alfa-2b
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentobarbital
  • Perampanel
  • Perindopril; Amlodipine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenobarbital
  • Phentermine; Topiramate
  • Phenylephrine; Promethazine
  • Phenytoin
  • Pimozide
  • Posaconazole
  • Potassium-sparing diuretics
  • Pramipexole
  • Prasugrel
  • Pregabalin
  • Primidone
  • Procarbazine
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Propantheline
  • Propoxyphene
  • Quazepam
  • Quetiapine
  • Quinidine
  • Quinine
  • Ramelteon
  • Ranolazine
  • Rasagiline
  • Remifentanil
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifampin
  • Risperidone
  • Ritonavir
  • Rizatriptan
  • Rolapitant
  • Ropinirole
  • Rotigotine
  • Rucaparib
  • Safinamide
  • Scopolamine
  • Secobarbital
  • Selpercatinib
  • Serotonin-Receptor Agonists
  • Sertraline
  • Sibutramine
  • Simeprevir
  • Sodium Oxybate
  • Solifenacin
  • Spironolactone
  • St. John’s Wort, Hypericum perforatum
  • Sufentanil
  • Sumatriptan
  • Suvorexant
  • Tapentadol
  • Tasimelteon
  • Tazemetostat
  • Tedizolid
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Temazepam
  • Terbinafine
  • Tetrabenazine
  • Tezacaftor; Ivacaftor
  • Thalidomide
  • Thiazide diuretics
  • Thiethylperazine
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Ticagrelor
  • Tizanidine
  • Tolterodine
  • Topiramate
  • Torsemide
  • Trazodone
  • Triamterene
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trihexyphenidyl
  • Trimethobenzamide
  • Trospium
  • Tucatinib
  • Valproic Acid, Divalproex Sodium
  • Vemurafenib
  • Venlafaxine
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Vortioxetine
  • Voxelotor
  • Warfarin
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
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