Atypical opioid (μ-agonist + SNRI)
Tramadol hydrochloride
Brand names: Zydol, Tramacet (combo)
Adult dose
Dose: PO IR: 50–100mg every 4–6h (max 400mg/day). PO MR: 100–200mg BD. IV/IM: 50–100mg every 4–6h
Route: PO/IV/IM
Frequency: q4-6h
Dose adjustments
Renal
Reduce / extend interval if eGFR <30
Clinical pearls
- CD3 controlled drug; CYP2D6 polymorphism affects analgesia
- MHRA: avoid in epilepsy / serotonergic combinations
Contraindications
- Concurrent MAOI / within 14 days
- Acute alcohol/opioid intoxication
- Uncontrolled epilepsy
- Severe hepatic impairment
- Children <12
Side effects
- Nausea/vomiting
- Dizziness
- Constipation
- Seizures (lower threshold)
- Serotonin syndrome (with serotonergic drugs)
- Hypoglycaemia
- Dependence
- Respiratory depression
Interactions
- MAOIs (avoid)
- SSRIs/SNRIs
- TCAs
- Triptans
- Strong CYP2D6/3A4 inhibitors
- Alcohol
Monitoring
- Pain
- Sedation
- Mental state
Reference: BNF; NICE; MHRA; FPM; https://bnf.nice.org.uk/drugs/tramadol-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Morphine Milligram Equivalents (MME) Calculator · Pain / Opioids
- Opioid Conversion / Equianalgesic Guide · Pain Management
- Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management
- Finnegan Neonatal Abstinence Scoring Tool (FNAST) · Neonatal Abstinence Syndrome
- Modified Finnegan Neonatal Abstinence Score (NAS) · Neonatal
- Withdrawal Assessment Tool (WAT-1) for Paediatric Iatrogenic Withdrawal · Critical Care
Pathways
- Opioid overdoseRecommendedTOXBASE/NPIS; Resuscitation Council UK; BNF
- Serotonin syndromeRecommendedHunter criteria (Dunkley 2003); TOXBASE/NPIS; BNF
Same specialty
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines