Скільки діє Трамадол за часом

Tramadol

Medically reviewed by Melisa Puckey, BPharm. Last updated on Aug 15, 2023.

What is tramadol?

Tramadol is a strong pain medication used to treat moderate to severe pain that is not being relieved by other types of pain medicines. Tramadol is a synthetic opioid and acts in the brain and spine (central nervous system) to reduce the amount of pain you feel.

The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an as-needed basis for pain.

Warnings

Seizures have been reported in patients taking tramadol. Your risk of seizures is higher if you are taking higher doses than recommended. Seizure risk is also higher in those with a seizure disorder or those taking certain antidepressants or opioid medications.

Tramadol should not be used if you are suicidal or prone to addiction.

You should not take tramadol if you have severe breathing problems, a blockage in your stomach or intestines, or if you have recently used alcohol, sedatives, tranquilizers, narcotic medication, or an MAO inhibitor (isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others).

Tramadol can slow or stop your breathing, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Keep this medicine where others cannot get to it.

Tramadol should not be given to a child younger than 12 years old, or anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids. Ultram ER should not be given to anyone younger than 18 years old.

Taking tramadol during pregnancy may cause life-threatening withdrawal symptoms in the newborn.

Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

Before taking this medicine

You should not take tramadol if you are allergic to it, or if you have:

• severe asthma or breathing problems;
• a stomach or bowel obstruction (including paralytic ileus);
• if you have recently used alcohol, sedatives, tranquilizers, or narcotic medications; or
• if you have used an MAO inhibitor in the past 14 days (such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine).

Tramadol should not be given to a child younger than 12 years old. Ultram ER should not be given to anyone younger than 18 years old.

Do not give this medicine to anyone younger than 18 years old who recently had surgery to remove the tonsils or adenoids.

Seizures have occurred in some people taking tramadol. Your seizure risk may be higher if you have ever had:

• a head injury, epilepsy or other seizure disorder;
• drug or alcohol addiction; or
• a metabolic disorder.

To make sure tramadol is safe for you, tell your doctor if you have ever had:

• breathing problems, sleep apnea;
• liver or kidney disease;
• urination problems;
• problems with your gallbladder, pancreas, or thyroid;
• a stomach disorder; or
• mental illness, or suicide attempt.

If you use tramadol during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks.

Ask a doctor before using tramadol if you are breastfeeding. Tell your doctor if you notice severe drowsiness or slow breathing in the nursing baby.

How should I take tramadol?

Take tramadol exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Never use tramadol in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to take more of this medicine.

Never share tramadol with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law.

Stop taking all opioid medications when you start taking tramadol.

Tramadol can be taken with or without food, but take it the same way each time.

Swallow the capsule or tablet whole to avoid exposure to a potentially fatal overdose. Do not crush, chew, break, open, or dissolve.

Measure liquid medicine with the supplied syringe or a dose-measuring device (not a kitchen spoon).

Never crush or break a tramadol tablet to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death.

You may have withdrawal symptoms if you stop using tramadol suddenly. Ask your doctor before stopping the medicine.

Store at room temperature away from moisture and heat. Keep track of your medicine. You should be aware if anyone is using it improperly or without a prescription.

Do not keep leftover tramadol. Just one dose can cause death in someone using it accidentally or improperly. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, mix the leftover medicine with cat litter or coffee grounds in a sealed plastic bag throw the bag in the trash.

Dosing information

Usual Adult Dose for Pain:

Adults (17 years or older): 50 to 100 mg orally every 4 to 6 hours as needed for pain
-For patients not requiring rapid onset of analgesic effect: Initial dose: 25 mg orally once a day; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days
Maximum dose: 400 mg per day.

Usual Adult Dose for Chronic Pain:

Extended-Release (ER):
18 years or older (tramadol-naive): 100 mg orally once a day
-Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions
-Maximum Dose: 300 mg/day

For patients CURRENTLY receiving Immediate-Release (IR) Tramadol:
Initial Dose: Calculate 24-hour IR requirement and initiate with a total daily ER dose rounded down to the next lowest 100 mg increment orally once a day

Conversion from other Opioids: Discontinue all other around the clock opioid drugs prior to initiating therapy
-Initial dose: 100 mg ER orally once a day
-Individually titrate in 100 mg increments every 5 days to an effective dose that minimizes adverse reactions
-Maximum Dose: 300 mg/day.

