Instructions for medical application

drug

Tramadol.

Tradename

Tramadol.

International non-proprietary title

Tramadol.

Dosage form

Solution for injection 50 mg / 1 ml, 2 ml

Structure

1 ml of solution contains

active substance -tramadol hydrochloride 50.0 mg,

auxiliary substance Water for injection up to 1 ml.

Description

Transparent colorless liquid.

F.armacotherapeutic group

Analgesics. Opioids.opidoids are other. Pamadol.

N02AX02 PBX code.

Pharmacological properties

Pharmacokinetics

Absolute bioavailability with intramuscular administration of tramadol is 100%. The semi-exploration absorption period is approximately 0.6 hours.

Protein binding is 20%. Tramadol penetrates the hemat and placenta. The drug is detected in breast milk only in very small quantities (0.1%).

Tramadol and its metabolites are derived through the kidneys. Only O-dememetiltramadol is pharmacologically active.

The elimination period of half-life is approximately 6 hours, regardless of the method of application. In case of violation of the function of the liver or kidney, a slight increase in the half-life is expected. In cases of heavier disorders (liver cirrhosis, creatinine clearance< 5 мл/мин) ожидается 2-3-кратное увеличение времени элиминации.

It is excreted by the kidneys - 90% and through the intestines - 10%.

Pharmacodynamics

Tramadol is analgesic central action and refers to the class of opiate agonists. Therefore, morphine antagonists can counteract opiate-similar effects.

The binding of tramadol with opiate receptors prevents the release of neurotransmitters from synapses caused by pain pulses, and inhibits the transmission of pain impulses into a nociceptive system.

An analgesic effect occurs quickly and persists for several hours. In addition to the analgesic effect, Tramadol has an anti-flame effect and effect of central antidepressants.

Indications to use

Acute and chronic, moderate and strong pain syndrome various etiology (including the elderly):

For malignant tumors

In case of injuries

With pain caused by myocardial infarction

With neuralgiy

In diagnostic or therapeutic procedures

Prevention of pain syndrome in the preoperative period.

Method of application and dose

The solution is prescribed to / in, in / m. Doses are set depending on the intensity of pain syndrome.

Tramadol should not be prescribed longer than it is a therapeutically necessary.

For adults and adolescents over 12 years old, one-time dose is 1-2 ml of injection solution. If after one-time application did not come satisfactory analgesia, then after 30-60 minutes, a one-time dose of 50 mg can be assigned additionally.

For strong pain As an initial dose, 100 mg of tramadol can be prescribed. For pain relief, 400 mg / day is usually enough.

For the treatment of pain associated with oncological diseases And with strong pains in the postoperative period, it is possible to apply in higher doses.

The injection solution tramadol is diluted with water for injections. Data from dilution (1 ml of a solution for tramadol injection contains 50 mg of tramadol hydrochloride).

Example: adolescence, weighing 45 kg, prescribed a dosage of 1.5 mg of tramadol hydrochloride per 1 kg of body weight. This requires 67.5 mg of tramadol hydrochloride. Consequently, 2 ml of the solution for tramadol injection is diluted with four ml of water for injection. A concentration of 16.7 ml of tramadol hydrochloride per 1 ml is obtained, then 4 ml is injected from the dilute solution (about 67 mg of hydrochloride tramadol).

In elderly patients (75 years or more) due to the possibility of slow removal, the interval between the drugs can be increased in accordance with individual characteristics.

In case of kidney and liver diseases, it is possible to prolong the action of tramadol. For this category of patients, an increase in the interval between receptions of one-time doses is recommended.

Side effects

Sweating, dizziness, headache, weakness, fatigue, inhibition, drowsiness, sleep disturbance, confusion, violation of movement coordination

Stimulation of the CNS (nervousness, assets, anxiety, tremor, muscle spasms, euphoria, emotional lability, hallucinations)

Seizures of central genesis (when intravenous administration In high doses, or with the simultaneous appointment of antipsychotic drugs)

Depression, amnesia, violation of cognitive function, paresthesia, instability gait, reducing mental ability

Dry mouth, nausea, vomiting, difficulty in swallowing, meteorism, abdominal pain, constipation, diarrhea

Tachycardia, orthostatic hypotension, syncope, collapse, vasodulation

Urticaria, itching, examine, bullous rash

Muscular weakness

Stevens-Jones syndrome

Layella syndrome

Hypoglycemia

Difficulty urination, dysuria, urine delay

Violation of vision, taste, expansion of pupils

DISNEE, inhibition of the respiratory center

Disruption of menstrual cycles

Drug development is possible with long-term use.

