Availability and usage

Tramadol is categorized as a CNS (central nervous system) medicine which is usually promoted as tramadol hydrochloride (i.e. hydrochloride salt). Quite rarely tartrate can be found, and in some countries (such as the United States) very rarely this drug is obtainable in the form for both oral administration and injection, either intravenous or intramuscular. The 50 mg generic tablet represents the most popular dose offered on the market. This form is produced by several pharmaceutical companies. Besides, it is also commonly available in combination with paracetamol or acetaminophen, in such medications as Ultracet, containing a reduced dose of tramadol (37.5 mg) and APAP (325 mg). Injection solutions are intended for use in patient-controlled analgesia pumps, either as the single agent or combined with another active substance, e.g morphine.
Various forms of Tramadol include:
- Tablets for oral administration (regular or extended release, chewable, low-residue or uncoated)
- capsules (regular or extended release)
- suppositories
- effervescent powders and tablets
- powders for compounding
- sterile solution ampules for subcutaneous, intravenous and intramuscular injections
- preservative-free solutions for spinal routes of injection (epidural, caudal etc.)
- alcohol and alcohol-free liquids for oral and sub-lingual administration, available in regular phials and bottles, pumped bottles, and dropper phials
- tablets and capsules containing paracetamol, aspirin or acetaminophen.
External use of Tramadol is also a regular practice. This agent has been widely applied as an ingredient of various multi-component topical preparations - creams, gels, and solutions. Such forms as rectal foam, concentrated retention enema and transdermal plasters are also used in medical practice.
Tramadol is characterized with unpleasant taste. It is rather bitter, but much less bitter, in comparison with morphine. Drops and liquid preparations for oral and sublingual administration come either with or without added flavoring. Its relative effectiveness through transmucosal administration (i.e. sublingual, rectal) is evaluated as similar to efficiency of codeine. In human liver Tramadol metabolizes to prepotent metabolites.
Maximum daily dose depends on the route of administration. Generally, it is 400 mg for oral use and 600 mg for parenteral use. But some producers and some formulations determine lower doses as maximum. For instance, maximum dose of Ultracet containing 37.5 mg tramadol and 325 mg acetaminophen is 8 tablets (300 mg) per day. The same daily dose is maximum for Ultram.
Several categories of patients should consult their healthcare professionals prior to taking Tramadol. They are: patients administering selective serotonin reuptake inhibitors, such as Prozac, strong opioids (methadone, morphine etc), serotonin noradrenaline reuptake inhibitors, such as Effexor; elderly patients - 75 y.o. or more, pediatric patients younger than 18 y.o., and patients with severe renal or hepatic problems and conditions.