WHAT IS TRAMADOL (ULTRAM)?
When a patient is in need of a short-acting pain reliever with the potency of a narcotic (like codeine or hydrocodone), prescription tramadol is becoming a popular choice by U.S. physicians. Recent data suggests tramadol is the second most widely prescribed "opioid" type short-acting pain reliever, claiming nearly 25% of the prescription business in this category. The tramadol market exceeded 30 million prescriptions in 2010.
As a registered pharmacist my goal is to provide accurate information to help inform patients about the safe and effective use of medications. In this article I will focus on the use of Tramadol for pain. I will address the following issues with respect to tramadol:
- What is tramadol (what other names does it go by, strengths, etc.)?
- How should tramadol be taken?
- What side-effects or other concerns are there with tramadol?
This article, as with my other articles, are not intended to replace the advice or instructions you have received from your personal physician or pharmacist. Please use this information on tramadol as a resource in discussing this medication with your health care provider.
WHAT IS TRAMADOL?
Tramadol is a synthetic prescription opioid pain reliever developed by a German drug manufacturer in the late 1970s. Tramadol came to the U.S. for the first time as an oral formulation in March of 1995 under the brand name "Ultram" and marketed by Janssen Pharmaceuticals.
Tramadol is unique. It works a little like codeine (a narcotic pain reliever) and a little like Effexor (an antidepressant). It stimulates the same pain-relieving receptors that other narcotic pain relievers act upon (known as "mu" receptors) while at the same time increasing levels of norepinephrine and serotonin (a common mechanism for some antidepressants).
Tramadol is available by prescription only and in a variety of forms in the U.S:
- Ultram (tramadol) 50mg tablets (also available generically)
- Ultram ER (tramadol) 100mg, 200mg & 300mg tablets (this is an extended "once a day" version of tramadol)
- Ultracet (tramadol with acetaminophen) 37.5mg/325mg (a combination of tramadol with Tylenol)
- Rybix ODT (tramadol) 50mg (an orally disentegrating tablet version of tramadol)
- Conzip (tramadol) 100mg, 200mg, 300mg extended release capsules.
DOSAGE: Tramadol is intended for adults, ages 17 and over. Use in children ages 16 and under is not recommended.
Tramadol 50mg (immediate release) Tablets:The appropriate dosage for tramadol is 50mg - 100mg every 4 to 6 hours. The extended release versions are intended for once daily dosing. The total daily dosage of immediate-release tramadol should not exceed 400mg daily.
If you have never taken tramadol, and are beginning with the 50mg tablet, it is often a good idea to slowly titrate your dose upwards over several days. However, if you need immediate pain relief (i.e. you are not on any other pain medication) this may not be possible. The typical titration approach is to begin with 25mg in the morning, and then slowly increase this dose every 3 days by 25mg more. Once taking 25mg 4 times daily, then 50mg at once can be attempted.
I suggest taking tramadol with food to reduce stomach upset.
Orally Disintegrating Tablets (Rybix ODT):
This information on taking Rybix is provided directly from the manufacturer: "Place RYBIX ODT tablet on the tongue until it completely disintegrates and then swallow it. It may take approximately one minute for the tablet to disintegrate on the tongue. Tablet may be taken with or without water."
Rybix is mint flavored (just in case you were wondering about that).
Like the tablets, a titration of a slowly increasing dose is ideal. The optimal dosage is 50mg-100mg every 4-6 hours, not to exceed 400mg daily.
Usage in patients under 16 years of age is not recommended.
Long acting Tramadol (e.g. Conzip & Ultram ER):
Typically patients begin the long acting forms on the lowest strength. This is taken once daily for 2-5 days, after which the dose may be increased. This is continued until the optimal dose is reached, typically 200mg to 300mg daily. Dosages above 300mg daily are not recommended.
These tablets should NOT be split, crushed or chewed. They will taste awful. But more importantly, chewing or crushing destoys the time-released mechanism and could lead to a dangerous overdose.
Conzip & Ultram ER are for adults 18 years of age and older.
SIDE EFFECTS AND OTHER CONCERNS
So, is tramadol safe? Should you take tramadol? What side-effects can I expect when taking tramadol?
Tramadol has side-effects. Many people cannot tolerate them. It is a strong medication, and consequently can produce some uncomfortable and unwanted reactions. For example:
One-third (1/3) to two-thirds (2/3) of all patients trying tramadol will experience some of these side-effects. That is a lot. For this reason I recommend you ask your doctor for some samples before buying this yourself. If you must pay for it to try it, then be sure to get a small amount to begin with if possible.
Tramadol may interact with other medications. Of special concern are medicatons that increase serotonin levels (many anti-depressants), as tramadol will also do this and could lead to a potentially serious condition known as "serotonin syndrome." Tramadol should not be mixed with alcohol or any other tranquilizers (sleeping pills).
Other drugs that should not be mixed with tramadol include: erythromycin (an antibiotic), ketoconazole (an anti-fungal), carbamazapine (for seizures), quinidine (for heart rhythm), St. John's Wort (an OTC herbal product), digoxin (for CHF) and others.
- Avoid taking if you have epilepsy or seizures
- Pregnancy - avoid if possible. Tramadol is not recommended during pregnancy
- Liver or Kidney disease - Dose reductions will be necessary
If you have been taking tramadol regularly for a long time, discontinuation should be done by means of slowly tapering off of the medication. Abrupt discontinuation is not recommended.
I hope this information has provided you with some useful insights into the use of tramadol. If you have any further questions, please do not hesitate to post them below!