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Drowsiness

Larger doses produce respiratory depression, hypotension, and muscle rigidity.

Other side-effects include difficulty with micturition, ureteric or biliary spasm, dry mouth, sweating, headache, facial flushing, vertigo, bradycardia, tachycardia, palpitation, postural hypotension, hypothermia, hallucinations, dysphoria, mood changes, dependence, miosis, decreased libido or potency, rashes, urticaria and pruritus.

Overdose: Respiritory depression - Immediate Naloxone administration and/or artificial ventilation.

Contraindications:

Avoid in:-

Acute respiratory depression,

Acute alcoholism and

If there is risk of paralytic ileus.

Pregnancy (studies have found it NOT to be teratogenic however it is not recommended in pregnancy.)

Breast feeding – approximately 0.1% of the dose taken by mother is passed into breast milk however breast feeding is not recommended on tramadol.  

Also avoid in raised intracranial pressure or head injury (affects pupillary responses vital for neurological assessment); avoid injection in phaeochromocytoma (risk of pressor response to histamine release)

Cautions:

Withdrawal effects at therapeutic doses in about 1 in 8000 patients.- Can cause dependence and abuse and should therefore be confined to short term use.

In Renal and/or hepatic impairment elimination may be prolonged. Dosage should be adjusted as appropriate.

Head injury or increased intracranial pressure.

Patients with shock.

Patients prone to convulsions.

Concurrent administration with other CNS depressant drugs.

Patients with respiratory depression

Any activity where impairment of alertness is undesirable or dangerous e.g. driving a car or operating machinery

Interactions:

These are the interactions that should be avoided or monitored very closely.

Drug

Effect of interaction

Antidepressants

CNS excitation or depression with associated hypertension or hypotension respectively if given concurrently or within 2 weeks of an MAOI

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