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Atypical opioid (μ-agonist + SNRI)

Tramadol hydrochloride

Brand names: Zydol, Tramacet (combo)

Tramadol is an opioid analgesic for moderate pain that also has serotonergic and noradrenergic activity.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Tramadol hydrochloride extended-release tablets should be prescribed only by healthcare professionals who are knowledgeable about the use of extended-release/long-acting opioids and how to mitigate the associated risks. (2.1) Use the lowest effective dosage for the shortest duration of time consistent with individual patient treatment goals. Reserve titration to higher doses of tramadol hydrochloride extended-release tablets for patients in whom lower doses are insufficiently effective and in whom the expected benefits of using a higher dose opioid clearly outweigh the substantial risks. (2.1, 5) Initiate the dosing regimen for each patient individually, taking into account the patient’s …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-11-20. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It is a weak opioid-receptor agonist and also inhibits serotonin and noradrenaline reuptake, both contributing to analgesia.

Prescribing in practice

  • Its serotonergic action increases the risk of serotonin syndrome (e.g. with SSRIs/SNRIs) and of seizures, particularly at higher doses or with a lowered seizure threshold.
  • Like codeine it depends partly on CYP2D6 metabolism; it is a controlled drug.
  • Additive sedation and respiratory depression occur with other CNS depressants.

Monitoring

Review analgesic benefit, the serotonergic burden of co-medication, and signs of dependence.

Counselling the patient

  • Do not combine it with alcohol or other sedatives.
  • Report agitation, sweating, tremor or confusion (possible serotonin reaction).
  • Take it only as prescribed; it can be habit-forming.

Evidence & guidelines

Used for moderate pain, with particular caution about serotonin syndrome, seizures and dependence.

Reference: NICE; MHRA; FPM; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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