Tramadol: painkiller in tablets and ampoules, instructions for use

Tramadol is a very old opioid painkiller. The pharmaceutical drug is used to eliminate severe pain; to a greater extent, the drug is prescribed to cancer patients. The analgesic effect of Tramadol is 5 times less than that of morphine. The medication is sold as a single drug or in combination with paracetamol.

Group: pharmaceutical drugs

Is Tramadol a drug?

At the initial stage of studying tramadol, it was recognized that pain relief occurs due to the participation of the opioid system, the medication was classified as a narcotic painkiller.

Trambadol

The small number of side effects is explained by the establishment of a mixed mechanism of action. In Russia, the analgesic is included in the group of vital and essential drugs.

Consequently, according to the current classification, Tramadol is not considered a narcotic substance, but is classified as a potent drug. The medication is not dispensed without a prescription from the attending physician.

Use in doses exceeding the therapeutic range contributes to the formation of dependence.

Instructions for use

As mentioned above, Tramadol is sold in pharmacies only with a doctor's prescription. The prescription is written out on form 148-1/у-88.

Rp.: Tab. Tramadoli 0.1 DtsN 30 S. 1 tablet. * 2 w.d.

In tablets

The tablets are taken orally, without chewing, swallowing whole. It is important to take the medicine with enough water.

The medicine is used exclusively as prescribed by the doctor, the dosage is selected individually for each patient, it all depends on the severity of the pain. Recommended dosages are only indicative; the duration of treatment with tablets is determined by the doctor personally for each patient. When treating chronic pain, an analgesic dosage schedule should be followed.

You should not take more than 8 tablets with a dosage of 50 mg or 4 tablets with a dosage of 100 mg per day (exceptions: postoperative pain, oncology).

A single dose for persons over 14 years of age (weight over 25 kg) is equal to 1 tablet with a dosage of 50 mg or half a tablet with a dosage of 100 mg. If the pain does not go away, you can take 1 more tablet after an hour.

For severe pain, a single dose may be 100 mg.

In persons over 75 years of age, in patients with renal or liver failure, Tramadol is eliminated from the body more slowly. It may be advisable to increase the time between new doses.

In ampoules

Solution for injection 50 mg/ml and 100 mg/2 ml.

The doctor selects the dosage of the drug individually for each patient.

For persons over 14 years of age, the drug is administered slowly by drip, 1 ml-2 ml of solution (50-100 mg), 400 mg is the permissible dosage per day. When administered subcutaneously or intramuscularly, the drug is taken in the same dosage. A repeat drip can be placed only after 4 hours.

The recommended dosage per day should not exceed 400 mg, but in severe cases, doctors take the liberty of increasing the dosage to 600 mg.

For patients with kidney or liver failure, doctors may prescribe a lower dosage of pain medication.

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Composition and release form

10 pcs in blister; There are 5 blisters in a box.

10 pcs in blister; There are 2 blisters in a box.

in dropper bottles of 10 or 20 ml; There is 1 dropper bottle in the box.

in ampoules of 1 ml; in a box there are 5 ampoules of 1 ml each.

in ampoules of 2 ml; in a box there are 5, 10 or 50 ampoules of 2 ml.

10 pcs in blister; There are 1 or 2 blisters in a box.

Drug effect and side effects

Drug addicts taking Tramadol experience:

• A feeling of bliss that lasts almost the entire period of intoxication
• Duration of the trip is about 10 hours
• Excitement due to the duality of the mechanism of action
• Slowness, lethargy, drowsiness
• Getting a "high" from ordinary things that caught their attention (watching a tree)

Symptomatic therapy with the drug often goes well. But exceeding the dose and using it for non-medical purposes is accompanied by the following symptoms:

1. Increased heart rate
2. Headache
3. Excessive sweating
4. Muscle weakness
5. Nausea and vomiting
6. Insomnia
7. Impaired coordination of movements
8. Severe lethargy
9. Stomach ache
10. Allergy
11. Dyspnea
12. Swallowing disorder
13. Urinary retention

How to relieve withdrawal symptoms from Tramadol

Dependence on Tramadol is very strong. Rapid withdrawal of the drug provokes the development of withdrawal symptoms.

