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Indications and Dosage. Buy Tramadol 200mg online, for sale in Australia

Oral
Moderate to severe pain

Adult: As conventional tab/cap/orodispersible or dispersible tab: 50-100 mg 4-6 hourly. Max: 400 mg daily. As modified release (12-hourly) cap: Initially, 50-100 mg bid, may be titrated to 150 mg or 200 mg bid if necessary. Max: 400 mg daily. As modified release (24-hourly) tab/cap: Initially, 100 mg or 150 mg once daily. Max: 300 mg or 400 mg daily. Use the lowest effective dose for the shortest possible treatment duration. Adjust dose based on the severity of pain and individual sensitivity. Dosage recommendations may vary among countries and individual product (refer to detailed product guideline).
Child: ≥12 years Same as adult dose.
Elderly: >75 years Dosage interval may be prolonged according to individual requirements. Treatment recommendations may vary among countries and individual products (refer to detailed product guideline). Buy Tramadol 200mg online, for sale in Australia

Parenteral
Postoperative pain

Adult: Initially, 100 mg via slow IV, IM, or SC inj, followed by 50 mg every 10-20 minutes up to a total of 250 mg (including the initial dose) in the 1st hour. Subsequent doses of 50 mg or 100 mg 4-6 hourly may be given. Max: 600 mg daily.
Child: ≥12 years Same as adult dose.
Elderly: >75 years Dosage interval may be prolonged according to individual requirements. Buy Tramadol 200mg online, for sale in Australia

Parenteral
Moderate to severe pain

Adult: 50-100 mg 4-6 hourly via slow IV over 2-3 minutes, IM, or SC inj. Max: 600 mg daily.
Child: ≥12 years Same as adult dose.
Elderly: >75 years Dosage interval may be prolonged according to individual requirements.

Administration

May be taken with or without food. Buy Tramadol 200mg online, for sale in Australia

Incompatibility

IV/IM/SC: May form precipitates when mixed in the same syringe with diazepam, diclofenac Na, flunitrazepam, glyceryl trinitrate, indometacin, midazolam, piroxicam, and phenylbutazone.

Contraindications

Acute intoxication with centrally acting analgesics, hypnotics, psychotropic drugs, alcohol, or other opioids; uncontrolled epilepsy, significant respiratory depression, acute or severe bronchial asthma (in unmonitored setting or lack of resuscitative equipment), known or suspected gastrointestinal obstruction (including paralytic ileus). Children <12 years and in children <18 years who have undergone tonsillectomy and/or adenoidectomy. CYP2D6 ultrarapid and poor metabolisers. Concomitant use or within 14 days after MAOI therapy. Use for narcotic withdrawal treatment or during light planes of anaesthesia. Buy Tramadol 200mg online, for sale in Australia

Monitoring Parameters

Monitor renal function, LFTs, pain relief, respiratory status (particularly within the 1st 24-72 hours of initial therapy and dose increases), mental status or alertness, blood pressure, heart rate, blood glucose (if hypoglycaemia is suspected), bowel function. Evaluate patient’s alcohol use, history of alcoholism, risk for addiction, misuse, or abuse before initiating and regularly during therapy. Monitor for signs and symptoms of serotonin syndrome (e.g. mental status changes, autonomic instability, neuromuscular changes, gastrointestinal symptoms), hyponatraemia (particularly during initial treatment), tolerance, addiction, abuse, misuse, or suicidal ideation. Observe for withdrawal symptoms, mood changes, pain control, and use of other substances upon discontinuation. Buy Tramadol 200mg online, for sale in Australia

Overdosage

Symptoms: Vomiting, sedation, miosis, seizures, skeletal muscle flaccidity, cold and clammy skin, pulmonary oedema, bradycardia, QT prolongation, hypotension, partial or complete airway obstruction, atypical snoring, CV collapse, respiratory depression, coma, serotonin syndrome, respiratory failure. Management: Supportive treatment. Maintain patent airway and CV functions; initiate assisted or controlled ventilation as necessary. Employ oxygenation and administer vasopressors in case of circulatory shock and pulmonary oedema as clinically indicated. Administer naloxone for respiratory depression and IV diazepam to control seizures; other IV benzodiazepines may also be considered. Perform gastric lavage or administer activated charcoal within 2 hours of ingestion. Buy Tramadol 200mg online, for sale in Australia

