Tramadol: Dual-Mechanism Analgesic

• Dual-mechanism analgesic agents treat moderate to moderately severe pain.

Prototype Medication

• Tramadol is the prototype medication for dual-mechanism analgesic agents.

Expected Pharmacologic Action

• Tramadol binds to selected opioid receptors.
• Tramadol blocks reuptake of norepinephrine and serotonin in the CNS.

Adverse Drug Reactions

• Tramadol adverse effects are rare, but can include sedation, dizziness, headache, nausea, and constipation.
• Respiratory depression is rare with tramadol
• Seizures can occur with tramadol, avoid in clients with a history of seizures.
• Urinary retention maybe experienced

Interventions

• Monitor clients during ambulation and offer support as necessary.
• Recommend the lowest effective dose and for short-term use only to minimize adverse drug reactions.
• Give tramadol with food and an antiemetic as needed for nausea if prescribed.
• Measure baseline vital signs, including respirations.
• If the respiratory rate falls below 12/min, stimulate breathing.
• Prepare to administer an opioid antagonist, such as naloxone, to restore the respiratory rate.
• Naloxone might only be moderately effective in reversing respiratory depression caused by tramadol, so the best intervention is prevention.
• Monitor for manifestations of seizure activity and institute precautions.
• Have airway and suction equipment readily available, as well as padding for the side rails and headboard.
• Monitor for urinary retention and report any difficulty in urination to the provider.

Administration

• Clients will not feel tramadol's therapeutic effects until approximately one hour after administration.
• Anticipate when clients will need their next dose to facilitate timely dosing that prevents recurrence of pain.
• Clients need to swallow the extended-release form of tramadol whole, instead of crushing or chewing them.

Client Instructions

• Avoid taking tramadol prior to driving or activities that require mental alertness.
• Sit or lie down if feeling lightheaded and change positions gradually to avoid dizziness.
• If constipation occurs, increase fluid and fiber intake, as well as activity and exercise.
• Take tramadol only when needed and on a short-term basis, to minimize the risk of adverse drug reactions, respiratory depression in particular.
• Report any episodes of urinary retention to the provider.

Contraindications and Precautions

• Tramadol is contraindicated in clients who are acutely intoxicated with alcohol, opioids or psychotropic medications.
• Tramadol is contraindicated in clients who have seizure disorders or respiratory depression.
• Tramadol is contraindicated in clients under the age of 12, or under the age of 18 following tonsillectomy and/or adenoidectomy.
• Use tramadol with caution in clients who have a history of substance use disorder, liver, or renal disease.
• Use tramadol with caution in clients who have increased intracranial pressure, and in older adults.

Interactions

• Administration of tramadol with monoamine oxidase inhibitors (MAOIs), poses the risk for a hypertensive crisis.
• Its use with selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, MAOIs, and triptans pose a risk for serotonin syndrome.
• Tramadol increases the effects of CNS depressants.
• Tramadol decreases the levels of carbamazepine.
• Administering tramadol concurrently with St. John’s wort increases its sedative effects.