Usual Geriatric Dose for Pain:

Dose selection should be cautious generally starting at the low end of the dose range

Over 75 years:
Maximum dose of Immediate-release: 300 mg per day.

Usual Geriatric Dose for Chronic Pain:

Dose selection should be cautious generally starting at the low end of the dose range

Over 75 years:
Maximum dose of Immediate-release: 300 mg per day.

Usual Pediatric Dose for Pain:

Tramadol is not recommended for use in pediatric patients

17 years or older: See Adult Dose.

What happens if I miss a dose?

Since tramadol is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing.

Your doctor may recommend you get naloxone (a medicine to reverse an opioid overdose) and keep it with you at all times. A person caring for you can give the naloxone if you stop breathing or don't wake up. Your caregiver must still get emergency medical help and may need to perform CPR (cardiopulmonary resuscitation) on you while waiting for help to arrive.

Anyone can buy naloxone from a pharmacy or local health department. Make sure any person caring for you knows where you keep naloxone and how to use it.

What should I avoid while taking tramadol?

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how tramadol will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Tramadol side effects

Get emergency medical help if you have signs of an allergic reaction to tramadol (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Tramadol can slow or stop your breathing, and death may occur. A person caring for you should give naloxone and/or seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Tramadol may cause serious side effects. Call your doctor at once if you have:

• noisy breathing, sighing, shallow breathing, breathing that stops during sleep;
• a slow heart rate or weak pulse;
• a light-headed feeling, like you might pass out;
• seizure (convulsions); or
• low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious breathing problems may be more likely in older adults and people who are debilitated or have wasting syndrome or chronic breathing disorders.

Common side effects of tramadol may include:

• constipation;
• nausea and vomiting;
• stomach pain;
• dizziness;
• drowsiness;
• tiredness;
• headache;
• itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect tramadol?

You may have breathing problems or withdrawal symptoms if you start or stop taking certain other medicines. Tell your doctor if you also use an antibiotic, antifungal medication, heart or blood pressure medication, seizure medication, or medicine to treat HIV or hepatitis C.

Many other drugs can be dangerous when used with tramadol. Tell your doctor if you also use:

• medicine for allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder;
• other opioid medicines;
• a benzodiazepine sedative like Valium, Klonopin, or Xanax;
• sleep medicine, muscle relaxers, or other drugs that make you drowsy; or
• drugs that affect serotonin, such as antidepressants, stimulants, or medicine for migraines or Parkinson's disease.

This list is not complete. Other drugs may interact with tramadol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here.

Many other drugs can be dangerous when used with tramadol. Tell your doctor if you also use:

• medicine for allergies, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder;
• other opioid medicines;
• a benzodiazepine sedative like Valium, Klonopin, or Xanax;
• sleep medicine, muscle relaxers, or other drugs that make you drowsy;
• drugs that affect serotonin, such as antidepressants, stimulants, or medicine for migraines or Parkinson's disease.
• drugs that affect serotonin levels in your body - a stimulant, or medicine for depression, Parkinson's disease, migraine headaches, serious infections, or nausea and vomiting.

This list is not complete. Many other drugs may affect tramadol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Popular FAQ

Yes, it is safe for most people to take tramadol with acetaminophen, ibuprofen, or aspirin if they are old enough (aspirin is not recommended for children less than 16 years and tramadol should not be taken by children under the age of 12). Continue reading

How much tramadol you give your dog depends on the size of your dog. Smaller dogs do not need as much tramadol as larger dogs need to relieve pain. If you give too much tramadol your dog is likely to have more severe side effects. The tramadol dosage for dogs is usually between 0.45 to 1.8 mg per pound of body weight (1mg to 5 mg/kg). The frequency varies depending on what you are giving it for. For general pain, it is given every 8 to 12 hours, but for cancer-related pain, it can be administered every 6 hours. Continue reading

Both tramadol and codeine are prescription opioid painkillers, and they seem to be equally effective in terms of pain relief. There is no evidence that tramadol is any stronger than codeine at relieving pain. Continue reading

Symptoms of tramadol withdrawal can start 8-24 hours after the last dose. Untreated, withdrawal symptoms usually last for 4-10 days. Withdrawal is caused by stopping the drug suddenly. Continue reading

Tramadol generally starts to relieve pain within an hour in its fast-acting forms, which are used for short-term pain management. With slow-release or extended-release (ER) forms, the drug may take longer to start because it’s gradually released over 12 or 24 hours, but pain relief lasts longer. Continue reading