Psychological symptoms of withdrawal:

• Hallucinations
• Aggressiveness
• Depression
• Hysterics
• Suicidal tendencies

The physical manifestations of withdrawal are the same as the side effects that occur when taking medications in high doses.

If withdrawal symptoms occur, it is better to seek help from a doctor. Detoxification will help relieve the painful symptoms of withdrawal.

The doctor will develop a schedule for stopping the medication and prescribe a diet. During treatment it is necessary to stop drinking alcohol.

How long does it stay in urine?

Metabolites of the drug remain in the urine for about a week. The half-life depends on the regularity of use of the analgesic and the presence of problems with the urinary system.

Tramadol for oncology

The medicine will be prescribed to cancer patients if pain does not decrease after using less toxic but highly effective painkillers. Long-term use of opiates risks addiction.

But in cancer patients in the terminal stage and with metastases, drug addiction is excluded.

Overdose

Persons over 14 years of age are usually prescribed 50 mg of the drug at a time (1 tablet). Repeated administration of the tablet form is allowed after 30-60 minutes if the desired effect does not occur.

The permissible single dose for injection is 50-100 mg (1-2 ampoules). Repeated administration should be carried out no earlier than after 4 hours.

The maximum dose of the drug per day for persons over 14 years of age is 400 mg, sometimes the dosage is increased to 600 mg. Elderly people should not take more than 300 mg of the drug per day.

Usually, for children under 14 years of age, the doctor prescribes Tramadol in the form of injections or drops. A single dosage depends on the patient’s weight (1-2 mg/kg), the maximum dosage per day should not exceed 8 mg/kg.

Increasing these dosages can lead to coma and death. If symptoms of overdose occur, it is important to provide fresh air to the patient and urgently call an ambulance.

Tramadol, 50 mg/ml, solution for injection, 2 ml, 5 pcs.

Tablets:
orally,
with a small amount of liquid. The drug is used as prescribed by a doctor, the dosage regimen is selected individually, depending on the severity of the pain syndrome and the sensitivity of the patient. The duration of treatment is determined individually; the drug should not be prescribed beyond the period justified from a therapeutic point of view.

In the absence of other prescriptions, the drug should be prescribed in the following dosages: orally for a single use in adults and children over 14 years of age - 50 mg, after 30-60 minutes the same dose can be repeated, but not more than 8 doses per day. The maximum daily dose is 400 mg.

Elderly people (75 years and older) and patients with renal failure require individual dosage. When creatinine Cl is less than 30 ml/min and in patients with liver failure, a 12-hour interval is required between taking subsequent doses of the drug.

Solution for injection:
intravenously
(injected slowly, no more than 1 ml of solution per minute, which corresponds to 50 mg of tramadol),
intramuscularly, subcutaneously
. To dilute the drug, you can use water for injection, saline solution and 5% dextrose solution.

Dilution of the drug Tramadol with water to obtain the final concentration is shown in the table.

Table

The doses recommended below are indicative. In practice, it is necessary to select the minimum analgesically effective dose. The duration of treatment with the drug is determined individually. Do not use longer than is justified from a therapeutic point of view.

Adults and teenagers over 14 years of age:

single dose - 50-100 mg, repeated administration of the drug after 4-6 hours is possible. Maximum daily dose - 400 mg.

Children from 1 to 14 years old:

single dose 1-2 mg/kg, maximum daily dose - 8 mg/kg.

Patients with impaired renal and/or liver function.

In patients in these categories, it is difficult to remove tramadol from the body. In the case of the treatment of acute pain syndromes in such patients, when a rare or single dose of tramadol is necessary, no special dosage changes are required. However, in the case of treatment of chronic pain, it is necessary to remember the danger of accumulation of the drug in the body, therefore it is advisable to increase the intervals between its individual doses. The drug should be prescribed with caution to patients with impaired renal function (50–100 mg 2 times a day), as well as to persons with cirrhosis of the liver (in this group of patients, T1/2 of tramadol increases almost 3 times).

Elderly patients.

