General recommendations and precautions of Tramadol!

April 27th, 2008

Written and Endorsed by:
Vlãsceanu Alexandra - Medical Student
“Carol Davila” University of Medicine and Pharmacy,
Physical therapy and medical rehabilitation specialty,
Bucharest, Romania

Experienced doctors prescribe analgesic medication only after a careful consult and thorough evaluation of the patient. They want to make sure that a particular drug is suitable for the medical condition the patient is suffering from, without severe adverse reactions or any drug interactions appearing. That is also the case of Tramadol, an efficient opiate drug, administered as a pain reliever.

If you are pregnant or you intend to become a mother in the near future, you will have to mention that to your doctor. Studies have shown that Tramadol can be harmful for an unborn baby, causing malformations, powerful withdrawal symptoms and even fetal death. If you are breast feeding, you should not take Tramadol at all as the same studies have shown that Tramadol can pass into the mother’s milk, causing unwanted side-effects for the baby. The best thing for you to do is to schedule a meeting with your attending physician, discussing both the risks and benefits of using Tramadol while being pregnant or breast-feeding.

We have mentioned about drug interactions. Once you intend to follow a treatment with Tramadol, you will have to tell your doctor detailed information about current prescriptions. That affirmation is also valid for non-prescription medicine, including herbal products and dietary preparations. If you are allergic to any medication, type of food or diverse substances, be sure to mention that as well. Any information is essential when it comes to establishing the right treatment plan. Tramadol is contraindicated to patients who are allergic to similar drugs, including codeine or morphine.

Many patients refuse to recognize they had a drinking problem or a history of substance abuse. When it comes to prescribing Tramadol, this information is highly significant and patients with such a medical history will not be considered as suitable. Those suffering from mental illnesses (schizophrenia), with suicidal thoughts and abnormal behavior will also be disregarded. You will have to mention to your doctor if you have had any trauma to your head, breathing problems, epilepsy or seizures. Excessive doses or long-term treatments with Tramadol can increase the risk of convulsions. The risk is increased even more when Tramadol is administered simultaneously with tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) or other opioids of similar structure.

As Tramadol is contraindicated to those who have liver or kidney problems, you should tell your doctor if you suffer from such medical conditions. If you have been diagnosed with cirrhosis, for example, your dosage of Tramadol is reduced to 50 mg/12 hours. You are to take the same dosage if you are suffering from other liver disease, including hepatitis. You should also know that Tramadol is not recommended for those who suffer from severe hepatic impairment, as a large percent of the drug is metabolized in the liver. Dosage reduction applies to those suffering from kidney disease as well. If your creatinine clearance falls under the value of 30ml/min, then the dosage will be reduced extremely. As Tramadol is partially metabolized in the kidney, you will not be taking the drug after being diagnosed with kidney failure. One interesting aspect is that the usual dosage is not modified in case of patients undergoing hem dialysis. This is because only a small portion of Tramadol is removed during this procedure.

Often times, Tramadol is given to patient suffering from chronic pain of diverse types. You should contact your doctor if the Tramadol treatment stops working for you, as you may develop tolerance to the drug. Tolerance is nothing to be scared of and it can be simply resolved by increasing the dosage a little. Still, be careful and do not increase the dosage after your own liking. You might have to call the doctor or even seek immediate medical attention if severe side-effects appear and prevent you from functioning normally. We are talking about vertigo, somnolence, nausea, vomiting, anorexia, constipation or diarrhea, diaphoresis (excessive sweating). More serious adverse reactions can become life-threatening and you have to recognize the danger: chest pain, extreme agitation, lack of coordination, muscle rigidity. High doses of Tramadol and multiple drug taking are likely to cause these symptoms, so be extra careful.

You will also have to keep in mind the situations when Tramadol is contraindicated. Here a few examples:
- opioid treatment contraindicated;
- allergic reaction to opioids – including anaphylactic shock;
- alcohol or substance abuse (opioids, narcotics such as morphine or codeine, sedatives, tranquillizers or sleeping drugs);
- carbamazepine, antidepressants (nefazodone) treatments;
- Breast-feeding.

If you follow the directions written on your prescription label, you won’t have any problem with your Tramadol treatment. You can always resort to the Internet for additional information on the subject. Thus, you will be informed that for those with stomach problems, Tramadol is to be taken with a glass of milk of food. You will be explained potential side-effects in detail and a few tips on how to overcome them. Let’s see one particular example. If Tramadol causes your mouth to be dry (condition generally known as xerostomia), you can try chewing sugar-free gum or drinking larger quantities of water. Also, if your eyes are dry and your vision blurred from Tramadol, you can use lubricating drops.

At any moment of your Tramadol treatment, you should consult with your doctor. Regular visits are a must in order to assess the progress of the treatment and discuss about any problems you might have. Only a medical professional is certified to explain to you withdrawal symptoms and how to avoid more serious ones while trying to stop the treatment. As for the dosage, you should start with a low dosage of 25 mg and increase it gradually until you reach 100 mg/day. Do not take more than 300 mg/day if you are over 75 years old and not more than 200 mg/day if you have kidney problems.

Written and Endorsed on April 27th, 2008 by:

Vlãsceanu Alexandra - Medical Student
“Carol Davila” University of Medicine and Pharmacy,
Physical therapy and medical rehabilitation specialty,
Bucharest, Romania