Tramadol is eliminated from your system within roughly 2 days of taking the drug, but this does not mean that it can no longer be detected by certain drug tests. Continue reading

Yes, you can take these medications together. Tramadol is safe to take with ibuprofen and may be used to provide additional pain relief. But be aware 800mg ibuprofen is a high dose of ibuprofen that may cause gastrointestinal side effects such as abdominal pain or reflux if taken long term. Continue reading

Any drug that is classified as an "opioid" can cause constipation. Examples of commonly prescribed opioids that may cause this side effect include morphine, tramadol, fentanyl, methadone, hydrocodone, codeine and oxycodone. Continue reading

No, Tramadol is not an anti-inflammatory drug or muscle relaxer. Because it’s not an anti-inflammatory drug, it likely won’t reduce any swelling you have when taken alone. Continue reading

More about tramadol

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• Breastfeeding

Patient resources

Tramadol

Tramadol may be habit forming, especially with prolonged use. Take tramadol exactly as directed. Do not take more of it, take it more often, or take it in a different way than directed by your doctor. While taking tramadol, discuss with your health care provider your pain treatment goals, length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or has had an overdose or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse tramadol if you have or have ever had any of these conditions. Talk to your health care provider immediately and ask for guidance if you think that you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

Tramadol may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had slowed breathing, asthma, or lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways). Your doctor will probably tell you not to take tramadol. Also tell your doctor if you have or have ever had a head injury, brain tumor, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weak or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.

When tramadol was used in children, serious and life-threatening breathing problems such as slow or difficulty breathing and deaths were reported. Tramadol should never be used to treat pain in children younger than 12 years of age or to relieve pain after surgery to remove the tonsils and/or adenoids in children younger than 18 years of age. Tramadol should also not be used in used in children 12 to 18 years of age who are obese or who have a neuromuscular disease (disease that affects the nerves that control voluntary muscles), a lung disease, or obstructive sleep apnea (condition in which the airway becomes blocked or narrow and breathing stops for short periods during sleep) as these conditions may increase their risk of breathing problems.

Taking certain other medications during your treatment with tramadol may increase the risk that you will experience breathing problems or other serious, life threatening breathing problems, sedation, or coma. Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take tramadol with other medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.

Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with tramadol increases the risk that you will experience these serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment.

Tell your doctor if you are pregnant or plan to become pregnant. If you take tramadol regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight.

If you are taking the tramadol extended-release tablet or capsule, swallow them whole; do not chew, break, divide, crush, or dissolve them. If you swallow broken, chewed, crushed, or dissolved extended-release preparations, you may receive too much tramadol at once instead and this may cause serious problems, including overdose and death.

Do not allow anyone else to take your medication. Tramadol may harm or cause death to other people who take your medication, especially children.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with tramadol and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

Why is this medication prescribed?

Tramadol immediate-release tablets and oral solution are used as a short-term treatment to relieve severe pain (pain that begins suddenly, has a specific cause, and is expected to go away when the cause of the pain is healed) in people who are expected to need an opioid pain medication and who cannot be controlled by the use of alternative pain medications. Tramadol extended-release tablets and capsules are used to relieve severe and persistent pain in people who are expected to need an opioid pain medication to relieve pain around-the-clock for a long time and who cannot be treated with other pain medications. Tramadol extended-release tablets and capsules should not be used to treat mild or moderate pain, short-term pain, or pain that can be controlled by medication that is taken as needed. Tramadol is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

How should this medicine be used?

Tramadol comes as an immediate-release tablet, a solution (liquid), an extended-release (long-acting) tablet, and an extended-release (long-acting) capsule to take by mouth. The immediate-release tablet and solution are taken usually with or without food every 4 to 6 hours as needed (usually for no more than a few days). The extended-release tablet and extended-release capsule should be taken once a day. Take the extended-release tablet and the extended-release capsule at about the same time of day every day. If you are taking the extended-release tablet or extended-release capsule, you should take it consistently, either always with or always without food. Take tramadol exactly as directed. Do not take more medication as a single dose or take more doses per day than prescribed by your doctor. Taking more tramadol than prescribed by your doctor or in a way that is not recommended may cause serious side effects or death.

Your doctor may start you on a low dose of tramadol and gradually increase the amount of medication you take, not more often than every 3 days if you are taking the solution or regular tablets or every 5 days if you are taking the extended-release tablets or extended-release capsules.

