Tramadol is a centrally acting analgesic that is used in the treatment of moderate to moderately severe pain. Tramadol is a synthetic analog of the phenanthrene alkaloid codeine, is an opioid and also a prodrug. Common brand names of Tramadol are Amaryll, Cetodol, Clomadol, Dolcet, Dolmal, Dolotral, Dolpaz, Doltrahex, Gesidol, Mardol, Microdol, Milador, Mosepan, Pengesic, Peptrad, Plazadol, Siverol, Tracaine, Tradomal, Tradonal, Tramadin, Tramal, Tramid, Tramkor, Tramundin, Unitral, Vistra, and Vitral. Tramadol is classified as an Analgesic.
Action of Tramadol
Tramadol binds to ยต-opiate receptors and inhibits reuptake of norepinephrine and serotonin. It reduces intensity of pain stimuli incoming from sensory nerve endings, altering pain perception and emotional response to pain.
Individualization of Dose
Good pain management practice dictates that the dose be individualized according to patient need using the lowest beneficial dose. Studies with tramadol in adults have shown that starting at the lowest possible dose and titrating upward will result in fewer discontinuations and increased tolerability
In all patients with creatinine clearance less than 30 mL/min, it is recommended that the dosing interval of tramadol hydrochloride tablets be increased to 12 hours, with a maximum daily dose of 200 mg. Since only 7% of an administered dose is removed by hemodialysis, dialysis patients can receive their regular dose on the day of dialysis.
The recommended dose for adults patients with cirrhosis is 50 mg every 12 hours.
In general, dose selection for an elderly patient over 65 years old should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy. For elderly patients over 75 years old, total dose should not exceed 300 mg/day.
Side Effects and Adverse Reactions of Tramadol
Side Effects of Tramadol
Dizziness or vertigo
Nausea and Vomiting
Constipation
Headache
Somnolence
Pruritus
CNS Stimulation
Asthenia
Diaphoresis
Dyspepsia
Dry mouth
Diarrhea
Malaise
Vasodilation
Anorexia
Flatulence
Rash
Visual disturbance
Urinary retention or frequency
Menopausal symptoms
Adverse Reactions of Tramadol
Respiratory depression
Seizures
Prolonged duration of action and cumulative effect may occur in patients with impaired hepatic or renal function.
Nursing Considerations for Clients Taking Tramadol
Assess onset, type, location, and duration of pain.
Effect of medication is reduced if full pain recurs before next dose.
Assess drug history especially carbamazepine, CNS depressant medication, MAOIs.
Review past medical history, especially epilepsy or seizures.
Assess renal or hepatic function laboratory values.
Give without regards to meals
Monitor pulse and blood pressure.
Assist with ambulation if dizziness or vertigo occurs.
Dry crackers or cola may relieve nausea.
Palpate bladder for urinary retention.
Monitor pattern of daily bowel activity and stool consistency.
Sips of tepid water may relieve dry mouth.
Assess for clinical improvement and record onset of relief from pain.
Patient Teachings for Clients Taking Tramadol
May cause dependence.
Avoid alcohol and over-the-counter medications.
May cause drowsiness, dizziness, and blurred vision.
Avoid tasks requiring alertness and motor skills until response to drug is established.
Inform physician if severe constipation, difficulty in breathing, excessive sedation, seizures, muscle weakness, tremors, chest pain, and palpitations occur.
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