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TRAMADOL HCL ER (TRAMADOL HCL)
- Chronic pain
- Tramadol Er Tablet,extended Release 24Hr Mphase
- Tramadol Er Tablet,extended Release 24 Hr
- By Indication
tramadol ER 100 mg tablet,extended release 24hr mphase
- 2 tablets (200 mg) by oral route once daily
tramadol ER 200 mg tablet,extended release 24hr mphase
- 1 tablet (200 mg) by oral route once daily
tramadol ER 300 mg tablet,extended release 24hr mphase
- 1 tablet (300 mg) by oral route once daily
tramadol ER 100 mg tablet,extended release 24 hr
- 1 tablet (100 mg) by oral route once daily
tramadol ER 200 mg tablet,extended release 24 hr
- 1 tablet (200 mg) by oral route once daily
tramadol ER 300 mg tablet,extended release 24 hr
- 1 tablet (300 mg) by oral route once daily
Chronic pain
- 1 tablet (100 mg) by oral route once daily
- 2 tablets (200 mg) by oral route once daily
- 1 tablet (200 mg) by oral route once daily
- 1 tablet (300 mg) by oral route once daily
- Azilect
- Depade
- Eldepryl
- isocarboxazid
- linezolid
- Marplan
- Matulane
- methylene blue (antidote)
- naltrexone
- naltrexone microspheres
- Nardil
- Parnate
- phenelzine
- procarbazine
- rasagiline
- Revia
- selegiline HCl
- tranylcypromine
- Vivitrol
- Zelapar
- Zyvox
Contraindicated
- almotriptan malate
- Alsuma
- Amerge
- amitriptyline
- amitriptyline-chlordiazepoxide
- amoxapine
- Amrix
- Anafranil
- Axert
- Buprenex
- buprenorphine
- buprenorphine-naloxone
- butorphanol tartrate
- Butrans
- carbamazepine
- Carbatrol
- clomipramine
- cyclobenzaprine
- cyclobenzaprine with msm
- desipramine
- doxepin
- eletriptan HBr
- Epitol
- Equetro
- Frova
- frovatriptan
- imipramine HCl
- imipramine pamoate
- Imitrex
- Imitrex Statdose Kit Refill
- Imitrex Statdose Pen
- maprotiline
- Maxalt
- Maxalt-mlt
- nalbuphine
- naratriptan
- Norpramin
- nortriptyline
- Pamelor
- perphenazine-amitriptyline
- protriptyline
- Relpax
- rizatriptan
- Silenor
- Suboxone
- sumatriptan
- sumatriptan succinate
- Sumavel Dosepro
- Surmontil
- Tabradol
- Tegretol
- Tegretol Xr
- Tofranil
- Tofranil-pm
- trimipramine
- Vivactil
- zolmitriptan
- Zomig
- Zomig Zmt
- Zubsolv
Severe
Moderate
- abiraterone
- Aplenzin
- Belviq
- Brintellix
- Brisdelle
- Buproban
- bupropion HBr
- bupropion HCl
- Celexa
- cinacalcet
- citalopram
- Coumadin
- Cymbalta
- desvenlafaxine
- desvenlafaxine fumarate
- desvenlafaxine succinate
- dextromethorphan-quinidine
- duloxetine
- Effexor Xr
- escitalopram oxalate
- Fanatrex
- Fetzima
- fluoxetine
- fluvoxamine
- Forfivo Xl
- gabapentin
- gabapentin enacarbil
- Gralise
- Gralise 30-day Starter Pack
- Horizant
- Jantoven
- Khedezla
- Lamisil
- levomilnacipran
- Lexapro
- lorcaserin
- Luvox Cr
- milnacipran
- mirabegron
- mirtazapine
- Myrbetriq
- nefazodone
- Neurontin
- Nuedexta
- olanzapine-fluoxetine
- Oleptro Er
- ondansetron
- ondansetron HCl
- ondansetron HCl (PF)
- paroxetine HCl
- paroxetine mesylate
- Paxil
- Paxil Cr
- Pexeva
- Pristiq
- Prozac
- Prozac Weekly
- quinidine gluconate
- quinidine sulfate
- Remeron
- Remeron Soltab
- Sarafem
- Savella
- Sensipar
- sertraline
- Symbyax
- terbinafine
- trazodone
- venlafaxine
- Viibryd
- vilazodone
- vortioxetine
- warfarin
- Wellbutrin
- Wellbutrin Sr
- Wellbutrin Xl
- Zofran
- Zofran Odt
- Zoloft
- Zuplenz
- Zyban
- Zytiga
- Adenoidectomy in pediatric patient
- Alcohol intoxication
- Benzodiazepine overdose
- Gastrointestinal obstruction
- Lactating mother
- Opioid overdose
- Serotonin syndrome
- Tonsillectomy in pediatric patient
Contraindicated
- Abrupt drug withdrawal causing life-threatening sequelae
- Alcohol withdrawal syndrome
- Alcoholism
- Asthma
- Central nervous system infection
- Chronic obstructive pulmonary disease
- Depression
- Drug abuse
- Hepatic cirrhosis
- Intracranial hypertension
- Kidney disease with likely reduction in GFR
- Lower seizure threshold
- Obstructive sleep apnea syndrome
- Respiratory depression
- Seizure disorder
- Suicidal
- Suicidal ideation
Severe
Moderate
- Adrenal cortical insufficiency
- CYp2d6 poor metabolizer
- CYp2d6 ultrarapid metabolizer
TRAMADOL HCL ER (TRAMADOL HCL)
- Chronic pain
- None
- Constipation
- Dizziness
- Flushing
- Headache disorder
- Insomnia
- Nausea
- Pruritus of skin
- Vertigo
- Vomiting
- Xerostomia
More Frequent
Severe
Less Severe
- Respiratory depression
- Acute abdominal pain
- Acute confusion
- Anorexia
- Arthralgias
- Blurred vision
- Diarrhea
- Drowsy
- Dyspepsia
- Flatulence
- General weakness
- Hyperhidrosis
- Hypertension
- Nervousness
- Orthostatic hypotension
- Skin rash
- Symptoms of anxiety
- Urinary retention
- Vasodilation of blood vessels
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Abnormal ECG
- Accidental injury
- Adrenal cortical insufficiency
- Anaphylaxis
- Androgen deficiency
- Anemia
- Angioedema
- Bronchospastic pulmonary disease
- Dyspnea
- Hearing loss
- Hepatic failure
- Hepatitis
- Hypoglycemic disorder
