💊 Tramadol (Tramadol Hydrochloride)
Tramadol is an opioid medicine prescribed for severe and persistent pain that requires an opioid analgesic and cannot be adequately treated with alternative options. It carries important warnings about addiction, abuse, misuse and respiratory depression. It must be used only by prescription and under medical supervision.
In Arabic: ترامادول هيدروكلوريد (أقراص ممتدة المفعول)
✅ What it is used for
- Management of severe and persistent pain that requires an opioid analgesic and cannot be adequately treated with alternative options, including immediate-release opioids
- Not indicated as an as-needed (prn) analgesic
🧪 Active ingredient
Tramadol hydrochloride: an opioid agonist that binds μ-opioid receptors and weakly inhibits reuptake of norepinephrine and serotonin; these mechanisms are believed to produce its analgesic effect.
🌿 Benefits
- Relief of severe, persistent pain when other treatment options are inadequate
- Once-daily dosing with the extended-release formulation
📝 How to use
- The dose is set by your doctor or pharmacist according to your condition; do not change it on your own
- Take once daily at approximately the same time every day
- Swallow tablets whole; do not crush, chew or break them, to avoid exposure to a potentially fatal dose
- Do not exceed the maximum daily dose set by your doctor (300 mg per day)
- Do not use with other tramadol products
- Do not stop suddenly without medical advice, as this can cause serious withdrawal symptoms
💊 Dosage forms
- Extended-release tablets 100 mg
- Extended-release tablets 200 mg
- Extended-release tablets 300 mg
⚠️ Common side effects
- Dizziness
- Constipation
- Nausea
- Headache
- Somnolence (drowsiness)
- Flushing
- Pruritus (itching)
- Vomiting
- Insomnia
- Dry mouth
🚨 Serious — seek medical help
- Life-threatening respiratory depression
- Addiction, abuse, misuse, overdose
- Serotonin syndrome
- Seizures
- Suicidal thoughts or behavior
- Severe hypotension
- Adrenal insufficiency
- Serious hypersensitivity reactions (e.g., anaphylaxis)
- Withdrawal symptoms on abrupt discontinuation
- Opioid-induced hyperalgesia and allodynia
⛔ Do not use if
- Children younger than 12 years of age
- Post-operative management in children younger than 18 years following tonsillectomy and/or adenoidectomy
- Significant respiratory depression
- Acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus
- Hypersensitivity to tramadol
- Concurrent use of MAOIs or use within the last 14 days
❗ Warnings & precautions
- Risk of addiction, abuse and misuse; assess before prescribing and reassess regularly during treatment
- Risk of respiratory depression, especially at initiation or after a dose increase
- Accidental ingestion, especially by children, of even one dose can be fatal
- Combining with benzodiazepines or other CNS depressants (including alcohol) may cause profound sedation, respiratory depression, coma and death
- Risk of seizures even within the recommended dose range; higher with higher doses, certain drugs, and in patients with epilepsy
- Do not use in suicidal or addiction-prone patients; use caution with tranquilizers, antidepressants, or alcohol abuse
- Monitor closely in chronic pulmonary disease, elderly, cachectic or debilitated patients
- Avoid in circulatory shock, impaired consciousness or coma
- Use caution with increased intracranial pressure, brain tumors or head injury
- Use not recommended in severe hepatic or renal impairment
- Do not abruptly discontinue; taper under medical supervision
🔄 Drug interactions
- CYP2D6 inhibitors (e.g., quinidine, fluoxetine, paroxetine, bupropion): may raise tramadol levels and increase risk of seizures and serotonin syndrome
- CYP3A4 inhibitors: may increase tramadol levels; close monitoring is required
- Benzodiazepines, other CNS depressants and alcohol: risk of profound sedation, respiratory depression and coma
- MAOIs: contraindicated during treatment or within 14 days of use
- Serotonergic drugs (SSRIs, SNRIs, tricyclic antidepressants): risk of serotonin syndrome and seizures
- Other drugs that lower seizure threshold (e.g., neuroleptics) and other opioids: increase seizure risk
🤰 Pregnancy
Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome, which can be life-threatening. Animal studies showed decreased fetal weights and reduced ossification. Tell your doctor if you are pregnant or planning pregnancy.
🍼 Breastfeeding
Breastfeeding is not recommended during treatment with this medicine.
🧒 Children
Safety and effectiveness in pediatric patients have not been established. It is contraindicated in children younger than 12 years and for post-tonsillectomy/adenoidectomy pain management in those younger than 18. Avoid in adolescents 12–18 years with risk factors for respiratory depression unless benefits outweigh risks.
👴 Older adults
Higher rates of adverse events (e.g., constipation, fatigue, weakness, postural hypotension, dyspepsia) occur in patients over 65. Use with caution over 65 and with even greater caution over 75; titrate slowly and consider monitoring renal function.
