Adults (17 years of age and over)
For patients with moderate to moderately severe chronic pain not requiring rapid
onset of analgesic effect, the tolerability of tramadol hydrochloride can be
improved by initiating therapy with a titration regimen. The total daily dose
may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg
q.i.d.). After titration, tramadol hydrochloride tablets 50 mg to 100 mg can be
administered as needed for pain relief every four to six hours, not to exceed
400 mg per day.
For the subset of patients for whom rapid onset of analgesic effect is required
and for whom the benefits outweigh the risk of discontinuation due to adverse
events associated with higher initial doses, tramadol hydrochloride tablets 50
mg to 100 mg can be administered as needed for pain relief every four to six
hours, not to exceed 400 mg per day.
Individualization of Dose
Good pain management practice dictates that the dose be individualized according
to patient need using the lowest beneficial dose. Studies with tramadol in
adults have shown that starting at the lowest possible dose and titrating upward
will result in fewer discontinuations and increased tolerability.
In all patients with creatinine clearance less than 30 mL/min, it is recommended
that the dosing interval of tramadol hydrochloride tablets be increased to 12
hours, with a maximum daily dose of 200 mg. Since only 7% of an administered
dose is removed by hemodialysis, dialysis patients can receive their regular
dose on the day of dialysis.
The recommended dose for adult patients with cirrhosis is 50 mg every 12 hours.
In general, dose selection for an elderly patient over 65 years old should be
cautious, usually starting at the low end of the dosing range, reflecting the
greater frequency of decreased hepatic, renal or cardiac function and of
concomitant disease or other drug therapy. For elderly patients over 75 years
old, total dose should not exceed 300 mg/day.
[>30 ml/min]: No changes
[< 30]: Give 50-100 mg q12 hours (maximum: 200 mg/day.)
Insufficient data. Guidelines for crcl <30 above seem reasonable.
National Institutes of Health, U.S. National Library of Medicine,
DailyMed Database. Provides access to the latest drug monographs submitted to the
Food and Drug Administration (FDA). Please review the latest applicable package insert for
additional information and possible updates. A local search
option of this data can be found here.
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical
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