Drug Interactions

Increased risk of INR elevation and ecchymoses with coumarin derivatives (e.g. warfarin). Increased risk of convulsions with SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), anorectics, TCAs, antipsychotics, and other seizure-threshold lowering agents (e.g. bupropion, mirtazapine). Concomitant use with mixed agonist/antagonist analgesics (e.g. buprenorphine, butorphanol, nalbuphine, pentazocine) may precipitate withdrawal symptoms and/or diminish analgesic effect in patients after prolonged therapy with tramadol. Concomitant use with CYP2D6 inhibitors (e.g. paroxetine, fluoxetine, quinidine, bupropion) may increase plasma levels of tramadol and decrease plasma concentration of M1 (active metabolite). Concomitant use with CYP3A4 inhibitors (e.g. erythromycin, ketoconazole, ritonavir) may increase tramadol plasma concentration which may result in greater amount of metabolism by CYP2D6 isoenzyme and increased levels of M1. May decrease plasma levels with CYP3A4 inducers (e.g. rifampicin, carbamazepine, phenytoin). Buy Tramadol 200mg online, for sale in Australia
Potentially Fatal: May result in serotonin syndrome when used concomitantly or within 14 days after MAOI therapy. May result in sedation, respiratory depression, and coma with benzodiazepines or other CNS depressants. May increase the risk of serotonin syndrome with SSRIs, SNRIs, TCAs, lithium, triptans, 5-HT3 receptor antagonists, certain muscle relaxants (e.g. metaxalone, cyclobenzaprine), and drugs that affect serotonergic neurotransmitter system (e.g. mirtazapine).

Food Interaction

May potentiate the CNS depressant effects of alcohol. May increase the risk of serotonin syndrome with St. John’s wort.

Lab Interference

May give false-positive result in urine detection of phencyclidine. Buy Tramadol 200mg online, for sale in Australia

Action

Description: Tramadol is a centrally acting analgesic that has opioid agonist properties. It binds to μ-opiate receptors in the CNS resulting in inhibition of ascending pain pathways, thus altering the perception of and response to pain. Its inhibition of neuronal uptake of norepinephrine and enhancement of serotonin release may also contribute to its analgesic effect.
Onset: Analgesia: Oral (immediate release): Within 1 hour (peak effect: 2-3 hours).
Duration: Analgesia: Oral: 3-6 hours (peak effect: 1-4 hours post-dosing). Buy Tramadol 200mg online, for sale in Australia
Pharmacokinetics:
Absorption: Rapidly and completely absorbed following oral administration. Bioavailability: Oral: Approx 75% (immediate release); approx 85-90% (modified release; as compared to immediate release); IM: 100%. Time to peak plasma concentration: Tramadol: Approx 2 hours (immediate release); approx 4-12 hours (modified release).
Distribution: Widely distributed in the body. Crosses the placenta; enters breast milk (small amounts). Volume of distribution: IV: 2.9 L/kg (females); 2.6 L/kg (males). Plasma protein binding: Approx 20%.
Metabolism: Extensively metabolised in the liver mainly via N- and O-demethylation by CYP2D6 and CYP3A4 isoenzyme, glucuronidation, and sulfation into several metabolites; O-desmethyltramadol (M1) is the only active metabolite. Buy Tramadol 200mg online, for sale in Australia
Excretion: Via urine (60% as metabolites, approx 30% as unchanged drug). Elimination half-life: Oral: Immediate release: 6.3 ± 1.4 hours (tramadol); 7.4 ± 1.4 hours (M1). Modified release: Cap: Approx 10 hours (tramadol); approx 11 hours (M1); Tab: Approx 7.9 hours (tramadol); 8.8 hours (M1).

Chemical Structure