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Opioid Analgesic (Weak-Moderate) / SNRI

Tramadol

Brand names: Zamadol, Tramquel, Tilodol SR

Tramadol is a centrally acting opioid analgesic used for moderate-to-severe pain, combining weak opioid activity with effects on monoamine pathways.

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.

Clinical monograph

How it works

It is a weak mu-opioid receptor agonist that also inhibits the reuptake of serotonin and noradrenaline, contributing to its analgesic effect.

Prescribing in practice

  • It lowers the seizure threshold and can cause serotonin syndrome, so use with particular caution alongside antidepressants and other serotonergic or seizure-threshold-lowering drugs.
  • It is a controlled drug with potential for dependence and misuse, and effect can be unpredictable in poor or ultra-rapid CYP2D6 metabolisers.
  • Reduce the dose in renal and hepatic impairment and in the elderly, and counsel on drowsiness, nausea and constipation.

Monitoring

Monitor analgesic response, sedation and signs of serotonin toxicity or seizures, and review the ongoing need for treatment to limit dependence.

Counselling the patient

  • This medicine can cause drowsiness and dizziness, so take care when driving.
  • Tell your doctor about any antidepressants or other medicines, as combinations can be harmful.
  • Do not exceed the prescribed dose and avoid alcohol.

Evidence & guidelines

Tramadol is recommended for moderate-to-severe pain as a step on the analgesic ladder in NICE and pain management guidance.

Reference: MHRA Drug Safety Update on Serotonin Syndrome; 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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