DRUG STUDY: TRAMADOL

Drug Name Drug Classification Mechanism of Action and Drug Action Drug Effects Interactions
Indications (Serious/Common)
Generic Name: Pharmacologic: Mechanism of Action: Pharmacokinetics Side effects (common by Drug – Drug
A: Immediate-release—75% system): Increase risk of CNS depression
Tramadol Opiod Binds to opioid receptors. absorbed after oral when used concurrently with
Inhibits reuptake of serotonin administration; Extended CNS: dizziness, headache, other CNS depressants,
Trade Name: Therapeutic: and norepinephrine in the CNS. release (Ultram)— 85–90% somnolence, anxiety, CNS including alcohol,
Therapeutic Effects: Decreased (compared with immediate- stimulation, confusion, antihistamines,
ConZip Opiate (narcotic) analgesics pain. release). coordination disturbance, sedative/hypnotics, opioid
Ultram (centrally acting) euphoria, malaise, analgesics, anesthetics, or
Ryzolt D: Crosses the placenta; enters nervousness, sleep disorder, psychotropic agents.
Dosage: Indication(s): breast milk. weakness.
Increase risk of seizures with
Recommended: Moderate to moderately severe M: Mostly metabolized by the EENT: visual disturbances high doses of penicillins,
Immediate-release pain (extended-release liver; one metabolite has cephalosporins,
PO (Adults _18 yr): formulations indicated for analgesic activity; Half-life: CV: vasodilation. phenothiazines, opioid
Rapid titration—50–100 mg patients who require around-the Tramadol—6–8 hr, ER—7.9 analgesics, or antidepressants.
q 4–6 hr (not to exceed 400 clock pain management). hr; active metabolite—7–9 hr; GI: constipation, nausea,
mg/day [300 mg in patients both are increase in renal or abdominal pain, anorexia, Carbamazepine increase
_75 yr]). hepatic impairment. diarrhea, dry mouth, metabolism and decrease
Gradual titration 25 mg/day dyspepsia, flatulence, effectiveness of tramadol
initially, increase by 25 E: 30% is excreted unchanged vomiting. (increased doses may be
mg/day q 3 days to reach in urine. required).
dose of 25 mg 4 times daily, GU: menopausal
then increase by 50 mg/day q symptoms, urinary
3 days to reach dose of 50 retention/ frequency.
mg 4 times daily; may then
use 50–100 mg q 4–6 hr Pharmacodynamics Derm: pruritus, sweating. Use cautiously in patients who

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 1
 (maximum dose = 400 Route: PO are receiving MAO inhibitors
mg/day). Onset: 1 hr Neuro: hypertonia. (increased risk of adverse
Peak: 2 – 3 hr reactions).
Extended-release Duration: 4 – 6 hr Misc: physical dependence,
PO (Adults): psychological dependence,
Not currently receiving Route: ER tolerance. CYP2D6 inhibitors, including
immediate-release— 100 mg Onset: unknown quinidine, fluoxetine,
once daily initially, may then Peak: 12 hr Adverse Reactions paroxetine, and bupropion,
titrate q 5 days up to 300 Duration: 24 hr (Serious, Life threatening) may decrease levels of active
mg/day; Life-threatening: metabolite (M1) and lead to
Currently receiving CNS: SEIZURES decrease analgesic effects.
immediate-release—calculate Misc: SEROTONIN
24-hr total dose of immediate SYNDROME CYP3A4 inhibitors, including
release product and give erythromycin, clarithromycin,
same dose (rounded down to ketoconazole, itraconazole, and
next lowest 100-mg Contraindications: protease inhibitors may allow
increment) of ER once daily Contraindicated in: for a greater degree of
(maximum dose = 300 Hypersensitivity; Cross metabolism via CYP2D6 and
mg/day). sensitivity with opioids increase levels of the active
may occur; Patients who metabolite (M1) leading to
are acutely intoxicated with respiratory depression.
alcohol,
sedatives/hypnotics, CYP3A4 inducers may
centrally acting analgesics, decrease levels.
opioid analgesics, or
psychotropic agents; Increase risk of serotonin
Patients who are physically syndrome when used with SSRI
dependent on opioid and SNRI antidepressants,
analgesics (may precipitate TCAs, MAO inhibitors, 5HT1
withdrawal); ER only—

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 2
 CCr _30 mL/min or hepatic agonists, CYP2D6 inhibitors,
impairment and CYP3A4 inhibitors.

