Tramal - instructions for use, analogs, reviews and release forms (50 mg capsules, 100 mg retard, 150 mg and 200 mg tablets, drops, suppositories, injection injections) anesthetic medication for pain in adults, children and pregnancy

In this article, you can read the instructions for using the drug Tramal. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of an anesthetic Tramal in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Tramal in the presence of existing structural analogues.Use for the treatment of pain in adults, children, as well as during pregnancy and lactation.

Tramal opioid analgesic. Has a pronounced analgesic effect, which is due to the agonistic effect on opioid receptors in the central nervous system. Tramadol (the active substance of Tramal) is a synthetic opioid, is a racemate of (+) and (-) isomers, which are involved in various ways in analgesic action. The isomer (+) is a pure agonist of opioid receptors, the isomer (-) inhibits the neuronal capture of norepinephrine, activates the central descending noradrenergic system, which disrupts transmission of pain impulses to the gelatinous substance of the spinal cord, both isomers act synergistically. Causes sedation.

In therapeutic doses, tramal has virtually no effect on the parameters of hemodynamics, does not inhibit the function of respiration. With controlled use, addiction and drug dependence develop extremely rarely and are less pronounced than morphine.

Composition

Tramadol hydrochloride + excipients.

Pharmacokinetics

When taking the drug, absorption is 90%.Bioavailability - 68% (increases with repeated use). Tramal penetrates the blood-brain barrier (GEB) and placental barrier, excreted in breast milk (0.1%). Binding to plasma proteins - 20%. Tramadol is biotransformed in the liver by N- and O-desmethylation followed by conjugation with glucuronic acid. 11 metabolites have been identified, of which mono-O-desmethyltramadol (M1) has pharmacological activity. It is excreted by the kidneys, 25-35% unchanged, the average cumulative index of renal excretion is 94%.

Indications

Pain syndrome of moderate and severe intensity of different etiology:

• in the postoperative period;
• with injuries;
• with pain caused by myocardial infarction (for parenteral use);
• in cancer patients;
• when conducting painful diagnostic or therapeutic manipulations.

Forms of release

Capsules 50 mg.

Drops for ingestion 100 mg.

Solution for injections (injections in ampoules).

Candles rectal 100 mg.

Tablets of prolonged action of 100 mg, 150 mg and 200 mg (Tramal retard).

Instructions for use and dosing regimen

The solution for injections is administered intravenously, intramuscularly or subcutaneously.

Inside the drug can be taken before, during and after meals. Capsules should be taken with a small amount of liquid, drops - on a piece of sugar or dissolved in a small amount of liquid.

Candles should be injected into the rectum.

Doses are set depending on the intensity of the pain syndrome.

Tramal should not be prescribed for longer than it is therapeutically necessary.

For adults and adolescents older than 14 years, a single dose is 50-100 mg (1-2 capsules, 20-40 drops, 1 suppository, 1-2 ml solution for injection). If after a single application there is no satisfactory analgesia, then after 30-60 minutes a single dose of 50 mg can be prescribed repeatedly.

For severe pain, 100 mg of tramadol hydrochloride can be given as the initial dose. To relieve pain, 400 mg per day is usually enough.

For the treatment of pain associated with cancer and with severe pain in the postoperative period, the drug can be used in higher doses.

For children over the age of 1 year, the drug in the form of a solution for injection and drops for oral administration is prescribed in a single dose at a rate of 1-2 mg / kg of body weight. The daily dose at the rate of 4-8 mg / kg is usually quite sufficient.

In elderly patients (75 years and over) due to the possibility of delayed excretion, the interval between doses can be increased in accordance with individual characteristics.

In diseases of the kidneys and liver, prolongation of the Tramal effect is possible. For this category of patients it is recommended to increase the interval between single dose doses.

Tablets Tramal retard

The dose is set depending on the intensity of pain and the individual sensitivity of the patient. Tram retard is enough to take 2 times a day, morning and evening, regardless of food intake.

Adults and adolescents over 14 years of age are prescribed 100 mg (1 tablet) twice a day, in the morning and in the evening. If the analgesic effect is insufficient, the dose can be increased by taking 1 tablet of 150 mg or 200 mg, also in the morning and in the evening, the intervals between doses are set individually, but should be at least 6 hours. The maximum dose is 400 mg per day.

