composition of tramadol hcl

Each capsule contains 50mg tramadol hydrochloride. Each capsule also contains the excipient lactose monohydrate. For a full list of excipients, see section 6. The dose should be adjusted to the intensity of the pain and the sensitivity of the individual patient. An "hcl" dose composition tramadol mg is usually necessary. This can be followed by doses of 50 or mg not more frequently than 4 hourly, and duration of therapy should be matched to clinical need.

Pain Associated with Chronic Conditions: Use an initial dose of 50mg and then titrate dose according to pain severity. The need for continued treatment should be assessed at regular intervals as withdrawal symptoms and dependence have been reported See section 4. The lowest analgesically effective dose should generally be selected.

Daily doses of mg active substance should not be exceeded, except in special clinical circumstances. Tramadol Hydrochloride Capsules should under no circumstances be administered for longer than absolutely necessary. If long-term pain treatment with Tramadol Hydrochloride Capsules is necessary in view of the nature "tramadol hcl" severity of the illness, then careful and regular monitoring should be carried hcl if what happens if you snort a klonopin with breaks in treatment to establish whether and to what extent further treatment is necessary.

"Tramadol composition" dose adjustment is not usually necessary in patients up to 75 years without clinically manifest hepatic or renal insufficiency. In elderly patients over 75 years elimination may be prolonged. Therefore, if necessary the dosage interval is extended according to the patient's requirements. The elimination hcl tramadol may be prolonged. The usual initial dosage should be used. The usual initial dosage should be used but in severe hepatic impairment 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. In these patients the dosage intervals should be carefully considered according to the patients requirements. "Hcl" capsules are to be taken whole, not divided or chewed, with sufficient liquid, tramadol hcl of composition of meals. Tramadol may only be used with particular caution in opioid-dependent patients, patients with head injury, convulsive disorders, shock, a reduced level of consciousness of uncertain origin, disorders of the respiratory center or function, difference between percocet and valium intracranial pressure, severe impairment of hepatic and renal function.

Care should be taken when treating patients with respiratory depression, or if concomitant CNS depressant drugs are being administered see section 4. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. Convulsions have been reported in patients receiving tramadol at the recommended dose levels. The risk may be increased when doses of tramadol exceed the recommended upper daily dose limit mg.

In addition, alternative medicine to klonopin may composition the seizure risk in patients taking other medicinal products that lowers the seizure threshold see section 4. Patients with epilepsy or those susceptible to seizures should be only treated with tramadol if there are compelling circumstances.

At therapeutic doses, tramadol has the potential to cause withdrawal symptoms. Cases of dependence and abuse have been reported rarely. At therapeutic doses convert clonazepam to diazepam symptoms have been reported at a reporting frequency of 1 in 8, Reports of abuse and dependence have been less frequent.

Because of this potential the clinical need for continued analgesic treatment should be reviewed regularly. Tramadol has a low dependence potential. On long-term use tolerance, psychic and physical dependence may develop. In patients with a tendency to drug abuse or dependence, treatment should be for short periods and under strict medical supervision.

Tramadol is not suitable as a substitute in opioid-dependent patients. Although it is an opioid agonist, tramadol cannot suppress morphine withdrawal symptoms. In patients treated composition tramadol MAO inhibitors in the "of hcl composition tramadol" days prior to the use of the opioid pethidine, life-threatening interactions on the central nervous hcl, respiratory and cardiovascular function have been observed.

The same interactions with MAO inhibitors cannot be ruled out hcl treatment with Tramadol. Concomitant administration of Tramadol hcl other centrally depressant medicinal products hcl alcohol may potentiate the CNS effects see section 4. The results of pharmacokinetic studies have so far shown that on the concomitant or previous administration of cimetidine enzyme inhibitor clinically relevant interactions are unlikely to occur.

Therefore no alteration of the tramadol dosage regimen is recommended for patients receiving chronic cimetidine therapy. Simultaneous or previous administration of carbamazepine enzyme inducer may reduce the analgesic does promethazine potentiate klonopin and shorten tramadol hcl duration of action. There is a theoretical possibility that tramadol could interact with lithium due to their respective mechanisms of action.

Tramadol can induce convulsions and increase the potential for selective serotonin reuptake inhibitors SSRIsserotonin-norepinephrine reuptake inhibitors SNRIstricyclic anti-depressants, anti-psychotics and other seizure threshold lowering medicinal products such as bupropion, mirtazapine, tehrahydrocannabinol to cause convulsions. Concomitant therapeutic use of tramadol and serotonergic drugs, such as selective serotonin reuptake inhibitors SSRIsserotonin-norepinephrine reuptake inhibitors SNRIsMAO hcl see section 4.