If you are taking the solution, use an oral syringe or measuring spoon or cup to measure the correct amount of liquid needed for each dose. Do not use a regular household spoon to measure your dose. Ask your doctor or pharmacist if you need help getting or using a measuring device,

Do not stop taking tramadol without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking tramadol, you may experience withdrawal symptoms such as nervousness; panic; sweating; difficulty falling asleep or staying asleep; runny nose, sneezing, or cough; pain; hair standing on end; chills; nausea; uncontrollable shaking of a part of your body; diarrhea; or rarely, hallucinations (seeing things or hearing voices that do not exist).

Tell your doctor if your pain increases, gets worse, or if you have new pain or an increased sensitivity to pain, especially after taking tramadol. Do not take more of it or take it more often than prescribed by your doctor.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking tramadol,

• tell your doctor and pharmacist if you are allergic to tramadol, other opiate pain medications, any other medications, or any of the ingredients in tramadol tablets, capsules, and oral solution. Ask your pharmacist for a list of the ingredients.
• tell your doctor or pharmacist if you are taking or receiving the following medications or if you have stopped taking them within the past 2 weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), or tranylcypromine (Parnate).
• The following nonprescription or herbal products may interact with tramadol: St. John's wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking tramadol. Do not start these medications while taking tramadol without discussing it with your healthcare provider.
• tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section, a blockage or narrowing of your stomach or intestines, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take tramadol if you have any of these conditions.
• tell your doctor if you have or have ever had seizures; an infection in your brain or spine; difficulty urinating; low blood levels of sodium; thoughts about harming or killing yourself or planning or trying to do so; diabetes; pancreas, gall bladder, or thyroid problems; or kidney or liver disease.
• tell your doctor if you are breastfeeding. You should not breastfeed while taking tramadol. Tramadol can cause shallow breathing, difficulty or noisy breathing, confusion, more than usual sleepiness, trouble breastfeeding, or limpness in breastfed infants.
• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking tramadol.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking tramadol.
• you should know that this medication may make you drowsy and may affect your coordination. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that tramadol may cause dizziness, lightheadedness, and fainting when you get up from a lying position. To avoid this, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
• you should know that tramadol may cause constipation. Talk to your doctor about changing your diet and using other medications to treat or prevent constipation.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If your doctor has told you to take tramadol regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Tramadol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• sleepiness
• headache
• nervousness
• uncontrollable shaking of a part of the body
• changes in mood
• heartburn or indigestion
• dry mouth

Some side effects can be serious. If you experience any of these symptoms or those mentioned in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• hives
• rash
• blisters
• hoarseness
• difficulty swallowing or breathing
• chest pain
• swelling of the eyes, face, throat, tongue, lips, hands, feet, ankles, or lower legs
• agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, or diarrhea
• nausea, vomiting, loss of appetite, fatigue, weakness, or dizziness
• changes in heartbeat
• headache, confusion, loss of energy, drowsiness, restlessness, muscle weakness, spasms or cramps
• hunger, shaking of a part of your body that you cannot control, irritability, or difficulty concentrating
• loss of consciousness
• seizures

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Tramadol may cause other side effects. Tell your doctor if you have any unusual problems while you are taking this medication.

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

While taking tramadol, you should talk to your doctor about having a rescue medication called naloxone readily available (e.g., home, office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. Your doctor may also prescribe you naloxone if you are living in a household where there are small children or someone who has abused street or prescription drugs. You should make sure that you and your family members, caregivers, or the people who spend time with you know how to recognize an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions. If symptoms of an overdose occur, a friend or family member should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Symptoms of overdose may include the following:

• decreased size of the pupil (the black circle in the center of the eye)
• difficulty breathing
• slow or shallowing breathing
• extreme drowsiness or sleepiness
• unable to respond or wake up
• slowed heartbeat
• muscle weakness
• cold, clammy skin

What other information should I know?

Keep all appointments with your doctor and laboratory. Your doctor may order certain lab tests to check your body's response to tramadol.

Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking tramadol.

Do not let anyone else take your medication. Tramadol is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist if you have any questions.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

• Conzip ®
• Qdolo ®
• Rybix ® ODT ¶
• Ryzolt ® ¶
• Ultram ® ¶
• Ultram ® ER ¶

Brand names of combination products

• Ultracet ® (containing Acetaminophen, Tramadol) ¶
• Seglentis ® (containing Celecoxib, Tramadol)

¶ This branded product is no longer on the market. Generic alternatives may be available.

