Tranal

Indications

Tramadol Hydrochloride is a prescription painkiller for moderate to moderately severe pain, such as pain after surgery or injury, or painful conditions when other painkillers like Paracetamol or Ibuprofen are not enough or not suitable. It is available as tablets, capsules, extended-release tablets, suppositories and injections, and in combination with Paracetamol.

How It Works

It is an opioid that acts on pain receptors in the brain and spinal cord. It also increases the levels of two brain chemicals, serotonin and noradrenaline, which helps block pain signals.

Dosage and Administration

Use only as prescribed, at the lowest dose and for the shortest time needed. Usual adult dose for ordinary tablets or capsules: 50 to 100 mg every 4 to 6 hours if needed, not more than 400 mg in 24 hours. Extended-release tablets are taken once or twice a day as prescribed and must be swallowed whole, never crushed or chewed. People over 75 and those with kidney or liver disease need lower doses or longer gaps, as advised by the doctor. Combination tablets with Paracetamol: as prescribed, and do not take other paracetamol-containing products at the same time. Injections are given by a doctor or nurse. Not for children under 12.

Interactions

• Antidepressants (such as Sertraline, Fluoxetine, Amitriptyline and Venlafaxine), MAO inhibitors, Triptans and Linezolid raise the risk of serotonin syndrome and seizures; do not take tramadol within 14 days of an MAO inhibitor.
• Alcohol, sleeping pills, Diazepam and other benzodiazepines, other opioids and sedating antihistamines can cause dangerous drowsiness and slowed breathing.
• Carbamazepine lowers its effect and raises seizure risk; Ondansetron may reduce its pain relief.
• It may increase the effect of Warfarin.

Contraindications

Allergy to tramadol; children under 12; severe breathing problems or a severe asthma attack; poisoning with alcohol, sleeping pills, painkillers or other mind-affecting drugs; use of an MAO inhibitor within the past 14 days; epilepsy that is not controlled; and after tonsil or adenoid removal in anyone under 18.

Side Effects

Common: nausea, vomiting, dizziness, drowsiness, constipation, headache, sweating and dry mouth. It can cause dependence (feeling you need it) with regular use. Get urgent medical help for: slow, shallow or difficult breathing; extreme sleepiness or being hard to wake; a seizure (fit); agitation, confusion, fever, fast heartbeat, muscle twitching or stiffness (signs of serotonin syndrome); or a serious allergic reaction such as swelling of the face or throat.

Pregnancy and Lactation

Avoid in pregnancy unless a doctor decides it is essential. Regular use late in pregnancy can cause withdrawal symptoms and breathing problems in the newborn. Not recommended while breastfeeding, as it passes into breast milk.

Precautions and Warnings

Take only as prescribed and never share it; it can be misused and cause addiction. Do not stop suddenly after regular use, as withdrawal symptoms can occur; the doctor will reduce the dose gradually. Do not drive or operate machinery if it makes you drowsy or dizzy, and do not drink alcohol. Use with care in epilepsy, head injury, lung disease, kidney or liver disease, and in older people. Keep it locked away from children and others.

Overdose

Overdose is a medical emergency. Signs include pinpoint pupils, very slow breathing, extreme drowsiness, seizures, low blood pressure and loss of consciousness. Call for emergency help or go to hospital immediately; an antidote (Naloxone) can be given in hospital.

Therapeutic Class

Opioid analgesic (centrally acting painkiller).

Storage

Store below 30°C in a dry place, away from light, and locked away out of the reach of children.