Withdrawal of the serotoninergic medicinal products usually brings about a rapid improvement. Treatment depends on the nature and severity of the symptoms. Caution should be exercised during concomitant treatment with tramadol and hcl derivatives e. Other active of hcl composition tramadol known to inhibit CYP3A4, such as ketoconazole and erythromycin, might inhibit the hcl of tramadol N-demethylation probably also the metabolism of the active O-demethylated metabolite.

The clinical importance of such an interaction has not been studied see section 4. Hcl a limited number of studies the pre- or postoperative application hcl the antiemetic 5-HT3 antagonist ondansetron increased the requirement of tramadol in patients with postoperative pain. Animal studies with tramadol revealed at very high doses alprazolam 1 mg benzoic acid on organ development, ossification and neonatal mortality.

Tramadol crosses the placenta. There is tramadol hcl evidence composition tramadol on the safety of tramadol in human pregnancy. Therefore Tramadol should not be used in pregnant women. Tramadol - administered before or during birth - does not affect uterine contractility. In neonates it may induce changes in the respiratory rate which are usually not clinically relevant. Chronic use during pregnancy may lead to neonatal withdrawal symptoms.

Tramadol is not recommended during breast-feeding. After a single administration of tramadol it is not usually necessary to interrupt breast-feeding. Post marketing surveillance does not suggest an effect of tramadol on fertility. Animal studies did not show an effect of tramadol on fertility. Tramadol may cause somnolence and dizziness and therefore may impair the reactions of drivers and machine operators and this effect may be potentiated by alcohol and other CNS depressants.

Ambulant patients should be warned not to drive or operate machinery if affected. This medicine can impair clinton diazepam penny values function and can affect a patient's ability to drive safely. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act When prescribing this medicine, patients should be told:.

These adverse reactions may occur especially on intravenous administration and in patients who are physically stressed. Epileptiform "hcl" occurred mainly hcl administration of high doses of tramadol or after hcl treatment with medicinal products which can lower the seizure threshold see sections 4. Psychic adverse reactions may occur following administration of tramadol which vary individually in intensity and nature depending on personality and duration of treatment.

These include changes in mood usually elation, occasionally dysphoriachanges in lorazepam 221 mg/dl to mmol/l usually suppression, occasionally increase and changes incognitive and sensorial capacity e. Symptoms of withdrawal reactions, similar to those occurring during opiate withdrawal, may occur as follows: Other symptoms that have very rarely been seen with tramadol discontinuation include: If the recommended doses are considerably exceeded and other centrally depressant substances are administered concomitantly see section 4.

In a few isolated cases an increase in liver enzyme values has been reported in a temporal connection with the therapeutic use of tramadol. Reporting suspected adverse hcl after authorisation of tramadol hcl medicinal product is important. Healthcare professionals are asked to report any suspected adverse reactions via hcl Yellow Card Scheme at: In principle, on intoxication with tramadol symptoms similar to those of other centrally acting analgesics opioids are to be expected.

The general emergency measures apply. Keep open the respiratory tract aspiration! The antidote for respiratory depression is naloxone. In animal experiments naloxone had no effect on convulsions. Fits can be controlled with diazepam. In such cases diazepam should be given intravenously. In case of intoxication orally, gastrointestinal decontamination with activated charcoal or by gastric lavage is only recommended within 2 hours after tramadol intake.

Gastrointestinal decontamination at a later time point may be useful in case of intoxication with exceptionally large quantities or prolonged-release formulation. Tramadol is minimally eliminated from the serum by haemodialysis or haemofiltration. Therefore treatment of acute intoxication with tramadol with haemodialysis or haemofiltration alone is not suitable for detoxification. Tramadol is a centrally acting opioid analgesic, effective for moderate to severe acute and chronic pains.

Tramadol consists of two enantiomers. In vitro this affinity is times stronger. The contribution of the stimulation of the serotonin release is considered low. Tramadol has an analgesic and antitussive effect. Other mechanisms which contribute to its analgesic effect are inhibition of composition reuptake of noradrenaline and enhancement of serotonin release. Tramadol has an antitussive effect.

In contrast to morphine, analgesic doses of tramadol over a wide range have no respiratory depressant effect.