In elderly patients (over 75 years of age), the elimination of tramadol from the body slows down, even when there are no clinical manifestations of impaired renal and/or liver function. In these patients, it is also necessary to increase the intervals between individual doses of the drug. It is recommended not to exceed the daily dose of 300 mg.

Addiction

Therapeutic doses of the drug usually do not cause pathological desire. However, a slight increase in dose leads to physical and psychological dependence.

As a result of regular use of the drug for 3 months, it becomes the only and “unique” drug for a person.

Physical cravings for the drug can be overcome, but fighting mental cravings requires patience and special efforts.

Even after detox therapy, Tramadol is not completely eliminated from the body.

Signs of use and consequences

Drug addicts manage to keep their addiction secret for a long time.
In many cases, loved ones find out about the disease at a serious stage, which complicates further treatment and rehabilitation of the patient. But addicts skillfully hide, so you should be especially attentive to teenagers and relatives. There are signs that indicate a person is taking drugs. To understand what to look for in the behavior and appearance of a dependent person, let’s consider several signs indicating the manifestation of dependence on a narcotic substance, in particular, the pharmaceutical drug in question:

• lethargy;
• violation of movement coordination;
• manifestation of inappropriate behavior, both at home and at work;
• aggression during chemical withdrawal;
• tremor of the limbs;
• limited interests;
• weight loss.

The life of a dependent person with a long experience is divided into two components. This is the period of action of the pharmaceutical drug and withdrawal of the substance. In search of a dose, drug addicts rarely stop; they do not think about the consequences of abuse. Moral and ethical values ​​are being lost. A person radically changes his behavior. His family doesn't recognize him. Only a state of euphoria can return him to a relatively normal state. Since life is subordinated to the drug, a person loses his job, loses professional interests, and does not communicate with friends. He acquires new hobbies and accomplices who are also obsessed with finding a new dose. Changes in behavior should alert loved ones.

Withdrawal syndrome or withdrawal begins a few hours after stopping the drug. These are dangerous conditions that can have fatal consequences if medical care is not provided. Relatives can easily see the person’s difficult physical and psychological condition. He exhibits the following symptoms:

• excessive sweating;
• chills;
• temperature increase;
• convulsions;
• joint pain;
• headache;
• dizziness;
• stomach pain;
• nausea;
• vomit.

Withdrawal is a consequence of regular drug use. In addition to physical symptoms, the manifestation of mental ones is increasing. A person experiences anxiety and excitement, fear and horror, he is prone to panic.

In this situation, relatives need to contact narcologists at the Svoboda RC. You cannot hesitate, since the patient’s condition does not allow time for this. Doctors unanimously recommend cleansing the body of the drug and its breakdown products in a clinic. Only in the hospital all conditions have been created. If necessary, you can call a narcologist to your home from the Svoboda RC. The doctor will conduct detoxification therapy, but on the condition that the drug addict’s health condition does not cause him concern. You must be prepared for the fact that withdrawal will take place in a hospital in any case if the addict is elderly, has chronic pathologies, as well as a long history of using pharmaceutical and other drugs, when combined with alcoholic beverages.

If you suspect use, at the initial stage of use, when withdrawal symptoms are not so clearly manifested, you can do a drug test. The chemical is found in urine, blood and hair. Laboratory tests provide reliable results, since pharmacy tests can detect a limited amount of narcotic substances used by a person.

Tramadol is eliminated from the body in 6-7 hours, but much depends on the patient’s health status, length of use, weight and other characteristics. The body is completely cleansed in 3 days. Most of the pharmaceutical drug is excreted through the kidneys (90%), through the gastrointestinal tract - 10%.

Compatibility with other drugs

Taking Tramadol and pregabalin together may cause constipation. To avoid this, it is necessary to follow preventive measures against intestinal obstruction and constipation.

Simultaneous use of an opioid painkiller with Analgin and Ketorol leads to increased toxic effects (drugs cannot be mixed).

Ketonol should not be mixed with Tramadol to avoid side effects.

When dealing with moderate pain due to cancer, the combination Tramadol + Diphenhydramine (increases the analgesic effect) is excellent.

If a doctor prescribes Tramadol, the patient must completely stop drinking alcohol.

