Tramadol Injectable: Dosing and Precautions

Therapeutic action

Opioid analgesic.

Indications

Moderate pain.

Forms and strengths, route of administration

• 100 mg ampoule (50 mg/ml, 2 ml) for IM injection, slow IV injection, or infusion.

Dose

• Child over 12 years and adult: 50 to 100 mg every 4 to 6 hours, maximum 600 mg daily.

Duration

Change to oral route as soon as possible.

Contra-indications, adverse effects, precautions

• Do not administer in severe respiratory depression or to patients at risk of seizures such as those with epilepsy, head injury, or meningitis.
• May cause dizziness, nausea, vomiting, drowsiness, dry mouth, sweating, and rarely allergic reactions, seizures, confusion, withdrawal symptoms, and respiratory depression in overdose.
• Do not combine with opioid analgesics, including codeine.
• Avoid combination with carbamazepine, fluoxetine, chlorpromazine, promethazine, clomipramine, haloperidol, and digoxin.
• Reduce doses by half and administer every 12 hours in elderly patients and in patients with severe renal or hepatic impairment.
• Use tramadol by infusion over 20 to 30 minutes rather than by IV injection.
• Pregnancy: no contra-indication, but closely monitor the neonate if large doses are given for prolonged periods at the end of the third trimester.
• Breast-feeding: use with caution, for a short period of 2 to 3 days, at the lowest effective dose, and monitor the mother and child.
• Tramadol is approximately 10 times less potent than morphine.
• In some countries, tramadol is on the list of narcotics: follow national regulations.
• Tramadol is not included in the WHO list of essential medicines.