Syndrome "Cancellation" is possible with a sharp abolition of the drug

The frequency of development of side effects increases with an increase in the duration of the preparation of the drug. With long-term use in large doses, the possibility of drug dependence is not excluded.

Contraindications

Increased sensitivity to tramadol hydrochloride or opiate

Glucose-6-phosphate dehydrogenase deficit

States accompanied by inhibition of breathing or pronounced inhibition of the central nervous system (alcohol poisoning, sedatives, drugs, drugs, psychotropic drugs)

Heavy renal and liver failure

The simultaneous use of monoaminoxidase inhibitors and a two-week period after their cancellation

Epilepsy (not controlled by treatment)

Violation of the consciousness of unknown genesis

Drug abolition syndrome

Dysfunction of the respiratory center, impaired respiratory function

Pain B. abdominal cavity Unclear origin

States accompanied by increased crankpot pressure, without artificial respiration

Risk of suicide

Opioid addiction

The incidence of biliary tract, hyperbilirubinemia, viral hepatitis, alcoholic liver damage

Pregnancy and lactation period

Children's age up to 12 years

Medicinal interactions

With the simultaneous use of tramadol with drugs that influence the central nervous system (antidepressants, neuroleptics, sedatives, anxiolitics and means used in anesthesiology), as well as with alcohol, it is possible to strengthen the action of the latter

The use of carbamazepine and other metabolic enzyme induces can lead to the weakening of the anesthetic effect of the hydrochloride tramadol, respectively, to the need to use higher doses of the drug

With systematic reception of barbiturates, especially phenobarbital, there is a possibility to reduce the anesthetic effect of opioid analgesics. Prolonged use of opioid analgesics or barbiturates stimulates the development of cross-tolerance

The simultaneous purpose of the tramadol hydrochloride and selective selection inhibitors of serotonin, tricyclic antidepressants and neuroleptics can increase the risk of convulsion

Naloxon activates breathing, eliminating analgesia after applying opioid analgesics

The tramadol solution cannot be mixed in one syringe with diclofenac solutions, indomethacin, phenylbutanosis, diazepam, fluiditrisetavcine, glyceryl trinitrate.

special instructions

Observe precautions when taking the drug in the following states:

In case of convulsions of central genesis

In cranial injuries

With hanging inspection

In patients with impaired liver and kidney function

With increased sensitivity to other micronistas opioid receptors

Tramadol should not be applied longer than the term justified from a therapeutic point of view. In the case of long-term treatment, it is impossible to exclude the possibility of developing drug addiction.

With increasing time intervals, tramadol in senior patients are used. Under the careful observation of the doctor and in reduced doses, tramadole hydrochloride should be used against the background of the action of drugs for anesthesia, sleeping pills and psychotropic drugs. The drug should not be combined with narcotic analgesics due to poor predictability of interaction effects. It is not recommended to apply for narcotic substance cancellation therapy. A combination with monoaminoxidase inhibitors should be avoided. Patients with epilepsy or patients susceptible to the development of convulsion should take tramadol only on life indications. During the treatment period, alcohol is not allowed.

Features of the influence of the medicinal product on the ability to control the vehicle or potentially hazardous mechanisms

It is not recommended to engage in activities requiring increased attention and high speed psychomotor reactions (driving vehicles and mechanisms management) due to possible occurrence adverse Reactions.

Overdose

Symptoms: nausea, vomiting, expansion of pupils, arterial hypertension. Most dangerous consequences The overdose of tramadol hydrochloride is the oppression of breathing, apnea and convulsions.

