Tramadol hydrochloride

  • Generic Name or Active Ingridient: Tramadol

Uses

Physicians order tramadol hydrochloride to relieve moderate to severe pain in adults.

General Drug Information

Tramadol hydrochloride is an opioid analgesic. Several drug manufacturers offer tramadol hydrochloride products as the brand name products, ConZip, Ryzolt, Ultracet and Ultram. Some manufacturers offer special formulations of tramadol hydrochloride, including special extended-release, delayed-release or orally disintegrating tablets. Drug makers may combine tramadol hydrochloride with acetaminophen.

Administration/Dosage

Tramadol hydrochloride is available in tablet or capsule form for oral use. Consumers should swallow regular or coated tablets whole; patients should allow orally disintegrating tablets to remain on the tongue for 30 to 60 seconds. Individuals should not split, crush, chew or dissolve the tablets or capsule before swallowing. Consumers can take tramadol hydrochloride with or without food.

Physicians should prescribe the lowest possible effective dose to reduce the risk for side effects. Doctors should start patients on the lowest possible dose and then slowly increase, or titrate, dosages to allow patients to become more tolerant to the effects of tramadol hydrochloride slowly and safely. As the patient becomes tolerant to tramadol hydrochloride, he will require higher doses to achieve the same level of pain relief.

Some patients require around-the-clock protection from chronic pain - these patients will likely take an extended-release formula of tramadol hydrochloride once a day, at the same time every day.

Other patients benefit from smaller doses several times each day. Doctors will start these patients out on 25 mg of tramadol hydrochloride a day and then increase dosage until the patient is taking 25 mg four times a day for a total of 100 mg of tramadol hydrochloride daily. After titration, the patient may take 50 - 100 mg every four to six hours as needed, not to exceed 400 mg per day.

Some patients need immediate relief from pain. For those people whose need for analgesia outweighs the risks of large doses of opioids, doctors skip the titration process and prescribe 50 to 100 mg of tramadol hydrochloride every four to six hours as needed. Maximum dosage is 400 mg per day.

Patients with certain types of kidney problems should take smaller doses every 12 hours for a maximum daily dosage of 200 mg. Because dialysis removes only a small percentage of tramadol hydrochloride from the bloodstream, dialysis patients may take their full dose on treatment days. The recommended dose for patients with cirrhosis of the liver is 50 mg every 12 hours.

Physicians should start elderly patients on very low doses and titrate cautiously. Patients over the age of 65 years tend to have decreased liver, kidney and heart function that can affect the way their bodies deal with tramadol hydrochloride. Total daily dose for patients over the age of 75 years is 300 mg per day.

Patients should not combine tramadol hydrochloride products.

Action

Tramadol hydrochloride depresses the consumer’s central nervous system, or CNS, to dull his brain’s perception of pain. CNS depression also sedates the patient and produces a pleasant feeling of euphoria. Tramadol hydrochloride also depresses various respiratory centers in the brain to decrease respiratory drive and cause slow, shallow and irregular breathing.

Opioids like tramadol hydrochloride act on certain muscle groups known as smooth muscles, like the muscles lining the intestinal walls that push stool through the digestive system or the duct that controls the flow of bile and pancreatic juices into the small intestine. Tramadol hydrochloride increases the tone of smooth muscles, making these organs stiffer and less functional or causing painful spasms.

Tramadol depresses the central nervous system, or CNS, to dull the brain’s perception of pain. Other result of CNS depression includes sedation and a pleasant feeling of euphoria. Opioids like tramadol also act on breathing centers to reduce the brain’s respiratory drive, causing slow, shallow and irregular breathing patterns.

Tramadol hydrochloride and other opioids act on the cardiovascular system to cause vasodilation, or widening of the blood vessels. This vasodilation lowers the pressure blood exerts against vessel walls, effectively lowering blood pressure. Sometimes vasodilation will lower blood pressure to the point of dangerous hypotension.

Tramadol hydrochloride affects the way the body reabsorbs, or “reuptakes,” serotonin. Serotonin is a neurotransmitter associated with mood, learning and sleep. Tramadol hydrochloride use can increase serotonin levels.

Warnings

Respiratory Depression

Respiratory depression is a serious and sometimes fatal breathing problem commonly associated with opioid use, especially at high doses in patients who are not opioid-tolerant. Decreased respiratory drive and inadequate breathing patterns cause low oxygen and high carbon dioxide levels.