The simultaneous use of Tramadol and Morphine can lead to breathing problems and arterial hypotension.

Combining Phenazepam and Tramadol can lead to increased side effects.

Tramadol for toothache

Tramadol is a mixed action analgesic. For severe toothache, an opioid pain reliever will help.

However, when taking Tramadol, you should be sure to familiarize yourself with the possible side effects and follow the dosage.

When the opportunity arises, you should immediately contact your dentist.

Tramadol for cats and dogs

Veterinarians prescribe opioid pain medication to dogs and cats for severe pain or after surgery, cancer, or injury. In addition, Tramadol is used to relieve pain in older dogs.

Depending on the situation, the recommended dose of medication for dogs can vary from 1.1 mg/kg to 9.9 mg/kg. The medication can be taken orally every 8 hours.

The recommended single dosage for cats is 3 mg/kg, repeated dosage is allowed only after 8 hours.

Products

Composition: 1 tablet (50 mg) contains: active substance: tramadol hydrochloride 50 mg excipients: potato starch, lactose, magnesium stearate

DESCRIPTION

Tablets are white or white with a slight yellowish tint.

Pharmacotherapeutic group

An analgesic with a mixed mechanism of action.

ATX code

N02AX02

Belongs to list 1 of potent substances.

pharmachologic effect

Tramadol is a cyclohexanol derivative with opiate-agonist properties. Refers to centrally acting analgesics. It has weak affinity for opiate receptors without preferential selectivity for certain receptor populations. It has analgesic, antitussive and sedative effects. The activity of tramadol is 1/10-1/6 of the activity of morphine. Unlike morphine, tramadol in therapeutic doses does not depress respiration, does not suppress gastrointestinal motility and does not affect cardiovascular activity.

Pharmacokinetics

When taken orally, it is quickly absorbed, the therapeutic effect occurs within 15-30 minutes. The therapeutic effect lasts for 4-8 hours. The maximum concentration in blood plasma after oral administration is observed after 1.5-2 hours. Plasma protein binding is about 20%. Penetrates through the placental barrier (the concentration in the blood of the umbilical vein is 80% of the concentration in the mother's blood). Biotransformation occurs in the liver through demethylation and conjugation with the formation of 11 metabolites (1 of them is active). It is excreted mainly by the kidneys (90%) and intestines (about 10%). If the functions of the liver and kidneys are impaired (creatinine clearance less than 80 ml/min), excretion slows down.

Indications for use

• Acute and chronic pain syndrome of strong and moderate intensity of various origins (malignant tumors, injuries, severe neurology, etc.); • Painful diagnostic and therapeutic manipulations.

Contraindications

• Hypersensitivity to any of the components of the drug; • Acute poisoning with alcohol, analgesics, sleeping pills and psychopharmacological drugs; • Treatment with MAO inhibitors and for 14 days after the end of this treatment; • Children under 14 years of age. Tramadol cannot be used as replacement therapy for drug addiction.

Carefully

• opioid addiction (dependence on opioids); • disturbances of consciousness of unknown origin; • disorders of the respiratory center and respiratory functions, as well as in conditions accompanied by increased intracranial pressure, if the patient is not on artificial respiration; • brain diseases; • shock; • epilepsy or tendency to seizures. In patients with epilepsy or prone to seizures, the drug is used only in exceptional cases; • patients with hypersensitivity to opioids.

Use during pregnancy and lactation

Tramadol penetrates the placental barrier. In small quantities (0.1% of the concentration in the blood plasma) it enters breast milk. In this regard, therapy during pregnancy should be limited to individual single doses. Long-term use during pregnancy should be avoided due to the risk of developing addiction in the fetus and the possibility of withdrawal syndrome in the neonatal period. The use of tramadol immediately before or during labor does not affect the contractile function of the uterus. In these cases, the newborn may experience a change in the frequency of respiratory movements, which is insignificant for clinical practice. The use of tramadol during lactation in the form of single doses does not require interruption of breastfeeding.

Directions for use and doses

Inside. The dosages used depend on the severity of the pain syndrome and the individual sensitivity of the patient. The time of taking the drug does not depend on the time of meals.