AHFS ® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists ® , 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

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Трамадол (Tramadolum) (166774) - инструкция по применению ATC-классификация

фармакодинамика . Трамадол — анальгетик центрального действия. Имеет смешанный механизм действия. Является неселективным агонистом опиоидных мю-, дельта- и каппа-рецепторов. Другими механизмами, которые участвуют в обеспечении анальгезирующего действия трамадола гидрохлорида, являются ингибирование обратного захвата норадреналина в нейронах и усиление серотонинергического ответа.
Открывает К + и Са ++ -каналы, вызывает гиперполяризацию мембран и тормозит проведение болевых импульсов. Анальгезирующий эффект обусловлен снижением активности ноцицептивной и усилением антиноцицептивной системы организма. Трамадола гидрохлорид проявляет противокашлевое действие. При применении в терапевтических дозах трамадола гидрохлорид не угнетает дыхание и не влияет на моторику кишечника.
Фармакокинетика . При приеме внутрь в ЖКТ абсорбируется более 90% трамадола. C_max в плазме крови достигается через 4,8 ч. Абсолютная биодоступность — 68%. Связывание с белками плазмы крови — 20%. Проникает через ГЭБ и плацентарный барьер. 0,1% препарата проникает в грудное молоко. Метаболизируется в печени. T_½ — 6 ч. Трамадола гидрохлорид и его метаболиты выделяются почками (25–35%) в неизмененном виде. Около 7% выводится с помощью гемодиализа.
Отмечено увеличение T_½ у пациентов в возрасте старше 75 лет.

Показания Трамадол

острый и хронический болевой синдром умеренной и значительной степени выраженности (перед- и послеоперационный периоды, злокачественные образования, травмы, невралгия). Проведение болезненных диагностических и лечебных манипуляций.

Применение Трамадол

дозу и длительность лечения устанавливает врач индивидуально, исходя из интенсивности болевого синдрома.
Взрослым и детям в возрасте от 14 лет назначают внутрь (с небольшим количеством жидкости независимо от приема пищи) по 1 капсуле (50 мг). При сильной боли одноразовая доза может составить 2 капсулы (100 мг).
Суточная доза не должна превышать 8 капсул (400 мг).
Препарат нельзя применять дольше срока, оправданного с терапевтической точки зрения. Больным с умеренным нарушением функции печени/почек, а также лицам пожилого возраста дозы подбирают индивидуально.
При умеренной печеночной недостаточности рекомендуется снижать дозу или увеличивать интервал между приемами.
При умеренной почечной недостаточности целесообразно увеличить интервал между приемами. Для пациентов с клиренсом креатинина

Противопоказания

повышенная чувствительность к действующему веществу или другим компонентам препарата. Острая алкогольная интоксикация, острое отравление снотворными, анальгетическими или психотропными препаратами; тяжелая печеночная недостаточность, тяжелая почечная недостаточность (клиренс креатинина

Побочные эффекты

со стороны нервной системы: часто — возможно усиленное потоотделения, головная боль, головокружение; редко — слабость, заторможенность, снижение скорости реакций, нарушение сна, кошмарные сновидения, эйфория, галлюцинации, тревожность, эмоциональная лабильность, депрессия, амнезия, парестезии, сонливость, эпилептиформные приступы, тремор, угнетение дыхания, нарушение координации и речи, синкопе, спутанность сознания, тревожность.
Со стороны органов чувств: редко — нарушение зрения, вкуса, мидриаз.
Со стороны пищеварительной системы: часто — тошнота, рвота, сухость во рту, изменение аппетита, запор, метеоризм, боль в эпигастрии, диарея; в отдельных случаях отмечалось повышение уровней печеночных ферментов.
Со стороны сердечно-сосудистой системы: нечасто — тахикардия, ощущение сердцебиения; снижение АД вплоть до коллапса (ортостатический коллапс); редко — брадикардия, повышение АД.
Аллергические реакции: крапивница, зуд, екзантема, буллезная сыпь, ангионевротический отек, анафилактические реакции.
Со стороны мочевыделительной системы: затрудненное мочеиспускание, дизурия, задержка мочи.
Со стороны дыхательной системы: диспноэ, ухудшение течения БА, бронхоспазм.
Со стороны скелетно-мышечной системы: редко — спазм мышц, непроизвольное сокращение мышц, мышечная слабость.
Другие: нарушение менструального цикла, усталость.
Изредка Трамадол может вызвать медикаментозную зависимость у пациентов, склонных к злоупотреблению лекарственными средствами, а также при длительном применении высоких доз препарата. Резкая отмена после длительного применения препарата может вызвать синдром отмены (проявления, подобные симптомам отмены наркотических препаратов: психомоторное возбуждение, беспокойство, раздражительность, бессонница, тремор, парестезии, приступы фобии, галлюцинации, спутанность сознания, деперсонализация, паранойя, шум в ушах, расстройства со стороны пищеварительной системы).