Seizures

Tramadol hydrochloride may cause seizures, even at therapeutic doses. High doses increase this risk, as does using more than one product containing tramadol. When used alongside tramadol hydrochloride, some drugs increase the risk for seizures, including the popular group of drugs used to treat depression - SSRIs. These SSRIs, or selective serotonin reuptake inhibitors, further slow down the removal of serotonin from the bloodstream, causing high levels of this hormone and increasing the risk for seizures.

Other drugs increase the risk for seizures when taking alongside tramadol hydrochloride, including other opioid drugs, anti-seizure medications and the popular antidepressant and high blood pressure medication known as MAOIs.

Those with epilepsy or other seizure disorders face an increased risk for seizure activity while taking tramadol hydrochloride.

Suicide

Patients posing a risk for suicide or prone to addiction should not use tramadol hydrochloride. Physicians should consider alternate forms of pain treatment for patients with a history of alcohol or drug abuse and to those with emotional disturbances or depression. Consumers should not exceed recommended dosages and should abstain from alcohol use while using tramadol hydrochloride to reduce the risk for suicide.

Anaphylaxis and Allergic Reactions

Any consumer can suffer an allergic reaction or anaphylaxis from tramadol hydrochloride. Anaphylaxis is a dangerous form of allergic reaction but, unlike an allergic reaction, someone can suffer anaphylaxis the first time he takes tramadol hydrochloride.

Other allergic reactions to tramadol hydrochloride include the wheezing known as bronchospasm, itching and hives, swelling, and serious, potentially fatal skin reactions. Those with a history of anaphylaxis face a higher risk for allergic reactions and anaphylaxis and should therefore avoid tramadol hydrochloride.

Serotonin Syndrome

Because tramadol hydrochloride slows the reuptake of serotonin, toxic levels of this hormone may accumulate in the consumer’s system to cause serotonin syndrome. This potentially lethal form of drug poisoning may occur when the patient consumes two or more drugs that increase serotonin levels.

Symptoms of serotonin syndrome include agitation, hallucinations, coma, fast pulse and erratic blood pressure. The victim may experience high body temperature, loss of coordination, diarrhea, nausea and vomiting.

Head Injury and Increased Intracranial Pressure

Tramadol hydrochloride and respiratory depression can cause high carbon dioxide levels and increase the intracranial fluid pressure inside the patient’s skull. Head injuries and pre-existing intracranial pressure can enhance these effects. Furthermore, tramadol hydrochloride can cause changes that mimic the effects of a head injury; tramadol hydrochloride can obscure the presence or healing process of head injuries.

Dependence

Tramadol hydrochloride may cause physical dependence similar to that caused by morphine. Anyone who takes tramadol hydrochloride regularly, for therapeutic or for recreational purposes, can become physically dependent on tramadol hydrochloride. An opioid-dependent person experiences uncomfortable withdrawal symptoms when he stops taking tramadol hydrochloride suddenly. Physicians should remain alert for signs of dependence and counsel patients accordingly.

Precautions

The tramadol hydrochloride consumer may feel dizzy or drowsy. Tramadol hydrochloride can impair the patient’s physical and mental abilities. Consumers should avoid operating a motor vehicle or other heavy machinery until they know how tramadol hydrochloride affects them.

Contraindications

Tramadol hydrochloride is not appropriate for everyone. Patients who are hypersensitive to tramadol hydrochloride should not use this drug.

Tramadol hydrochloride is not appropriate in settings where other opioids are unsuitable, including in unmonitored locations without resuscitation equipment. Individuals having an asthma attack or suffering high carbon dioxide levels should not use tramadol hydrochloride.

Those patients severely intoxicated after using alcohol, hypnotics, sedatives, opioids and other CNS pain relievers or any other drug that alters the patient’s mental status should not consume tramadol hydrochloride.

Pregnancy, Labor and Delivery, Breastfeeding

There are no adequate or well-controlled studies in pregnant women to determine how tramadol hydrochloride affects these women or their fetuses, earning tramadol hydrochloride an FDA rating. Pregnant women should take tramadol hydrochloride only when the benefits to the mother’s health clearly outweigh the potential risks.

Physicians have reported neonatal withdrawal syndrome, stillbirths and deaths after tramadol hydrochloride use during pregnancy. Breastfeeding mothers may pass tramadol hydrochloride through human milk onto a nursing baby. Mothers should not breastfeed while using tramadol hydrochloride.

Drug Interactions

Patients should provide a list of all their current medications to the prescribing physician, including all prescription and over-the-counter drugs; tramadol hydrochloride can counteract with other medications in unsafe or unintended ways.

SSRIs and MAOIs increase the risk for seizures and serotonin syndrome.

