Brief Description: – Centrally acting opiate agonist that inhibits the uptake of norepinephrine and serotonin, suggesting both opiod and nonopiod mechanisms of pain relief. May produce opiod-like effects, but causes less respiratory depression than morphine. How Supplied: – ULTRAM® Tablets – 50 mg are white, capsule-shaped, coated tablet imprinted “ULTRAM on one side and “06 59” on the scored side. Bottles of 100 tablets. Dispense in a tight container. Store 25°C (77°F). Indications:
-Management of moderate to moderately severe pain. Dosing: For adults 17 years and over: Ultram should be started at 25 mg/day every AM and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day (meaning 25 mg four times a day). Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg four times a day). After titration, ULTRAM® 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
For geriatric patients (75 years or older) total does should not exceed 300 mg/day In all patients with creatinie clearance less than 30 ml/min, it is recommended that the dosing interval of ULTRAM® be increased to 12 hours, with a maximum daily dose of 200 mg. Since only 7% of an administered dose is removed by hemodialysis Common Side Effects: Dizzieness, spinning sensation, constipation, upset stomach, headache, drowsiness, feeling nervous or anxious, dry mouth Serious Side Effects:
Agitation, hallucination, fever, fast heart rate, overactive reflexes, vomiting, diarrhea, loss of coordination, fainting, seizures (convulsing), a red blistering peeling skin rash, shallow breathing, weak pulse dyspepsia, anorexia, flatulence, urinary retention. Warning and Precautions: – Use caution with debilitated patients, chronic respiratory disorders, respiratory depression, older adults, liver disease, renal impairment, myxedema, hyptothyroidism, GI disease, acute abdominal conditions, increased ICP, history of seizures, patients older than 75 and women who are pregnant.
– Ultram may cause seizures and/or serotonin syndrome when taken along with serotonergic agents or drugs that significantly reduce the rate at which Ultram leaves your body – Ultram may decrease your ability to perform potentially dangerous mental or physical tasks such as driving a car or operating machinery – Ultram should not be taken with alcohol – Ultram should be used with caution when taking medications such as tranquilizers, hypnotic drugs or other opiate containing pain relievers.
Use of these medicines may increase your risk of breathing difficulties, decreased rate of breathing, decreased heart rate, and loss of consciousness that could possibly lead to coma or death. Drug Interactions -Carbamazepine significantly decreases tramadol levels. Tramadol may increase adverse effects of Mao inhibitors. Tricyclic antidepressants, cyclobenzaprine, phenothiazines, selective serotonin-reuptake inhibitors, MAO inhibitors may enhance seizure risk with tramadol. May increase CNS adverse effects when used with other CNS depressants.
Contradictions: Hypersensitivity to tramadol or other opioid analgesics; severe respiratory depression; severe or acute asthmas; patients on MAO inhibitors; substance abuse; alcohol intoxication; lactation. Clinical Pharmacology: – Rapidly absorbed from GI tract; 75% reaches systemic circulation. Onset: 30-60 minutes. Peak: 2 hours. Duration: 3-7 hours. Distribution: Approximately 20% bound to plasma proteins; probably crosses blood-brain barrier; crosses placenta; 0. 1% excreted into breast milk.
Metabolism: Extensively in liver by cytochrome P450 system. Elimination: Primarily in urine. Half-Life: 6-7 hours. Patient Counseling: Tell patient to exercise caution with potentially hazardous activities until response to drug is known. Make patient aware to not exceed the total number of mg prescribed for a 24 hour period. Make sure patient understands potential adverse side effects and report problems with bowel and bladder function, CNS impairment, and my any other bothersome adverse effects to prescriber. References: Pearson Nurses Drug Guide.