Treatment: maintaining adequate pulmonary ventilation and symptomatic therapy in conditions specialized branch. Antidote In the event of respiratory depression is Naloxone, it is advisable to use diazepams during convulsions.

Hemodialysis is ineffective.

Form release and packaging

2 ml of the drug is bottled into ampoules from a colorless glass with a notch or in ampoules of amber glass without a notch.

5 or 10 ampoules are placed together with the instructions for medical use in state and Russian, laid in a cardboard pack.

Storage conditions

In a dry-protected place at a temperature not higher than 25 o C.

Keep out of the reach of children!

Storage term

Do not use at the end of the expiration date.

Conditions of vacation from pharmacies

On prescription

Manufacturer

Kwality Pharmaceuticals Pvt Ltd. India

Packer

Denovo Impex LLP, Kazakhstan, Almaty, ul. Uthegen Batyr, 13

Owner of the registration certificate

Denovo Impex LLP, Kazakhstan

The address of the organization hosting on the territory of the Republic of Kazakhstan complaints from consumers for product quality (product):

Republic of Kazakhstan, Almaty, ul. Uthegen Batyr, 13

Denovo Impex LLP

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Tramadol - the drug from the group of opioid analgesics with the central mechanism of action, also related to anti-anti-drug drugs.

Release form and composition

Tramadol is made in the form of the following dosage forms:

• capsules: solid gelatin No. 2 with a housing and a yellow cap, inside the capsules contain a white or white powder with a yellowish color tinge (5, 6, 7, 8 or 10 capsules in the contour cellular package from the PVC film and aluminum printed lacquered foil, in Cardboard pack 1, 2, 3, 4, 5, 6, 8 or 10 packs; 5, 6, 7, 8, 10, 20, 30, 40, 50 or 10 capsules in the polymer container, in a cardboard pack 1 container) ;
• tablets: white or white with a slightly yellowish tint of color (10 or 20 tablets in the contour cellular packaging, in a cardboard pack 1 or 2 packs);
• injection solution: colorless transparent, without noticeable mechanical inclusions [1 or 2 ml in an ampoule of transparent neutral glass (on an ampoule there is a color encoding ring and a color point), in a blister from aluminum foil and PVC films 5 ampoules, in a cardboard pack 1 blister];
• rectal suppositories: a torpedo-shaped shape with a smooth surface, white, with a bare odor (5 suppositories in a blister from PVC and polyethylene, in a cardboard pack 1 or 2 blisters);
• drops: transparent colorless or slightly brownish solution with a distinct anise and mint smell (10 ml in a bottle of amber glass, supplemented by a built-in polyethylene dripper and an injected polypropylene cover with the control of the first opening, in a cardboard pack 1 bottle).

1 tramadol capsule contains:

• active substance: Tramadol - 50 mg;
• auxiliary components: magnesium stearate - 1.5 mg, microcrystalline cellulose - 37.14 mg, milk sugar (monohydrate lactose) - 66.36 mg.

Capsule shell (body and lid) contains: gelatin - up to 100%, titanium dioxide - 2%, dye sunny sunset yellow - 0.0059%, chinoline yellow dye - 0.75%.

1 Tablet tramadol contains:

• active substance: tramadol hydrochloride - 50 or 100 mg;
• auxiliary components: Potato starch, magnesium stearate, lactose (milk sugar).

1 ml of injection solution tramadol contains:

• active substance: tramadol hydrochloride - 50 mg;
• auxiliary components: water for injection - up to 1 ml, sodium anhydrous acetate - 2.5 mg.

1 Suppository tramadol contains:

• auxiliary components: Vepsol E75 (Fat W solid) - 145 mg, Vepsol W35 (solid fat) - 900 mg.

1 ml drop tramadol contains:

• active substance: tramadol hydrochloride - 100 mg;
• auxiliary components: sucrose - 200 mg, anise flavor - 0.1 mg, peppermint flavor - 0.1 mg, glycerol - 180 mg, sodium saccharinate dihydrate - 5 mg, propylene glycol - 160 mg, potassium sorbate - 1.64 mg, Polysorbate - 201 mg, purified water - up to 1 ml.