🌡️ Storage
Store at 20–25 °C (68–77 °F); excursions permitted between 15 and 30 °C. Dispense in a tight, light-resistant container. Keep out of reach of children, store securely and dispose of properly.
⏰ Missed dose
The provided label text does not give missed-dose instructions. Consult your doctor or pharmacist and do not double the dose on your own.
🆘 Overdose
Symptoms may include respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold clammy skin, constricted pupils, bradycardia, hypotension, and death. Seek emergency care immediately. An opioid overdose reversal agent such as naloxone may be given for serious respiratory or circulatory depression, though it may increase seizure risk. The tablet continues to release drug, so careful monitoring is needed.
💰 Price & brands in your area
🏛️ Official price in Palestine — Ministry of Health price list:
| Product | Company | Pack | Price |
|---|---|---|---|
| TRAMAL 100 MG INJECTION (2 ML) Tramadol HCl 100 mg/ 2 ml | Pharmacare Store | 5 AMPOULES OF 2 ML / BOX | 13 ₪ |
| TRAMARAZ DROPS 10 ML Tramadol Hydrochloride | Al salameh drug store | 10 ml | 16 ₪ |
| TRAMAL LONG 100 mg TABLETS (10 TAB) Tramadol HCl 100mg | Pharmacare Company | 10 TABLETS / BOX | 22 ₪ |
| ZALDIAR TABLETS Tramadol hydrochloride37.5 mg and 325 mg Paracetamol | Pharmacare Company | 20 TABLETS / BOX | 25 ₪ |
| TRAMAL LONG 150 MG (10 tab) Tramadol HCl 150 mg | Pharmacare Company | 10 tab | 36 ₪ |
| TRAMAL 50 MG DISPERSIBLE TABLETS (30 TAB) Tramadol HCl 50mg | Pharmacare Company | 30 TABLETS / BOX | 38 ₪ |
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Mechanism of action
Opioid μ-agonist and inhibitor of norepinephrine and serotonin reuptake. Opioid activity results from low-affinity binding of the parent compound and higher-affinity binding of the O-desmethyl metabolite M1, which in animal models is up to 6 times more potent in analgesia and 200 times more potent in μ-opioid binding.
Labeled dosing
Label adult dosing: once daily at the same time each day. Converting from tramadol IR: calculate the total 24-hour IR dose and start at a dose rounded down to the next lower 100 mg increment, then adjust to need and tolerance. Converting from other opioids: discontinue them (except as needed for breakthrough pain) and start at 100 mg once daily, titrating by 100 mg every 5 days according to need and tolerance. Do not exceed 300 mg/day. Final dosing is determined by the prescriber.
- Use the lowest effective dose for the shortest duration
- Discuss opioid overdose reversal agents with patient/caregiver at initiation and renewal
- Reassess periodically for ongoing need, adverse reactions, and signs of addiction, abuse or misuse
- Do not rapidly reduce or abruptly discontinue in a physically dependent patient
- Subject to an Opioid Analgesic REMS
- Schedule IV controlled substance
🎓 Key points for students
- Tramadol is a μ-opioid agonist plus norepinephrine/serotonin reuptake inhibitor
- The active metabolite M1 (O-desmethyl) has much higher μ-receptor affinity than the parent drug
- Beyond classic opioid risks, it carries seizure and serotonin syndrome risk
- Key contraindications: age <12, post-tonsillectomy/adenoidectomy <18, respiratory depression, GI obstruction, MAOI use
- Maximum 300 mg/day; do not combine with other tramadol products
- Hemodialysis is not expected to help in overdose (removes <7% of dose in 4 hours)
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What is tramadol used for?
For severe and persistent pain that requires an opioid analgesic and is not adequately managed by alternatives. It is not for as-needed use.
Can I crush or chew the tablet?
No. Tablets must be swallowed whole; crushing or chewing can expose you to a potentially fatal dose.
What are the most common side effects?
Dizziness, constipation, nausea, headache, drowsiness, flushing, itching, vomiting, insomnia and dry mouth.
Can I take it with alcohol or sedatives?
No. Combining with alcohol, benzodiazepines or other CNS depressants can cause profound sedation, respiratory depression, coma and death.
Can I stop it suddenly?
No. Abrupt discontinuation may cause serious withdrawal symptoms and uncontrolled pain. Your doctor will plan a gradual dose reduction.
Is it safe for children?
No. It is contraindicated in children under 12 and for post-tonsillectomy/adenoidectomy pain in those under 18.
⚕️ For education only — not a substitute for advice from your doctor or pharmacist. Do not start or stop any medicine without advice. Source: official FDA drug label via openFDA (2025-11), simplified. Updated: 2026-11-10.