Toxicity range
A lethal dose of tramadol has not been determined. The maximum recommended daily dose of this medicine is 400 mg. The therapeutic drug concentration is between 100 mcg/ml and 300 mcg/ml. The lowest dose of the drug that has possibly been associated with death was 500 mg to 1000 mg in a 40 kg female, but details about the case are not completely known. A 3 gram intentional overdose during clinical trials produced emesis and no further sequelae. In foreign reports of fatalities associated with tramadol the dosage was reported to be between 3 to 5 grams.
Dependent patients
Tramadol is not recommended for patients who are dependent on opioids. Patients who have recently taken substantial amounts of opioids may experience withdrawal symptoms. Because of the difficulty in assessing dependence in patients who have previously received substantial amounts of opioid medication, administer the drug cautiously to such patients.
As reported in the multicenter prospective case series the lowest dose associated with seizure, tachycardia, hypertension or agitation was 500 mg. The lowest dose associated with coma and respiratory depression was 800 mg of tramadol. For children who had ingested the medicine, no symptoms were reported if the child received less than 10 mg/ kg.
Labor and delivery
Tramadol should not be used in pregnant women prior to or during labor unless the potential benefits outweigh the risks. Safe use in pregnancy has not been established. Chronic use during pregnancy may lead to physical dependence and post-partum withdrawal symptoms in the newborn. This drug has been shown to cross the placenta. The mean ratio of serum in the umbilical veins compared to maternal veins was 0.83 for 40 women given tramadol during labor.
The effect of this drug, if any, on the later growth, development, and functional maturation of the child is unknown.
Although the manufacturer states that it should not be used in children less than 16 years of age because safety and efficacy have not been proven, tramadol has been reportedly used in children over the age of 1 year at a dose of 1-2 mg/kg.
Buy cheap tramadol – overdose treatment
Treatment of victims of tramadol overdose is largely symptomatic and supportive. Assisted ventilation, a source of oxygen, a central line, and IV fluids are the initial treatments of choice. The induction of emesis is not recommended because of the potential for seizures associated with this medicine. Gastric lavage with airway protection may be indicated if performed within 1 to 2 hours of the overdose, or in patients who are comatose or at risk of seizures. One dose of an activated charcoal slurry, aqueous or mixed with saline cathartic, should be administered at a dose of 50 grams for adults and 1g/kg body weight in infants and children. The antidote for respiratory depression caused by opioid agonists is naloxone. Since tramadol has more than one mechanism of action, not all of the symptoms of overdose will be reversed with naloxone therapy.
Patients with a variety of chronic painful conditions were studied in double-blind trials of one to three months duration. Average daily doses of approximately 250 mg of the drug in divided doses were generally comparable to five doses of acetaminophen 300 mg with codeine phosphate 30 mg daily, five doses of aspirin 325 mg with codeine phosphate 30 mg daily, or two to three doses of acetaminophen 500 mg with oxycodone hydrochloride 5 mg daily.
The initial dose of naloxone for children or adults is 2 mg given IV. If a single 2 mg dose of naloxone dose not reverse the patient's symptoms, then 2 to 4 mg can be administered by IV bolus up to a total dose of 10 to 20 mg. The effective dose of naloxone can then be repeated every 20 to 60 minutes. The reversal of coma and respiratory depression is considered an adequate response.
