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tramadol (tram-a-dol)

imageRalivia, Ultram, Ultram ER


Therapeutic: analgesics (centrally acting)

Pharmacologic: opioid agonists


Moderate-to-moderately severe pain.


Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. Therapeutic Effects: ↓ pain.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, headache, somnolence, anxiety, CNS stimulation, confusion, coordination disturbance, euphoria, malaise, nervousness, sleep disorder, weakness. EENT: visual disturbances. CV: vasodilation. GI: constipation, nausea, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, vomiting. GU: menopausal symptoms, urinary retention/frequency. Derm: pruritus, sweating. Neuro: hypertonia. Misc: physical dependence, psychological dependence, tolerance.


Examination and Evaluation

  • Watch for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician or nursing staff.

  • Be alert for excessive sedation or somnolence. Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse.

  • Monitor other changes in mood and behavior, including euphoria, confusion, malaise, nervousness, and anxiety. Notify physician if these changes become problematic.

  • Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

  • Assess any incoordination or increased muscle tone. Report any coordination problems or hypertonia that might impair function or increase the risk of falls.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.


  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off centrally acting analgesics as soon as possible.

  • Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

  • Guard against falls and trauma (hip fractures, head injury). Implement fall-prevention strategies (See Appendix E), especially if patient exhibits sedation, dizziness, or blurred vision.

Patient/Client-Related Instruction

  • Advise patient that centrally acting analgesics are usually more effective if given before pain becomes severe; emphasize that adequate pain control will allow better participation in physical therapy.

  • Educate patient about the dangers of overdose; encourage patient to adhere to proper dosing schedule.

  • Emphasize that the risk of physical addiction (tolerance and dependence) is usually minimal during short-term treatment of pain. Advise patient that addiction is more likely during excessive or inappropriate use of centrally acting analgesics.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and decreased CNS function.

  • Advise patient to increase fluid intake ...

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