Особые указания

во время лечения Трамадолом не следует употреблять алкоголь.
При длительном применении Трамадола могут развиться привыкание и лекарственная зависимость.
Трамадол не следует применять для терапии синдрома отмены наркотических веществ.
Следует соблюдать особую осторожность при назначении препарата больным с травмами головы, повышенным внутричерепным давлением, умеренным нарушением функции почек или печени, больным со склонностью к судорогам, а также пациентам с повышенной чувствительностью к опиатам. Риск появления судорог может быть выше у больных, которые применяют одновременно с Трамадолом средства, снижающие судорожный синдром. Пациентам с эпилепсией в анамнезе и склонностью к эпилептическим приступам можно назначать препарат только в случае крайней необходимости. С осторожностью применяют для лечения пациентов с ослабленной функцией дыхания или в случае одновременного применения средств, угнетающих деятельность ЦНС, из-за риска дальнейшего угнетения дыхания.
Препарат содержит лактозу, поэтому пациентам с редкими наследственными формами непереносимости галактозы, недостаточностью лактазы или синдромом глюкозо-галактозной мальабсорбции не следует применять препарат.
Способность влиять на скорость реакции при управлении транспортными средствами или работе с другими механизмами . При применении препарата следует воздержаться от управления транспортными средствами и работы с другими механизмами, которая требует повышенного внимания и быстрых психических и двигательных реакций.
Применение в период беременности или кормления грудью . Трамадол проникает через плацентарный барьер, поэтому применять препарат в период беременности не рекомендуется. Если есть показания для проведения обезболивающей терапии опиатами во время беременности, следует ограничиться одноразовым применением.
Небольшое количество Трамадола проникает в грудное молоко, поэтому не следует применять препарат в период кормления грудью. При одноразовом применении кормление грудью можно не прерывать.
Дети . Препарат не применяют для лечения детей в возрасте до 14 лет.

Взаимодействия

при одновременном назначении Трамадола с препаратами, которые угнетают ЦНС, возможно взаимное усиление центральных эффектов, в том числе угнетение дыхания.
Индукторы микросомального окисления (карбамазепин, барбитураты) уменьшают выраженность анальгетического эффекта и длительность действия. Длительное применение опиоидных анальгетиков или барбитуратов стимулирует развитие перекрестной толерантности.
Анксиолитики увеличивают выраженность анальгетического эффекта, длительность анестезии увеличивается при комбинации с барбитуратами. Налоксон активизирует дыхание, прекращая анальгезию после применения опиодных анальгетиков. При применении вместе с ингибиторами МАО и в течение 14 дней после их отмены, фуразолидоном, прокарбазином и нейролептиками есть риск развития судорог.
Хинидин повышает плазменную концентрацию трамадола и снижает содержание метаболита М1 за счет конкурентного ингибирования изоэнзима CYP 2D6.
При одновременном применении Трамадола и варфарина повышается риск возникновения побочных эффектов со стороны свертывающей системы крови. Трамадол может вызвать приступы и/или развитие потенциально опасного для жизни серотонинового синдрома при применении вместе с серотонинергическими препаратами.
Кетоконазол и эритромицин могут нарушать метаболизм трамадола. Клиническая значимость такого взаимодействия не изучена.
Ондансетрон повышает потребность трамадола у больных с послеоперационной болью.

Передозировка

симптомы: рвота, миоз, циркуляторные нарушения, угнетение сознания (вплоть до комы), судороги, угнетение дыхательного центра до полной остановки дыхания.
Лечение направлено на обеспечение проходимости дыхательных путей, поддержание дыхания и функции сердечно-сосудистой системы.
Антидотом при угнетении дыхательного центра является налоксон, при судорогах — бензодиазепин. Трамадол слабо выводится с помощью диализа, поэтому отдельного применения гемодиализа или гемофильтрации недостаточно.

Условия хранения

в сухом, защищенном от света месте при температуре не выше 25 °C.