Indications for use

• diagnostic and therapeutic manipulations accompanied by painful sensations;
• pain syndrome moderate and severe of various origin (in the postoperative period, in injuries, pain in patients with oncological diagnoses, myocardial infarction, neuralgia and other states).

Contraindications

Capsules and tablets

• epilepsy, non-full-fledged drug treatment;
• opioid substance cancellation syndrome;
• intoxication with sleeping medicines, analgesics, alcohol, opioids or other psychotropic drugs;
• glucose-galactose maleabsorption, lactose intolerance, lactase deficiency;
• combination with Mao inhibitors (monoaminoxidase), as well as for 2 weeks after the end of their reception;
• age up to 14 years;
• increased sensitivity to the active substance or the auxiliary components of the drug.

Solution for injection, rectal suppositories, drops

• suicidal moods, addiction to substances raising mental activity;
• states accompanied by the oppression of the respiratory center or the central nervous system (including poisoning of narcotic analgesics and other psychoactive drugs, sleeping preparations, alcohol);
• combination with Mao inhibitors (including linoxolid), including a period of 2 weeks after their cancellation;
• epilepsy, resistant to medication therapy;
• complex therapy of drug cancellation syndrome;
• renal and / or hepatic insufficiency in severe (creatinine clearance (CC) is less than 10 ml / min);
• glucose-galactose malabsorption, fructose intolerance, sacraise / isomaltase deficiency (for tramadol droplets);
• pregnancy and period breastfeeding (Application is possible only in the threat of life and health);
• age up to 1 year;
• increased sensitivity to tramadol and other analgesics.

Relative contraindications for all dosage forms

With particular caution, the tramadol should be prescribed with a pronounced drug dependence on opioid substances, increased intracranial pressure and cranial injury, as well as patients with disorders of the consciousness of incomprehensible origin.

Relative contraindications for injection solutions, droplets and rectal suppositories

• liver dysfunction and / or kidney (CC is 10-30 ml / min);
• co-use with neuroleptics, selective serotonin rejecting inhibitors (some antidepressants and drugs that contribute to a decrease in appetite), narcotic analgesics, tricyclic antidepressants and other tricyclic substances (for example, promethazine), antimigranous preparations (triptans);
• epilepsy;
• convulsions;
• acute pain in the stomach of unclear origin ("sharp" belly).

Relative Contraindications for Capsules and Tablets

• diagnosed severe intolerance of opioids of nonallergic and allergic genesis;
• shock condition;
• epilepsy and inclination to convulsive sections (for tablets);
• violations of the functioning of the respiratory center and breathing problems.

Method of application and dosage

Tramadol take inside, regardless of meals. The dose depends on the severity of pain syndrome.

Tramadol should not be applied after the need for it was disappeared. With long-term therapy, the drug requires periodic monitoring of the patient's condition, which allows to determine the feasibility of further use of the drug and the dose correction.

In patients over 75 years old without hepatic or renal failure in history, the dose correction is usually not required. However, patients in this age group tramadol can be excreted from the body slower. Therefore, subject to permanent observation of the patient's condition, an increase in the interval between the drugs is allowed. In the same way, in the case of kidney dysfunction and / or liver: the standard scheme involves the reception of 50-100 mg of the drug 2 times a day.

Maximum daily dose - 400 mg (at tablets - 300 mg), excluding strong pain sensations in the postoperative period or pain oncological origin. In the case of a solution for injection of tramadol, it can be increased to 1600 mg.

Capsules and tablets

Capsules tramadol swallow entirely, without removing the contents, not chewing and drinking with enough liquid. Recommended doses are approximate, it is always necessary to select the minimum dose of the means, which will give a tangible effect at regular reception. The duration of treatment varies depending on the patient's condition. With therapy of chronic pain syndrome, it is necessary to take the drug strictly according to the scheme appointed by the specialist.

For adults and adolescents older than 14 years old, the one-time dose of tramadol should not exceed 50 mg. If the anesthetic effect is poorly manifested, after 30-60 minutes, 50 mg of the drug is re-taken. With highly pronounced pain, it is recommended to increase the one-time dose of up to 100 mg.

