The reception of Tramadol pills is contraindicated in the following cases: hypersensitivity, conditions accompanied by respiratory depression or severe central nervous system depression (alcohol poisoning, sleeping pills, narcotic analgesics, and other psychoactive drugs and substances), pregnancy, lactation (in case of long – term use), childhood (up to 1 year for parenteral administration; up to 14 years for oral administration), the reception of MAO inhibitors, severe liver or kidney failure.
Tramadol should be used with caution in drug addiction, confusion, intracranial hypertension, traumatic brain injuries, epileptic syndrome (cerebral genesis), in patients with abdominal pain of unknown origin.
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How to use: dosage and course of treatment
Tramadol can be used intravenously, intramuscularly, subcutaneously, orally, rectally.
Orally:
• for a single use for adults and children over 14 years of age – take 0.05 g (pills, capsules) with a small amount of liquid or 20 drops of solution (or drops) for oral administration with a small amount of liquid or sugar. After 30-60 minutes, you can repeat the same dose, but no more than 8 doses per day.
• Pills-100-200 mg every 12 hours. Daily dose-0.4 g (in exceptional cases, for example, in cancer patients, it is possible to reduce the interval to 6 hours and increase the daily dose).
• Rectally-0.1 g. the frequency of reception is up to 4 times a day.
• Children over the age of 1 year should take it orally, taking only drops or parenterally (intravenous intramuscular and subcutaneous injections), at a dose of 1-2 mg/kg. The daily dose is 4-8 mg/kg (1 drop – 2.5 mg).
• The elderly and patients with renal insufficiency need an individual dosage of the drug (possible prolongation of T1 / 2). When the CC is less than 30 ml/min, and in patients with liver failure, a 12-hour interval between taking the next doses of the drug is required.
Tramadol pharmacological action
Opioid synthetic analgesic, which has a central effect and action on the spinal cord (it promotes the opening of potassium and calcium channels, causes hyperpolarization of the membranes and inhibits the conduct of pain impulses), increases the effect of sedative medications. Tramadol activates opiate receptors (mu-, delta-, kappa -) on pre- and postsynaptic membranes of afferent fibers of the nociceptive system in the brain and gastrointestinal tract. It slows down the destruction of catecholamines, stabilizes their concentration in the central nervous system.
Tramadol’s resistance to opioid receptors is 10 times weaker than that of codeine, and 6000 times weaker than that of morphine. The severity of the analgesic effect is 5-10 times weaker than morphine.
The analgesic effect is caused by a decrease in the activity of the nociceptive and an increase in the antinociceptive systems of the body.
In therapeutic doses, the drug does not significantly affect hemodynamics and respiration, does not change the pressure in the pulmonary artery, slightly slows down intestinal peristalsis, without causing constipation. It has some antitussive and sedative effects. The drug depresses the respiratory center, excites the starting zone of the emetic center, the nucleus of the oculomotor nerve.
If there is a case of prolonged use, then tolerance may develop. The analgesic effect develops in 15-30 minutes after ingestion and lasts up to 6 hours.
Tramadol Side effects
From the nervous system: sweating, dizziness, headache, weakness, fatigue, lethargy, paradoxical CNS stimulation (nervousness, agitation, anxiety, hallucinations), sleepiness, sleep disturbance, confusion, violation of coordination of movements, seizures of central origin (at/in the introduction in high doses or with concomitant administration of antipsychotic drugs (antipsychotic drugs), depression, amnesia, impaired cognitive function, paresthesias, unsteady gait.
Special instructions
• Not used Tramadol for the treatment of drug withdrawal syndrome.
• Do not use ethanol at the same time.
• In the case of a single intake, there is no need to interrupt breast-feeding.
• During treatment with Tramadol, care should be taken when driving vehicles and engaging in other potentially dangerous activities that require increased concentration and speed of psychomotor reactions.
Overdose
Symptoms: miosis, vomiting, collapse, coma, convulsions, respiratory center, depression, apnea.
If you carry out the treatment of overdose, it is necessary to ensure the patency of the respiratory tract, maintain breathing, and the activity of the cardiovascular system.
Opioid-like effects can be stopped by naloxone, convulsions-by benzodiazepine.
