Tramadol (Tramadol Hydrochloride)
Also sold as: Tramazac, Domadol, Contramal, Ultracet (with paracetamol)
Pregnancy
Cat C
Lactation
Avoid
Schedule
H1
Forms
Tablet 50/100mg +3
Indications
- Moderate-to-moderately severe pain (post-op, acute injury, chronic non-cancer pain — limited duration)
Adult Dosing
Moderate pain
50-100 mg PO every 4-6 hours; max 400 mg/day
Limit duration; risk of dependence
SR formulation
100-200 mg PO BD
Pediatric Dosing
AVOID in adolescents 12-18 with obesity, OSA, severe lung disease
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 30 | No adjustment |
| CrCl < 30 | Increase interval to every 12 hours; max 200 mg/day |
Hepatic Adjustment
Reduce to 50 mg every 12 hours in severe
Pregnancy & Lactation
Pregnancy: Category C
Avoid; neonatal withdrawal
Lactation: Avoid
Rapid metabolizers can cause infant respiratory depression
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| SSRIs, SNRIs, MAOIs, triptans | Serotonin syndrome (CONTRAINDICATED with MAOIs) | Major |
| CNS depressants, opioids, alcohol, BZDs | Respiratory depression | Major |
| Carbamazepine | Reduced tramadol effect | Moderate |
| Warfarin | Increased INR | Moderate |
| Ondansetron | Reduced tramadol analgesia | Moderate |
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Side Effects
Common
- Nausea, vomiting
- Constipation
- Dizziness
- Headache
- Sedation
- Sweating
Serious / Discontinue If
- Respiratory depression (esp. with other CNS depressants)
- Seizures (esp. >400 mg/day, with SSRIs, alcoholism)
- Serotonin syndrome
- Hypoglycemia
- Dependence
- Withdrawal on abrupt stop
- Suicidality risk
Contraindications
- Severe respiratory depression
- Acute alcohol/sedative intoxication
- MAOI use within 14 days
- Children <12y
- Hypersensitivity
- Uncontrolled epilepsy
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Tramazac 50 | Cadila | 10 tab ₹35 |
| Contramal 50 | Sanofi | 10 tab ₹45 |
| Ultracet (with PCM) | Janssen | 10 tab ₹55 |
Monitoring Required
- Pain score, respiratory rate, signs of dependence, MME totals
Patient Counseling Points
- Take with food
- Do not drive
- Do not combine with alcohol or other sedatives
- Limit duration
- Tell doctor if you have history of seizures
- Taper if used >2-3 weeks
Stop Googling drug references mid-consultation
EasyClinic auto-flags Tramadol interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- Specialty society guidelines (RSSDI/CSI/IAP)