Adults and adolescents over 14 years of age: A single dose is 50 mg of tramadol. In case of insufficiency or absence of analgesic effect, 50 mg of tramadol is taken again after 30-60 minutes. For severe pain, a single dose of 100 mg of tramadol. The analgesic effect usually lasts for 4-8 hours. The maximum daily dose is 400 mg.

Patients with impaired renal and/or liver function: In patients with impaired renal and/or liver function, it is difficult to eliminate tramadol from the body. In the case of treatment of acute pain syndromes in such patients, when a rare or one-time prescription of tramadol is necessary, no special dosage changes are required. However, in cases of treatment of chronic pain, it is necessary to remember the danger of accumulation of the drug in the body, therefore it is advisable to increase the intervals between its individual doses. The drug should be prescribed with caution to patients with impaired renal function (50-100 mg 2 times a day), as well as to persons with cirrhosis of the liver (in this group of patients, T1/2 of tramadol increases almost 3 times).

Elderly patients: In elderly patients (over 75 years of age), the elimination of tramadol from the body slows down even when there are no clinical manifestations of impaired renal and/or liver function. In these patients, it is also necessary to increase the intervals between individual doses of the drug. It is recommended not to exceed the daily dose of 300 mg.

Side effect

Cardiovascular system: tachycardia, decreased blood pressure (up to orthostatic collapse), syncope. Gastrointestinal tract: nausea, vomiting, dry mouth, abdominal pain, anorexia, flatulence, constipation.

Nervous system and mental sphere: anxiety, lack of coordination, euphoria or depression, miosis, sleep disorders, increased nervous excitability, cognitive impairment, paresthesia, tremor, amnesia, convulsions, hallucinations, respiratory depression, sedation of varying severity, dizziness, headache , increased muscle tone. Urinary system: difficulty or frequent urination.

Other: skin reactions (exanthema, itching) up to anaphylactic shock, Steven-Johnson syndrome, excessive sweating, dyspnea. Long-term use - drug dependence, with sudden o. A worsening of bronchial asthma has been reported, however, there has been no evidence of a negative effect of tramadol on asthma.

Overdose

Symptoms: miosis or mydriasis, vomiting, tachycardia, increased blood pressure, collapse, depression of consciousness, up to coma, respiratory depression (up to apnea).

Treatment: when administered orally, first of all, it is necessary to ensure that the stomach is cleared of the drug that has not yet been absorbed (artificial vomiting, gastric lavage). The main emergency measures in more severe cases are ensuring airway patency (intubation), maintaining breathing and the cardiovascular system. The antidote for depression of the respiratory center is naloxone, which is administered in repeated doses, because Its duration of action is shorter than that of tramadol. Benzodiazepines are used to relieve convulsive syndrome.

Interaction with other drugs

With the simultaneous use of tramadol and: • drugs that depress the central nervous system, especially antidepressants, as well as alcohol, the side effects of tramadol on the central nervous system increase; • drugs that can provoke seizures or increase seizure readiness (for example, antipsychotics and antidepressants), in very rare cases epileptic seizures can be observed. The risk of seizures increases with the use of high doses of tramadol - over 400 mg per day; • carbamazepine decreases and the analgesic effect of tramadol is reduced; • quinidine increases the plasma concentration of tramadol; • barbiturates and tranquilizers may enhance and increase the duration of the analgesic and sedative effects of tramadol. Long-term use of opioid analgesics or barbiturates stimulates the development of cross-tolerance.

special instructions

Recommended doses are approximate. In practice, it is necessary to select the minimum analgesically effective dose. The duration of treatment with the drug is determined individually. Do not use longer than is justified from a therapeutic point of view. When treating long-term pain syndrome, it is advisable to take short-term breaks in the use of tramadol in order to re-determine the required therapeutic dose. During the treatment period, it is necessary to avoid drinking alcohol and refrain from engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Release form

10 or 20 tablets in blister packs. 1 or 2 blister packs along with instructions for use are placed in a cardboard pack.

Best before date

3 years. Do not use after the expiration date stated on the packaging.

Best before date

Belongs to list 1 of potent substances. In a dry place, protected from light, at a temperature not exceeding 25°C, out of the reach of children.