Indications
-Indicated for moderate to moderately severe pain, such as:
**Postoperative pain
**Menstrual cramps
**Musculoskeletal pain
**Chronic and cancer-related pain
Warnings and Precautions
**Do not use in individuals allergic to tramadol
**Avoid co-use with alcohol, CNS depressants, SSRIs/SNRIs/MAOIs
**Not recommended in pregnancy unless medically indicated
**Adjust dose in hepatic or renal impairment
**Risk of dependency, withdrawal, respiratory depression
History and Development
**Discovered: By Grünenthal GmbH (West Germany), 1962
**Marketed in humans: Since 1977 as “Tramal”
**FDA approval: 1995 (USA) under the brand “Ultram”
**Designed to offer analgesia with lower addiction risk than traditional opioids
Misuse and Abuse
**Abused via high doses or mixed with sedatives to produce euphoria
**May result in addiction, withdrawal syndrome, seizures, or fatal overdose
**Cases of tramadol injection after capsule manipulation have been reported
**Used illicitly in several developing regions
Additional Notes
**Dual mechanism of action: μ-opioid receptor agonist and SNRI
**In Thailand, tramadol is a Schedule II controlled substance
**Illegal use without prescription is punishable by law
Dosage
**Adults & adolescents >14 years:
Initial dose: 50–100 mg every 4–6 hours
Maximum dose: 400 mg/day
To be used under medical supervision
Storage
Store below 30°C Keep out of reach of children
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