Tramadol

How it works

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

Prescribing in practice

• In older people use cautiously at reduced dose with extended intervals, as they are more susceptible to confusion, sedation, falls, hyponatraemia and constipation, and reduced renal function prolongs exposure.
• It lowers the seizure threshold and carries a serotonin-syndrome risk with serotonergic drugs such as SSRIs, SNRIs and certain antidepressants and triptans.
• Like other opioids it can cause dependence and respiratory depression, with additive risk alongside benzodiazepines and other CNS depressants.

Monitoring

Monitor older patients for pain control, sedation, confusion, constipation and signs of serotonin toxicity, and review continued need.

Counselling the patient

• It can cause drowsiness and dizziness; take care with driving and standing up.
• Do not combine with alcohol or other sedatives, and report agitation, tremor or a fast heartbeat.

Evidence & guidelines

General prescribing guidance and the SPC highlight tramadol's seizure, serotonergic and CNS risks, supporting cautious reduced-dose use in older adults.