In elderly patients (over 75 years of age), the release of the drug may be slowed. In such cases, it is necessary to increase the interval between doses in accordance with the patient's state of health.

With renal failure / dialysis and with liver failure, excretion of tramadol slows down. In this category of patients, it is necessary to individually select the interval between doses of the drug in accordance with the patient's state of health.

Tablets should be swallowed whole, without chewing with a sufficient amount of liquid.

Tramed retard should not be used for longer than it is therapeutically necessary.

Side effect

• nausea, vomiting;
• dry mouth;
• constipation;
• stomach ache;
• bloating;
• change in appetite;
• dizziness;
• feeling tired;
• drowsiness;
• confusion of consciousness;
• headache;
• mood changes (mainly improvement, less often - depression);
• change in activity (mainly suppression, less often - increase);
• violation of behavioral reactions;
• disturbance of sensations;
• cerebral convulsions (were observed almost in all cases when tramadol hydrochloride was administered intravenously in high doses, or if antipsychotics were simultaneously prescribed);
• irregular heartbeats;
• tachycardia;
• fainting or collapse (especially if the patient is in a vertical position or under physical exertion);
• redness;
• rash;
• muscle weakness (motor weakness);
• increased sweating (especially with rapid intravenous injection);
• difficulty in swallowing water.

Contraindications

• conditions accompanied by respiratory depression or severe CNS depression (alcohol poisoning, hypnotics, opioid analgesics, psychotropic drugs);
• withdrawal of narcotic substances;
• renal failure of severe degree (SC less than 10 ml / min);
• severe hepatic impairment;
• simultaneous use of MAO inhibitors and a 2-week period after their withdrawal;
• hypersensitivity to the drug and other opioid analgesics.

Application in pregnancy and lactation

During pregnancy and lactation, Tramal's administration is only possible according to vital indications, the application should be limited only to one-time administration.

special instructions

With caution and under the supervision of a doctor, the drug should be prescribed to patients with impaired renal and hepatic function, with craniocerebral trauma, increased intracranial pressure, epilepsy, persons with drug dependence on opioids, with abdominal pain of an unknown genesis ("acute abdomen") ,with confusion of unclear origin, disturbances from the respiratory center or respiratory function.

The condition of patients with central seizures should be carefully monitored during treatment with Tramalom.

After prolonged use of Tramal, it is impossible to completely exclude the possibility of developing drug dependence. Therefore, only the doctor must decide on the duration of treatment and its interruptions. The patient should be warned about the need to strictly adhere to the dose and duration of treatment prescribed by the doctor and not transfer the drug to others. Long-term treatment for chronic pain syndrome should be carried out only on strict indications.

The drug is released by prescription. It belongs to the list of strong substances of the Standing Committee on Drug Control of the Ministry of Health of the Russian Federation.

The use of alcohol during the period of use of any Tramal dosage forms should be deleted.

Impact on the ability to drive vehicles and manage mechanisms

During treatment with Tramal, the patient must abandon all activities requiring increased attention and speed of psychomotor reactions (including driving, work at the machine), becausethe drug can have a strong enough impact on psychophysical abilities (including decreased attention, slowing reactions).

Drug Interactions

Tramal enhances the effect of drugs that have a depressing effect on the central nervous system, as well as ethanol (alcohol).

Inductors of microsomal oxidation (including carbamazepine, barbiturates) reduce the severity of the analgesic effect and the duration of action of tramadol.

Long-term use of opioid analgesics or barbiturates stimulates the development of cross tolerance.

Anxiolytics increase the severity of the analgesic effect of tramadol, the duration of anesthesia increases when combined with barbiturates. Naloxone activates breathing, eliminating analgesia after the use of opioid analgesics.

With the simultaneous use with Tramal inhibitors MAO, furazolidon, procarbazine, neuroleptics - the risk of seizures (lowering the threshold convulsive readiness).

Quinidine increases the plasma concentration of tramadol.

Analogues of the drug Tramal

Structural analogs for the active substance:

• Protradon;
• Sintradon;
• Tramadol;
• Tramadol hydrochloride;
• Tramaclosidol;
• Tramal;
• Tramped retard;
• Tremolin;
• Tramundine retard.

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