Tramadol

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Tramadol: an Analgesic Tramadol, also know as Saliva ER, Saliva Flashdose, Ultram, Ultram ER, and Ultram ODT, is an synthetic, centrally acting opioid analgesic. Ultracet is a combination drug of acetaminophen and tramadol. Tramadol can be taken orally four times daily. Extended-release tablet called Tramadol ER may be administered once daily (Hair, Curran, & Keam 2006). The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25 mg every 3 days to reach 100 mg/day (25 mg 4 times daily). Thereafter, doses can be increased by 50 mg every 3 days to reach 200 mg day (50 mg 4 times daily). Tramadol may be taken with or without food. Recommended dose for extended release tablets is 100 mg daily which may be increased by 100 mg every 5 days but not to exceed 300 mg /day. Extended release tablets should be swallowed whole and not crushed or chewed.” (Ogbru & Marks 2010, p. 1)

Ultracet is indicated for short-term therapy of acute pain and should not be taken for long term. Tramadol is used to manage moderate to severe pain in adults. It has been indicated that tramadol is significantly more effective than placebo drugs (Hair, Curran & Keam 2007). Tramadol is less effective than morphine but just as effective as codeine when combined with acetaminophen or aspirin (Lehne 2010). Tramadol is a white, bitter, crystalline and odorless powder which is almost completely absorbed rapidly after oral administration and reaches peak plasma levels in two hours. The absolute bioavailability is 75% when using a 100 mg tablet and is not affected by food. Tramadol has a steady state distribution of two days when using 100 mg four times daily. The plasma half-life of tramadol for single or multiple dosing is six to seven hours. It is metabolized extensively in the liver and may cross the blood-brain



References: Close B. (2005) Tramadol: does it have a role in emergency medicine? Emergency Medicine Australasia, 17, 73-83. Hair P., Curran M., Keam S. (2006) Tramadol Extended-Release Tablets. Drugs, 66(15), 2017-2027. Hair P., Curran M., Keam S. (2007) Tramadol Extended-Release Tablets in Moderate to Moderately Sever Chronic Pain in Adults Lehne R. (2010). Pharmacology for Nursing Care. St. Louis: Saunders Elsevier. Kaye, K. (2004). Austrailian Prescriber: Trouble with Tramadol. Retrieved from http://www.australianprescriber.com/magazine/27/2/26/7/. Ogbru O., Marks J. (2010) Medications and Drugs: tramadol (Ultram, Ultram ER). Retrieved from http://www.medicinenet.com/tramadol/article.htm. Payne K.A., Roelofse J.A. (2000) Tramadol drops in children: analgesic efficacy, lack of respiratory effects, and normal recovery times. RxList: The Internet Drug Index. (2008) Ultram (tramadol hydrochloride) Drug. Retrieved from http://www.rxlist.com/ultram-drug.htm. Skidmore-Roth L. (2009). Mosby’s Drug Guide for Nurses. St. Louis: Mosby Elsevier.

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