Tramadol

Tramadol is an alternative treatment option for osteoarthritis (OA) of the knee and hip for people who have failed treatment with acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) or cannot take these medications. Tramadol can also be used in conjunction with acetaminophen or NSAIDs.

Tramadol may be used for short periods of time to help treat pain associated with inflammatory arthritis.

Tramadol is taken orally in pill form.

Short acting:

• Tramacet® and generics: One to two tablets every four to six hours (maximum: eight tablets daily). Tramacet contains acetaminophen, maximum dose of acetaminophen from all sources: 4 g/day

• Ultram®: One to two tablets every four to six hours to a maximum of 400 mg daily

Long acting:

• Durela®, Ralivia® or Tridural®: Start with 100 mg once daily; may increase at weekly intervals to maximum 300 mg daily

• Zytram® XL: Start with 150 mg once daily; may increase at weekly intervals to maximum 400 mg daily

Tramadol is a type of opioid analgesic. It is thought to relieve pain by binding to opioid receptors in the central nervous system. Unlike other opioids, it also works by  inhibiting the reuptake of certain neurotransmitters known as norepinephrine and serotonin, but the opioid receptor binding is thought to be the main mechanism of action. 

Tramadol typically begins to work within one hour.

Tramadol interacts with a number of other medications. Please speak with your healthcare provider about whether any of the other medications you currently take interact with tramadol.

Do not take tramadol if you have an allergy to tramadol.

A number of tramadol products also contain acetaminophen. If you are taking other acetaminophen products, speak to your healthcare providers to ensure that you are not taking more than the maximum daily dose of acetaminophen (max: 4,000 mg/day).

Nausea, vomiting, dizziness, constipation, headache and drowsiness are common with tramadol. Approximately 40 percent of people discontinue use of tramadol because of its adverse effects, which limits its effectiveness in treating OA pain.    

While tramadol is often seen as a safer alternative to conventional opioids such as codeine, it is also susceptible to misuse, overdose, dependency, and addiction, even at recommended doses. If you have concerns or questions about tolerance and dependence, please talk to your healthcare provider.     

Do not exceed the maximum recommended daily dose of tramadol. Gradual dosage increases may help reduce some of the side effects. To reduce stomach upset, consider taking tramadol with food.

If you experience drowsiness and sedation while taking tramadol, please be cautious about operating hazardous machinery, including automobiles, until you are reasonably certain that tramadol does not affect your ability to engage in such activities.

People who are experiencing sedation and drowsiness may consider taking the medication closer to bedtime.

It should be recognized that tramadol is a type of opioid and can cause physical dependence as other opioids do, and precautions should be taken to avoid dependence by avoiding prolonged use.

Routine blood tests or monitoring are not normally required while you are taking tramadol. Your healthcare provider may meet with you regularly to ensure that tramadol is adequately controlling your pain and not causing any adverse effects.

Store this medication at room temperature (15 to 30 degrees Celsius) and keep it out of reach of children.