Table of contents

  • Brand Names
  • Drug Combinations
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Caution and personalized dose adjustment in patients with the following genotypes
  • Other genes that may be involved
  • Substrate of
  • Drug Interactions
  • Nutrition/Nutraceutical Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names


Austria: Adamon, Contramal, Cromatodol, Lanalget, Noax Uno, Nobligan, Tradolan, Tramabene, Tramadol, Tramadolor, Tramal, Tramastad, Tramundal; Belgium: Contramal, Doctramado, Dolzam, Tradonal, Tramadol; Bulgaria: Mabron, Noax Uno, Tralgit, Tramadol, Tramal, Tramalgin; Cyprus: Rofy, Tramadex, Tramadol, Mabron; Czech Republic: Mabron, Noax Uno, Protradon, Tradef, Tralgit, Tramabene, Tramadol, Tramagit, Tramal, Tramundin; Denmark: Dolol, Gemadol, Mandolgin, Metracop, Nobligan, Tadol, Tradolan, Tramadol; Estonia: Adamon, Mabron, Protradon, Tramadol, Tramal; Finland: Tradolan, Tramadin, Tramadol, Tramagetic, Tramal, Trambo, Tramium; France: Biodalgic, Contramal, Monoalgic, Monocrixo, Monotramal, Orozamudol, Takadol, Topalgic, Tramadol, Zamudol, Zumalgic; Germany: Adamon, Amadol, Hexamadol, IPC-Trama, Jutadol, Nobligan Retard, Tial, T-Long, Trace, Tradol-Puren, Tramabeta, Tram-ac, Tramadoc, Tramadol, Tramadolor, Trama-Dorsch, Tramadura, Tramagit, Tramal, Tramamed, Tramundin, Travex Retard; Greece: Oxxalgan, Tradol, Tramal; Hungary: Adamon, Contramal, Mabron, Ralgen, Tial, Tramadol, Tramadolor, Tramalgic, Tridural; Ireland: Biodol, By-Madol, Tradol, Tradorec, Tramake, Tramapine, Troxidol, Xymel, Zamadol, Zydol; Italy: Adamon, Contramal, Fortradol, Prontalgin, Tradonal, Traflash, Tralenil, Tralodie, Tramadolo, Tramalin, Tramamed, Unitrama, Unitramarim; Latvia: Mabron, Protradon, Trabar, Tramadol, Tramadolor, Tramal; Lithuania: Mabron, Protradon, Tramadol, Tramadolis Tramadolor, Tridural; Luxembourg: Dolzam, Tramal; Malta: BioDol, Tramadol; Netherlands: Tramal, Theradol, Tramagetic, Tramadol; Poland: Adamon, Noax Uno Poltram, Slovadol, Oratram, Poltram, Slovadol, Tramadol, Tralgit, Tramadal, Tramadol, Tramal, Tramcod, Tramium, Tramundin, Travictol; Portugal: Gelotralib, Nobligan, Paxilfar Tramadol, Tramal, Travex, Tridural, Zydol, Zytram; Romania: K-Alma, Mabron, Noax Uno, Tradolan, Tralgit, Tramacalm, Tramadol, Tramag, Tramal, Tramundin, Urgendol; Slovakia: Adamon, Mabron, Noax uno, Protradon, Tradef, Tralgit, Tramabene, Tramadol, Tramal; Slovenia: Tadol, Tramacur, Tramal, Tramundin; Spain: Adolonta, Dolodol, Dolpar, Gelotradol, Tioner, Tradonal, Tramadol, Zytram; Sweden: Gemadol, Nobligan, Tiparol, Tradolan, Tramadol, Tramuno, Tridural; UK: Tramadol, Zamadol, Zydol.

North America

Canada: Ralivia, Tridural, Zytram; USA: Ryzolt, Tramadol, Ultram.

Latin America

Argentina: Ana-Q, Calmador Rapid, Cloq, Nobligan, Trama-Klosidol, Tramadol, Tramal, Tramanovag; Brazil: Anangor, Dorless, Sensitram, Sylador, Trabilin, Tramaden, Tramadol, Tramadon, Tramal, Tramaliv, Zamadol; Mexico: Durodor Retard, Nobligan, Prontofort, Tradol, Tralic, Tramed, Trexol, Veldrol.


Japan: Tramal.

Drug combinations

Tramadol and Acetaminophen


Tramadol Hydrochloride: C~16~H~25~NO~2~.HCl. Mw: 299.84. (±)-cis-2-[(Dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol hydrochloride. CAS-36282-47-0; CAS-27203-92-5 (tramadol)(1969).

Pharmacologic Category

Analgesics and Antipyretics; Opiate Agonists. (ATC-Code: N02AX02).

Mechanism of action

Tramadol and active metabolite (M1) binds to μ-opiate receptors in CNS causing inhibition of ascending pain pathways, altering perception of and response to pain. Also inhibits reuptake of norepinephrine and serotonin, which also modifies ascending pain pathway.

Therapeutic use

Relief of moderate-to-moderately-severe pain.

Pregnancy and lactiation implications

Adverse events observed in animal studies. Tramadol has been shown to cross human placenta when administered during labor. Postmarketing reports following tramadol use during pregnancy include neonatal seizures, withdrawal syndrome, fetal death, and stillbirth. Not recommended for use during labor and delivery. Enters breast milk (not recommended in nursing women).

Unlabeled use


Hypersensitivity to tramadol, opioids, or any component of the formulation. Opioid-dependent patients. Acute intoxication with alcohol, hypnotics, centrally-acting analgesics, opioids, or psychotropic drugs.

Warnings and precautions

May cause CNS depression. Use with caution in debilitated patients (greater potential for critical respiratory depression). Seizures may occur (increased risk in patients receiving serotonin reuptake inhibitors (SSRIs or anorectics), other opioids, tricyclic antidepressants, other cyclic compounds (including cyclobenzaprine, promethazine), neuroleptics, MAOIs, or drugs which may lower seizure threshold; patients with history of seizures, or with risk of seizures are also at increased risk). Rare but serious anaphylactoid reactions (including fatalities) often following initial dosing reported. Pruritus, hives, bronchospasm, angioedema, toxic epidermal necrolysis, and Stevens-Johnson syndrome also reported (previous anaphylactoid reactions to opioids may increase risks for similar reactions to tramadol). Use with caution in history of drug abuse or acute alcoholism (potential for drug dependency exists). Tramadol may obscure diagnosis or clinical course of acute abdominal conditions. Avoid use in suicidal patients. Use with caution in heavy alcohol users. Rapid release absorption of tramadol from tablets that are broken, crushed, or chewed may lead to a potentially-lethal overdose (tablets should be swallowed whole). Use with extreme caution in head injury, intracranial lesions, or elevated intracranial pressure (exaggerated elevation of intracranial pressure may occur). Use with caution in mild-to-moderate hepatic impairment; extended release formulations should not be used in severe hepatic impairment. Use with caution in mild-to-moderate renal impairment; extended release formulations should not be used in severe renal impairment (CrCl <30 mL/minute). Patients with respiratory disorders may be at greater risk of respiratory depression (use with caution). Avoid use with serotonergic agents such as TCAs, MAOIs, triptans, venlafaxine, trazodone, lithium, sibutramine, meperidine, dextromethorphan, St. John’s wort, SNRIs and SSRIs (concomitant use associated with development of serotonin syndrome). Tolerance or drug dependence may result from extended use. Abrupt discontinuation should be avoided. Extended-release formulation should be used with extreme caution in the elderly (particularly >75 years of age); may be more sensitive to adverse effects.



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