Combining tramadol hydrochloride with other CNS depressants enhances the depressive effects of both drugs, increasing depression of the respiratory and central nervous systems. Examples of other CNS depressants include other opioids, sedatives, tranquilizers, general anesthesia, drugs to treat psychosis and alcohol.

Tramadol hydrochloride can interact with digoxin, warfarin and other drugs to affect the consumer’s blood clotting and bleeding time. Using tramadol hydrochloride with these drugs may cause high levels of digoxin or diminish the effectiveness of warfarin resulting in blooding problems in some patients.

Side effects

All drugs, including tramadol hydrochloride, can adversely affect some consumers. The most commonly reported side effects associated with tramadol hydrochloride use are dizziness, nausea, constipation, headache, sleepiness and flushing, which is an uncomfortable warmth and redness that spreads over the face and neck. Other commonly reported adverse reactions are itching, vomiting, trouble sleeping, dry mouth and diarrhea.

Overdose

Overdose of tramadol hydrochloride and other prescription painkillers is on the rise in the United States, with the numbers of overdose deaths tripling in just one decade. Between 1999 and 2008, deaths from prescription painkiller overdoses jumped to nearly .

Improper administration of tramadol hydrochloride increases the risk for overdose and death, including swallowing, inhaling or injecting crushed tramadol hydrochloride tablets. Using alcohol or other CNS depressants with tramadol hydrochloride increases the risk for fatal overdose.

Symptoms of tramadol hydrochloride overdose are respiratory depression, sleepiness that worsens to unconsciousness, limp muscles, pinpoint pupils and cold, clammy skin. Victims may suffer slow heartbeat, low blood pressure or death.

Tramadol hydrochloride overdose requires immediate medical attention. Emergency room staff will help the patient breathe by inserting a flexible tube to hold his airway open. They may connect this tube to a mechanical ventilator that takes over breathing responsibilities for the patient. Nurses will start intravenous fluids, medications and oxygen to control blood pressure, shock and fluid in the lungs. Attendants will perform CPR or other life saving measures as necessary.

Doctors will order naloxone if the patient shows signs of respiratory depression. Naloxone temporarily reverses some of the effects of tramadol hydrochloride but may increase the risk for seizures.

Abuse

Recreational drug abusers use tramadol hydrochloride because of the way it gets them high. Many people abuse tramadol hydrochloride by simply swallowing whole tablets while others crush the medication before swallowing, snorting or injecting it into a vein. Using tramadol hydrochloride in this manner increases the risk for side effects, overdose, addiction and physical dependence.

Withdrawal

Anyone who takes tramadol hydrochloride regularly for more than a few weeks can grow physically dependent on opioids and suffer uncomfortable withdrawal symptoms when he stops taking this medication suddenly. Withdrawal symptoms begin a few hours after the last dose and continue for several days.

Symptoms of withdrawal from tramadol hydrochloride include anxiety, perspiration, insomnia, stiff muscles, pain, nausea, shakiness, diarrhea, stuffy or runny nose and goose bumps. The individual may rarely suffer hallucinations.

Without intervention, withdrawal symptoms eventually disappear and do not return unless the individual again grows dependent on opioids. The opioid-dependent person can stop withdrawal symptoms at any time by taking more tramadol hydrochloride but he will remain opioid-dependent and suffer withdrawal the next time he stops taking this drug.

To avoid withdrawal, physicians suggest patients wean themselves from tramadol hydrochloride by taking smaller doses each day. This tapering method works well for most but stubborn and severe withdrawal symptoms prevent many people from discontinuing tramadol hydrochloride at the appropriate time.

Detox

The estimates there are almost 2 million Americans struggling with opioid dependence. To address this widespread need, many local healthcare institutions offer detoxification services. The detoxification patient receives drugs that counteract the effects tramadol hydrochloride along with medications to relieve the variety of withdrawal symptoms. Standard detoxification reduces the severity of symptoms and decreases the risks for complications, including dehydration and relapse to drug abuse.

Many informed patients now choose rapid detox, a more efficient and humane approach to detoxification care. During rapid detox, anesthesiologists sedate and anesthetize the patient before administering the usual detoxification and anti-withdrawal drugs. The rapid detox patient rests in a pleasant “twilight sleep” during the difficult detoxification process. Like standard detoxification, rapid detox reduces the risk for complications.

Storage

Consumers should store tramadol hydrochloride at temperatures between 68 to 77 degrees Fahrenheit but this drug can withstand temperatures ranging from 59 to 86 degrees Fahrenheit. This drug should be kept out of the reach of children.