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
- abdominal pain
- adrenocortical insufficiency
- agitation
- amenorrhea
- amnesia
- anaphylactoid reactions
- anemia
- angioedema
- anorexia
- anxiety
- arthralgia
- asthenia
- ataxia
- back pain
- blurred vision
- bradycardia
- bronchospasm
- cataracts
- chills
- cholecystitis
- cholelithiasis
- confusion
- constipation
- cough
- cystitis
- dental pain
- depression
- diaphoresis
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dysphagia
- dysphonia
- dyspnea
- dysuria
- ecchymosis
- elevated hepatic enzymes
- emotional lability
- euphoria
- fatigue
- fetal death
- fever
- flatulence
- flushing
- gastroesophageal reflux
- GI bleeding
- gonadal suppression
- gout
- hallucinations
- headache
- hearing loss
- hematuria
- hepatic failure
- hepatitis
- hot flashes
- hyperglycemia
- hyperkinesis
- hypertension
- hypertonia
- hypoesthesia
- hyponatremia
- hypotension
- impaired cognition
- impotence (erectile dysfunction)
- increased urinary frequency
- infection
- infertility
- influenza
- insomnia
- irritability
- lethargy
- libido decrease
- malaise
- menstrual irregularity
- migraine
- miosis
- muscle cramps
- myalgia
- myocardial infarction
- nasal congestion
- nausea
- neonatal opioid withdrawal syndrome
- night sweats
- orthostatic hypotension
- pallor
- palpitations
- pancreatitis
- paresthesias
- peripheral edema
- peripheral vasodilation
- pharyngitis
- physiological dependence
- proteinuria
- pruritus
- psychological dependence
- pulmonary edema
- pulmonary embolism
- QT prolongation
- rash
- respiratory depression
- restlessness
- rhinitis
- rhinorrhea
- seizures
- serotonin syndrome
- SIADH
- sinus tachycardia
- sinusitis
- sneezing
- Stevens-Johnson syndrome
- stomatitis
- suicidal ideation
- syncope
- thrombocytopenia
- tinnitus
- torsade de pointes
- toxic epidermal necrolysis
- tremor
- urinary retention
- urticaria
- vertigo
- visual impairment
- vomiting
- weakness
- weight loss
- withdrawal
- xerostomia
- 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
