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Tramadol parenteral

Updated 2 Feb 2023 | Opioid analgesics


Solution for injection and infusion containing tramadol hydrochloride

Drugs List

  • tramadol 100mg/2ml injection
  • ZAMADOL 100mg/2ml injection
  • ZYDOL 100mg/2ml injection
  • Therapeutic Indications


    Pain - moderate to severe
    Treatment of post-operative pain


    As with all analgesic drugs, the dose of tramadol should be adjusted according to the severity of the pain and the clinical response of the individual patient.


    Moderate to severe pain
    Usual dose is 50mg or 100mg 4 to 6 hourly by the intravenous or intramuscular route. Dosage should be adjusted according to pain severity and response. Intravenous injections must be given slowly over 2 to 3 minutes.

    Post-operative pain
    Administer an initial bolus of 100mg. During the 60 minutes following the initial bolus, further doses of 50mg may be given every 10 to 20 minutes, up to a total dose of 250mg including the initial bolus. Subsequent doses should be 50mg or 100mg 4 to 6 hourly, up to a total daily dose of 600mg.

    A total parenteral daily dose of over 600 mg should not be exceeded except in special circumstances.


    In patients over 75 years, there tends to be an increase in tramadol bioavailability and the elimination half-life of tramadol was increased by 17%.
    (See Dosage; Adults)


    12 years and over
    (See Dosage; Adults)

    Patients with Renal Impairment

    The elimination of tramadol may be prolonged.
    For patients with a creatinine clearance between 10 and 30ml/minute, the dosage interval should be increased to 12 hours.

    As tramadol is only removed very slowly by haemodialysis or haemofiltration, post-dialysis administration to maintain analgesia is not usually necessary.

    Patients with Hepatic Impairment

    The elimination of tramadol may be prolonged.
    In severe hepatic impairment the dosage interval should be increased to 12 hours.


    Acute alcohol intoxication
    Children under 12 years
    Risk of paralytic ileus
    Within 2 weeks of discontinuing MAOIs
    Acute asthma
    Acute respiratory depression
    Chronic obstructive pulmonary disease
    Long QT syndrome
    Renal impairment - creatinine clearance below 10ml/minute
    Torsade de pointes
    Uncontrolled epileptic disorder

    Precautions and Warnings

    Family history of long QT syndrome
    Impaired consciousness
    Patients over 75 years
    Predisposition to seizures
    Adrenal insufficiency
    Benign prostatic hyperplasia
    Biliary tract disorder
    CYP2D6 poor metaboliser genotype
    CYP2D6 ultra-rapid metaboliser genotype
    Electrolyte imbalance
    Epileptic disorder
    Excessive bronchial secretions
    Gastrointestinal obstruction
    Head trauma
    History of alcohol abuse
    History of drug misuse
    History of seizures
    History of torsade de pointes
    Inflammatory bowel disease
    Myasthenia gravis
    Opioid dependence
    Psychiatric disorder
    Raised intracranial pressure
    Renal impairment - creatinine clearance 10-30ml/minute
    Respiratory depression
    Severe hepatic impairment
    Sleep apnoea

    Correct electrolyte disorders before treatment
    Reduce dose and/or alter dose interval in patients with hepatic impairment
    Reduce dose and/or alter dose interval in patients with renal impairment
    Advise patient ability to drive or operate machinery may be impaired
    Advise patient drowsiness may affect ability to drive or operate machinery
    Advise patient not to drive until they know how the medicine affects them
    Advise patient this medicine may be subject to driving restrictions
    Not suitable as a substitute in opioid-dependent patients
    Consider monitoring ECG in patients at risk of QT prolongation
    Monitor at regular intervals as withdrawal symptoms & dependence may occur
    Monitor patient for signs and symptoms of respiratory depression
    Monitor patients with a history of alcoholism and drug abuse
    Monitor serum electrolytes
    Neonate exposed in utero: Monitor for neonatal withdrawal syndrome
    Patients on long-term therapy should be regularly reviewed
    Potential for drug abuse
    Tolerance and dependence may occur
    When used with SSRIs, risk of Serotonin syndrome
    Consider dose reduction if sleep-related breathing disorders occur
    Consider dose reduction or change in opioid if evidence of hyperalgesia
    Increased risk of central sleep apnoea and sleep-related hypoxemia
    May cause convulsions
    May increase risk of seizure
    Neonate exposed in labour: Risk of respiratory depression
    Prolonged use at high doses may result in hyperalgesia
    Withdrawal symptoms after long-term normal use on abrupt cessation
    Avoid abrupt withdrawal
    Maintain treatment at the lowest effective dose
    Reduce dose and/or alter dose interval in elderly patients
    Advise patient not to take St John's wort concurrently
    Advise patient to avoid alcohol during treatment
    Advise that effects are potentiated by CNS depressants (including alcohol)

    Not recommended during potentially light planes of general anaesthesia due to a possibly increased intra-operative recall reported.

    Pregnancy and Lactation


    Tramadol is contraindicated during pregnancy.

    The manufacturer does not recommend the use of tramadol during pregnancy. Prolonged use of tramadol during pregnancy may result in drug dependency in the foetus and withdrawal symptoms in the neonate.

    At the time of writing there is limited published information regarding the use of tramadol during pregnancy, however tramadol is known to cross the placenta, and administration of tramadol during labour may cause respiratory depression in the neonate (Briggs, 2015). Tramadol does not affect uterine contractility. Animal studies have shown adverse effects on the development of organs, bone formation and neonatal mortality with very large concentrations of tramadol. No teratogenic effects have been observed.


    Use tramadol with caution during breastfeeding.

    The manufacturer does not recommend the use of tramadol during breastfeeding, tramadol and its metabolites are secreted into breast milk, which may cause respiratory depression in the infant.

    LactMed (2020) state that healthy full term infants are unlikely to be adversely affected by exposure to tramadol via breast milk, however, if used in infants, the infant should be monitored for increased sleepiness, breathing difficulties, difficulty breastfeeding and limpness, and medical advice sought immediately should any of these occur.

    Effects on Ability to Drive and Operate Machinery

    This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them.

    Side Effects

    Abdominal discomfort
    Aggravation of existing asthma
    Allergic reaction
    Angioneurotic oedema
    Blurred vision
    Cardiovascular collapse
    Changes in cognitive and sensorial capacity
    Changes in mental activity
    Difficulty in micturition
    Disturbances of appetite
    Dry mouth
    Epileptiform seizures
    Gastric irritation
    Increases in hepatic enzymes
    Mild elation
    Mood changes
    Motor disturbances
    Postural hypotension
    Respiratory depression
    Sensory disturbances
    Sleep apnoea
    Sleep disturbances
    Urinary retention
    Withdrawal symptoms


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: April 2013

    Reference Sources

    British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.

    BNF for Children (2012-2013) Pharmaceutical Press, London.

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Handbook on Injectable Drugs, 15th Edition, Trissel, L. American Society of Health-System Pharmacists.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Summary of Product Characteristics: Zydol injection. Grunenthal Ltd. Revised March 2020.

    Summary of Product Characteristics: Zamadol injection. Meda Pharmaceuticals. Revised September 2012

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Tramadol Last revised: 21 September 2020
    Last accessed: 15 February 2021 Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: Last accessed: 6 January 2015 New drug driving offence implications for medicines packaging. Medicines Regulatory News. 10 December 2013. Available at: Last accessed: 6 January 2015

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