Tramadol: Difference between revisions
From Pharmacopedia
More actions
| [checked revision] | [checked revision] |
MDElliottMD (talk | contribs) Added empty fda_max parameter to MedTemplate call |
MDElliottMD (talk | contribs) parser-claude: Tramadol MedTemplate refill, Top 300 stub upgrade |
||
| (4 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Tramadol | ||
| brand | | brand = Ultram (IR), Ultram ER, ConZip ER | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:Opioid analgesics|Opioid analgesic (atypical, weak μ-agonist with serotonin/norepinephrine reuptake inhibition)]], [[:Category:Schedule IV controlled substances|Schedule IV controlled substance]], [[:Category:Analgesics|Analgesic]] | ||
| | | uses = <vote slug="moderate-severe-pain-use">Moderate to moderately severe pain (FDA)</vote>, <vote slug="chronic-pain-tramadol-use">Chronic pain in opioid-sparing regimens (off-label)</vote>, <vote slug="restless-legs-syndrome-use">Restless legs syndrome (off-label, second-line)</vote>, <vote slug="neuropathic-pain-broad-use">Neuropathic pain (off-label)</vote> | ||
| | | starting_dose = IR: 25-50 mg PO every 4-6 hours as needed, titrate as tolerated. ER: 100 mg PO once daily, titrate by 100 mg every 5 days | ||
| | | preparations = IR tablets 50 mg; ER tablets 100, 200, 300 mg (Ultram ER, ConZip); oral solution 5 mg/mL; combination products with acetaminophen (Ultracet) | ||
| | | fda_max = 400 mg/day (IR, adult); 300 mg/day (ER); 300 mg/day in elderly >75 years | ||
| | | pill_id = | ||
| routes | | routes = Oral | ||
| onset | | onset = 30-60 minutes (IR) | ||
| duration | | duration = 4-6 hours (IR); 24 hours (ER) | ||
| halflife | | halflife = Tramadol 6-7 hours; M1 active metabolite 7-9 hours<ref name="ultram-label">FDA Prescribing Information, Ultram (tramadol hydrochloride), Janssen, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020281s048lbl.pdf</ref> | ||
| bioavailability = ~75% (IR, rises with multi-dose administration due to saturable first-pass)<ref name="ultram-label" /> | |||
| pregnancy = Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.{{citation needed}} | |||
| legal = [[USLegal:Schedule IV|Schedule IV controlled substance]] in US (federally scheduled 2014); some states schedule higher<ref name="ultram-label" /> | |||
| | | mechanism = <vote slug="tramadol-mech-claim">Weak μ-opioid receptor agonist whose major analgesic activity comes from CYP2D6 conversion to O-desmethyltramadol (M1), a ~6-fold more potent μ-agonist. Tramadol also inhibits serotonin and norepinephrine reuptake (the SNRI-like component), which contributes meaningfully to analgesia and distinguishes the agent from traditional opioids. CYP2D6 ultra-rapid metabolizers produce dangerously high M1 levels with risk of fatal respiratory depression, particularly in children; CYP2D6 poor metabolizers get reduced opioid analgesic benefit and rely on the SNRI component.</vote> '''Serotonin syndrome''' risk with SSRIs, SNRIs, MAOIs, and other serotonergic agents. '''Seizure''' risk is dose-dependent and elevated in patients with epilepsy, head trauma, or concurrent serotonergic medicines. CPIC provides CYP2D6 genotype-guided opioid selection guidance<ref name="cpic-opioid-cyp2d6">CPIC Guideline for CYP2D6, OPRM1, and COMT and Opioid Use, 2021. https://cpicpgx.org/guidelines/cpic-guideline-for-codeine-and-cyp2d6/</ref>. | ||
| | |||
| | |||
| | |||
| | |||
}} | }} | ||
== References == | |||
<references /> | |||
[[Category:Opioid analgesics]] | |||
[[Category:Schedule IV controlled substances]] | |||
[[Category:Analgesics]] | [[Category:Analgesics]] | ||