Moderate to moderately severe pain in adults.
≥17yrs: Dissolve on tongue; swallow with or without water. Titration regimen: increase total daily dose by 50mg as tolerated every 3 days up to 200mg/day (eg, 50mg four times daily), then may increase to 50–100mg every 4–6 hours; max 400mg/day. For rapid onset of analgesic effect: 50–100mg every 4–6 hours as needed; max 400mg/day. >75yrs: max 300mg/day. Renal dysfunction (CrCl <30mL/min): increase dosing intervals to 12 hours; max 200mg/day. Cirrhosis: 50mg every 12 hours.
<17yrs: not recommended.
Acute intoxication with alcohol, hypnotics, narcotics, centrally-acting analgesics, other opioids, or psychotropic drugs.
Do not give to opioid-dependent patients. Respiratory depression. Increased intracranial pressure. Head injury. Seizure disorders. Acute abdomen. Renal or hepatic impairment. Suicidal ideation. Drug abusers. Avoid abrupt cessation. Elderly (esp. >75 years). Labor & delivery, pregnancy (Cat.C), nursing mothers: not recommended.
Concomitant MAOIs, carbamazepine, alcohol, or other forms of tramadol: not recommended. Increased risk of seizures and/or serotonin syndrome with SSRIs, SNRIs, tricyclics, cyclobenzaprine, promethazine, opioids, MAOIs, naloxone, triptans, linezolid, lithium, neuroleptics, others that lower seizure threshold. Potentiation with alcohol, other CNS depressants; reduce dose. May be potentiated by CYP2D6 inhibitors (eg, quinidine, fluoxetine, paroxetine, amitriptyline). May potentiate digoxin, warfarin. May be affected by CYP3A4 inhibitors (eg, ketoconazole, erythromycin) or CYP3A4 inducers (eg, rifampin, St. John’s Wort).
Dizziness, GI upset, constipation, headache, somnolence, pruritus, CNS stimulation, asthenia, sweating, dyspepsia, dry mouth, seizures, anaphylaxis.
Tabs—30 (5 x 6 blister cards)