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Other Names

  • Ultram
  • ConZip
  • Ryzolt


  • Type: Centrally acting analgesic
  • Dosage Forms: Immediate release tablet, Extended release capsule

Adult Dosing

  • PO
    • Immediate Release Tablets (50 mg)
      • Initiate at 25 mg po every morning
      • Titrate up in 25 mg increments every 3 days to reach 25 mg qid (total of 100 mg per day)
      • The total daily dose may be increased by 50 mg every 3 days as tolerated to reach 200 mg per day (50 mg po qid)
      • After titration, 50 to 100 mg may be administered q4-6h prn pain relief (not to exceed 400 mg per day)
    • Extended-release capsules (100 mg, 200 mg, 300 mg)
      • Initiate at 100 mg po every day
      • Titrate up 100 mg every 5 days as needed/tolerated (not to exceed 300 mg per day)
  • Maximum daily dose: 400 mg for IR, 300 mg for XR

Pediatric Dosing

  • Not recommended for pediatric use

Special Populations

  • Pregnancy Rating: Not recommended
  • Lactation Risk Categories: Not recommended
  • Renal Dosing
    • Adult: CrCl <30: increase dosing interval to q12h, max dose 200 mg per day
  • Hepatic Dosing
    • Adult: Cirrhotic patient dosing: 50 mg q12h


Emergency Medicine

  • Oral tramadol combined with acetaminophen administered early in the ED triage was associated with a decrease in IV morphine requirement and increased satisfaction among ED patients with acute pain compared to patients taking acetaminophen alone[1]
  • The use of tramadol in an emergency setting is not well studied, and this literature review concluded that tramadol does not offer any particular benefits over existing analgesics for the majority of emergency pain relief situations[2]

Chronic Pain

  • The Extended Release formulation of tramadol has proven efficacy in chronic pain conditions such as osteoarthritis and low back pain, with a favorable side effect profile. Clinical trials have also demonstrated an improvement in pain related sleep disturbances and physical function in those with chronic pain from oseoarthritis and low back pain.[3]


  • Known hypersensitivity reaction to tramadol
  • Intoxication with alcohol, hypnotics, narcotics, opioids, or psychotropic drugs
  • Acute or severe bronchial asthma or hypercapnia or respiratory depression in an unmonitored setting

Adverse Reactions

  • Major
    • Seizures
    • Suicide
    • Serotonin Syndrome
    • CNS and Respiratory Depression
  • Minor
    • Dizziness
    • Nausea
    • Headache
    • Constipation
    • Dry mouth


  • Half-life: 6-7 hours
  • Metabolism: Liver via CYP2D6, CYP3A4, and conjugation
  • Excretion: urine
  • Mechanism of Action
    • Centrally acting opioid analgesic
    • Weak reuptake inhibition of serotonin and norepinephrine

Drug Interactions

  • CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine, amitriptyline) and CYP3A4 inhibitors (ketoconazole, erythromycin)
  • Serotonergic drugs (SSRIs, MAOIs, triptans, linezolid, lithium, St. John’s Wort, triptans)
  • Quinidine
  • Carbemazepine
  • Digoxin and Warfarin

Other Considerations

  • Risk for misuse, abuse, diversion, and addiction
  • Tapering off the medication may reduce withdrawal symptoms

See Also


  1. Bouida W, Beltaief K, Msolli MA et al. Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain. Pain Pract. 2019 Mar;19(3):275-282.
  2. Close BR. "Tramadol: does it have a role in emergency medicine?." Emerg Med Australas. 2005 Feb;17(1):73-83.
  3. Rosenberg MT. "The role of tramadol ER in the treatment of chronic pain. International journal of clinical practice. 2009 Oct;63(10):1531-43
Created by:
Blakeburch on 3 April 2021 04:20:40
Last edited:
11 May 2023 18:40:42