- Increased urinary frequency
- Myocardial ischemia
- Peripheral ischemia
- Prolonged QT interval
- Pulmonary edema
- Pulmonary thromboembolism
- Seizure disorder
- Serotonin syndrome
- Stevens-johnson syndrome
- Suicidal
- Tachycardia
- Toxic epidermal necrolysis
Less Severe
- Agitation
- Bruising
- Cataracts
- Chills
- Cramps in legs
- Delirium
- Depersonalization
- Depression
- Dream disorder
- Drug dependence
- Dysgeusia
- Dysuria
- Ecchymosis
- Erectile dysfunction
- Euphoria
- Fever
- Flu-like symptoms
- Gastroenteritis
- Hallucinations
- Hematuria
- Hyperglycemia
- Hyperkinesis
- Hypertonia
- Hypotension
- Indifference
- Infertility
- Libido changes
- Menstrual disorder
- Miosis
- Mood changes
- Myalgias
- Neck stiffness
- Night sweats
- Palpitations
- Paresthesia
- Peripheral edema
- Pharyngitis
- Sinusitis
- Sleep disorder
- Stomatitis
- Syncope
- Tinnitus
- Tremor
- Twitching
- Urinary tract infection
- Urticaria
- Visual changes
- Weight loss
- Yawning
Contraindicated
Tramadol
Risk of slowed or difficult breathing and respiratory depression. Contraindicated age< 12 years,
- 1 Day – 12 Years
- 1 Risk of slowed or difficult breathing and respiratory depression. Contraindicated age< 12 years,
Severe Precaution
Tramadol
Contraindicated post adenoidectomy and/or tonsillectomy, Risk of slowed or difficult breathing and respiratory depression. Avoid in patient with obstructive sleep apnea, lung disease.
- 12 Years – 18 Years
- Contraindicated post adenoidectomy and/or tonsillectomy, Risk of slowed or difficult breathing and respiratory depression. Avoid in patient with obstructive sleep apnea, lung disease.
Management or Monitoring Precaution
None
Tramadol
- Severity Level:
2
- Additional Notes: Neonate seizure/withdrawal syn/fetal death reported;small teratogenic risk
Contraindicated
Tramadol
Low amounts excreted; monitor for respiratory depression
| General | Excretion Potential | Effect on Infant | Notes |
| Drug should not be given to breast feeding mothers | Excreted | Not known; no or inclusive data | Low amounts excreted; monitor for respiratory depression |
Precaution Exists
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Tramadol
General-Start at low doses; titrate slowly; do not exceed 300 mg/day in adults >75 years old. Consider naloxone Rx. Hepatic-Reduce dose for cirrhosis. Neuro/Psych-Risk for confusion, hallucination, delirium and falls. Lowers seizure threshold. Avoid use w/3 or more CNS active drugs. Endocrine-Monitor sodium level at start and with dose changes; risk of SIADH, hyponatremia. Pulmonary-Risk of resp depression. Renal-Avoid extended release form. Reduce dose for CrCl < 30 mL/min.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | Y | Y | N | Y | Y | Y |
BEERS: Y HEDIS: N STOPP: Y
No Known Risk
None
- Tramadol has a risk for abuse and addiction, which can lead to overdose and death. Tramadol may also cause severe, possibly fatal, breathing problems. To lower your risk, your doctor should have you take the smallest dose of tramadol that works, and take it for the shortest possible time.<br /><br />See also How to Use section for more information about addiction. The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.<br /><br />Also, other medications can affect the removal of tramadol from your body, which may affect how tramadol works. Be sure you know how to take tramadol and what other drugs you should avoid taking with it. See also Drug Interactions section.<br /><br />Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up. Keep this medicine in a safe place to prevent theft, misuse, or abuse. If someone accidentally swallows this drug, get medical help right away.<br /><br /> Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed.<br /><br />It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, take the smallest effective dose for the shortest possible time.<br /><br /> Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight. Children younger than 12 years should not use products that contain tramadol.<br /><br />Children between 12 and 18 years old should not use tramadol after certain surgeries (including tonsil/adenoid removal). Also, tramadol use is not recommended for children between 12 and 18 years old who are obese or have breathing problems. Some children are more sensitive to tramadol and have had very serious (rarely fatal) breathing problems such as slow/shallow breathing (see also Side Effects section). Talk with your doctor or pharmacist about the risks and benefits of this medication.
| Chronic pain | |
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| 0-9 | A-Z |
|---|---|
| G89.2 | Chronic pain, not elsewhere classified |
| G89.21 | Chronic pain due to trauma |
| G89.22 | Chronic post-thoracotomy pain |
| G89.28 | Other chronic postprocedural pain |
| G89.29 | Other chronic pain |
| G89.3 | Neoplasm related pain (acute) (chronic) |
Formulary Reference Tool