Drug – Food/Herbal

Drug – Laboratory
May cause increase serum
creatinine, increase liver
enzymes, decrease hemoglobin,
and proteinuria.

Treatment of Overdose/ Antidote

(if any):
Overdose may cause respiratory
depression and seizures.
Naloxone may reverse some, but
not all, of the symptoms of
overdose.

Treatment should be
symptomatic and supportive.
Maintain adequate respiratory
exchange. Hemodialysis is not
helpful because it removes only
a small portion of administered
dose. Seizures may be managed
with barbiturates or
benzodiazepines; naloxone
increases risk of seizures.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 3
Nursing Process: Tramadol

Assessment Nursing Planning Nursing Interventions with Appropriate Patient Evaluation/ Expected
Diagnoses Rationale (Italic) Teaching/Education Outcomes of Care
(Priority Problems)
Baseline assessment prior to The patient will: General
administration: ▪ Acute pain ▪ Experience therapeutic ▪ Give as prescribed, preferably ▪ Instruct patient on how and Decrease in severity of
▪ Risk for injury effects. before pain becomes severe. Be when to ask for pain pain without a significant
▪ Assess type, location, and ▪ Be free from or
aware that serious and rarely medication. alteration in level of
fatal anaphylactic reactions
intensity of pain before and 2–3 experience minimal ▪ May cause dizziness and consciousness or
have occurred, often following
hr (peak) after administration. adverse effect. drowsiness. Caution patient to respiratory status.
first dose.
▪ Verbalize understanding avoid driving or other
▪ Assess BP and respiratory rate of the drug’s use, activities requiring alertness
before and periodically during adverse effect, and until response to medication is
administration. Respiratory required precautions. known.
depression has not occurred with ▪ Demonstrate proper ▪ Advise patient that tramadol is
recommended doses. self- administration of a drug with known abuse
the medication. potential. Protect it from theft,
▪ Assess bowel function routinely. and never give to anyone other
Prevention of constipation should than the individual for whom
be instituted with increased intake it was prescribed.
of fluids and bulk and with ▪ Advise patient to change
laxatives to minimize positions slowly to minimize
constipating effects. orthostatic hypotension.
▪ Caution patient to avoid
Baseline assessment prior to concurrent use of alcohol or
administration: other CNS depressants with
this medication.
▪ Monitor patient for seizures. May
occur within recommended dose

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 4
 range. Risk is increased with ▪ Advise patient to notify health
higher doses and in patients care professional before taking
taking antidepressants (SSRIs, other RX, OTC, or herbal
SNRIs, tricyclics, or MAO products concurrently.
inhibitors), opioid analgesics, or
other drugs that decrease the ▪ Encourage patient to turn,
seizure threshold. cough, and breathe deeply
every 2 hr to prevent
▪ Monitor for serotonin syndrome atelectasis.
(mental-status changes (e.g.,
agitation, hallucinations, coma), ▪ Advise female patients to
autonomic instability (e.g., notify health care professional
tachycardia, labile BP, if pregnancy is planned or
hyperthermia), neuromuscular suspected, or if breast feeding.
aberrations (e.g., hyperreflexia,
incoordination) and/or Side Effects
▪ Advise patient to notify health
gastrointestinal symptoms (e.g.,
care professional if seizures or
nausea, vomiting, diarrhea) in
if symptoms of serotonin
patients taking these drugs
syndrome occur.
concurrently).

▪ Assess risk for opioid addiction,

abuse, or misuse prior to
administration. Abuse or misuse
of extended- release preparations
by crushing, chewing, snorting,
or injecting dissolved product
will result in uncontrolled
delivery of tramadol and can
result in overdose and death.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 5
Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 6