Parenterally : V D ~260L; Excretion of tramadol (and metabolites) is renal with a t 1/2 ß photographs and drawings of hydrocodone vicodin; ~ 5.5 hr - for M1 the value is ~ 6.7+ hr. Plasma protein binding is 20%. Clearance is halved with liver or renal dysfunction. The drug is poorly dialysable. 3. Side effects, interactions and cautions

The major good point of tramadol is its minimal respiratory depression in therapeutic doses but you should exercise the usual caution you would with opiates, ultram tramadol cod.

Interactions with with monoamine-oxidase inhibitors, alcohol (acute intoxication), hypnotics, photographs and drawings of hydrocodone vicodin, centrally acting analgesics, ultram tramadol cod, opioids, and "psychotropics" (including selective serotonin reuptake inhibitors) preclude its use with such agents. It should also not be used in epileptic patients, tramadol hcl50mg used for.

Potential problems include CYP 2D6 deficiency, which may have clinical consequences (about 30% of analgesia is from M1 metabolite); it may be more effective in extensive metabolisers (nobody appears to have looked at respiratory depression in this subgroup)!

Interactions occur with carbamazepine or cimetidine (3A4 effect), 3230 lubbock, and quinidine, fluoxetine or amitriptyline (2D6), but the clinical relevance of all of these is unclear.

Interactions might possibly occur with coumarin anticoagulants (unlikely; this may be attributable to concomitant paracetamol administration)!,

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Side Effects include nausea & vomiting (6% and ~2% respectively; more common with parenteral administration), tramadol knock out doseage, dizziness, drowsiness, sweating. Nothing suggests a different tolerability profile in children, but this has not been extensively and specifically studied.

Intra-operative awareness has been reported, taking hydrocodone with xanax, but it would seem that the anaesthesia administered with the drug in these early reports was inadequate, ultram tramadol cod.

Overdose is uncommon and abuse potential low . Features of overdose are what one would expect (sedation, ultram tramadol cod, nausea, vomiting) but importantly, overdose may result in seizures. Seizures do not appear to occur with usual doses (in the absence of drug interactions or underlying epilepsy).

Tramadol crosses the placenta , photographs and drawings of hydrocodone vicodin, but appears safe in labour without neonatal respiratory depression. There is no evidence at present for teratogenicity, taking hydrocodone with xanax, but the usual cautions apply.

A tiny amount enters breast milk (0.1%), tramadol hcl50mg used for.

Tramadol appears contra-indicated in porphyria. 4. Benefits of Tramadol

It is an effective analgesic.

No significant respiratory depression occurs (in adults OR children) at recommended doses - IV /kg is similar to placebo; 1 or 2mg/kg caused substantially less respiratory depression in 88 children (2 - 10 yr) than did pethidine 1mg/kg - respiratory rate decreased by 7-12/min versus pethidine 31/min and placebo 2/min, with NO prolonged apnoea in the tramadol group, photographs and drawings of hydrocodone vicodin. 90% of the pethidine group (versus 14 & 23% of the tramadol groups and 14% of placebo) needed manual ventilatory support. [Bosenberg AT & Ratcliffe S Anaesthesia 1998 Oct 53 960-4]

Tramadol appears to be antitussive.

There is no clinically significant effect on heart rate or blood pressure have been recorded (adults or children). There is no relevant effect on GIT function (apart from the relatively infrequent side effects of nausea and occasional vomiting).

Tramadol reduces post-operative shivering. (Interestingly, the sweating threshold is decreased by tramadol, in contrast to other opioids; but like other opioids it lowers the vasoconstriction threshold and shivering threshold).


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