tramadol hydrochloride Nursing Considerations & Management

 Drug Name

Generic Name :  tramadol hydrochloride

Brand Name: Ultram

Classification: Analgesic, centrally acting

Pregnancy Category C 

Dosage & Route

Available forms : Tablets—50 mg

  • Patients who require rapid analgesic effect: 50–100 mg PO q 4–6 hr; do not exceed 400 mg/day.
  • Patients with moderate to moderately severe chronic pain: Initiate at 25 mg/day in the morning and titrate in 25-mg increments q 3 days to reach 100 mg/day. Then, increase in 50 mg-increments q 3 days to reach 200 mg/day. After titration, 50–100 mg q 4–6 hr; do not exceed 400 mg/day.
  • Patients with cirrhosis: 50 mg q 12 hr.
  • Patients with creatinine clearance < 30 ml/min: 50–100 mg PO q 12 hr. Maximum 200 mg/day.
  • Safety and efficacy not established.
  • > 75 yr: Do not exceed 300 mg/day.
Therapeutic actions
  • Tramadol inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to mu-opiate receptors in the CNS.
  • Relief of moderate to moderately severe pain
Adverse effects
  • Sweating, dizziness, nausea, vomiting, dry mouth, fatigue, asthenia, somnolence, confusion, constipation, flushing, headache, vertigo, tachycardia, palpitations, miosis, insomnia, orthostatic hypotension, seizures, CNS stimulation e.g. hallucinations.
  • Potentially Fatal: Respiratory depression.
  • Suicidal patients, acute alcoholism; head injuries; raised intracranial pressure; severe renal impairment; lactation.
Nursing considerations
  • History: Hypersensitivity to tramadol; pregnancy; acute intoxication with alcohol, opioids, psychotropic drugs or other centrally acting analgesics; lactation; seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic impairment; past or present history of opioid addiction
  • Physical: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP; bowel sounds, normal output; LFTs, renal function tests
  • Control environment (temperature, lighting) if sweating or CNS effects occur.
  • WARNING: Limit use in patients with past or present history of addiction to or dependence on opioids.
Teaching points
  • You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals).
  • Report severe nausea, dizziness, severe constipation.