Depending on the intensity of pain syndrome, the analgesic effect of the drug is preserved for 4-6 hours (in the case of tablets up to 8 hours). In the postoperative period, short-term reception of higher doses of tramadol is allowed.

Injection

A solution for injection tramadol is introduced infusionally, subcutaneously, intramuscularly, intravenously. The dose of the drug is determined individually and modified in accordance with the intensity of pain. The standard reception scheme is as follows:

• adults and children over 14 years old: one-time dose - 50-100 mg (1-2 ampoules);
• children from 1 year to 14 years: one-time dose - 1-2 mg / kg body weight, the maximum daily dose should not exceed 4-8 mg / kg body weight.

It is allowed to repeatedly enter the drug after 4-6 hours. The intravenous drug is injected slowly, with a speed of no more than 1 ml per minute (corresponds to 50 mg of active substance) or used in a diluted form, mixing with a solution for infusion. If desired therapeutic effect It was not possible to achieve, after 20-30 minutes after intravenous administration, it is possible to continue to enter the infusion tramadol at a rate of 12 mg / h or take it inside in the form of tablets or capsules.

Suppositories rectal

Suppositories Tramadol are introduced directly into the rectum. Immediately after the introduction, it is recommended to remain in the position lying 30 minutes.

Adults and adolescents older than 14 years are prescribed 1 suppository 2 times a day: in the morning and in the evening, preferably after defecation. Before applying the candle, you need to warm up, holding it slightly in your hand. If necessary, the introduction of the suppository is repeated after 1-2 hours. Unacceptable exceeding the maximum daily dose (4 suppository).

In patients on hemodialysis, the drug is not canceled even on the day of dialysis. In patients with liver cirrhosis, one should not exceed the recommended maximum daily dose of 100 mg (1 suppository).

Drops

For adults and adolescents older than 12 years, the standard one-time dose is 20-40 drops (corresponds to 50 mg of tramadol). If the anesthetic effect is not expressed enough, after 30-60 minutes, 50 mg of tramadol is re-taken.

With a distinctly pronounced pain syndrome, the initial dose of the drug can be increased to 100 mg (no more than 1 time). Maximum daily dose - 160 drops.

Motherwise dose For children from 1 year to 12 years, it should not exceed 1-2 mg / kg, and the maximum daily dose is 4-8 mg / kg. A typical treatment diagram of patients of this age is as follows (1 drop - 2.5 mg of tramadol):

• up to 10 kg: 4-8 drops;
• 11-15 kg: 6-12 drops;
• 16-20 kg: 8-16 drops;
• 21-30 kg: 12-24 drops;
• 31-45 kg: 18-36 drops.

Side effects

• general Plan: Often - increased fatigue;
• cardiovascular system: infrequently - rapid heartbeat, orthostatic hypotension, tachycardia, collapse (mainly physical Loads or intravenous administration); Rarely - raising arterial pressure, bradycardia;
• immune system: rarely - anaphylactic shock and others allergic reactions (whistling breathing, shortness of breath, angioedema edema, bronchospasm);
• digestive system: very often - nausea; Often - dry mouth mucous membrane, vomiting, constipation; infrequently - diarrhea, flatulence, feeling of gravity in the epigastric region, difficulty swallowing, vomiting the urge, increased activity of hepatic enzymes; rarely - change of appetite;
• kidney and urinary system: rarely - urination disorders (urinary delay, dysuria, difficult urination);
• respiratory system: rarely - shortness of breath, inhibition of breathing (with a substantial exceeding the recommended doses and simultaneous reception of other drugs depressing the activities of the CNS);
• skeletal and muscular system: rarely - muscle weakness;
• nervous System: Very often - dizziness; Often - drowsiness, headaches; rarely fainting, paresthesia, coordination disorders, involuntary muscle contractions, convulsions (when taking high doses of the drug in combination with drugs that reduce the threshold of convulsive activity), tremor; occasionally - speech disorders;
• mental state: rarely - nightmares, sleep disorders, blurred consciousness, anxiety, hallucination, violation of the perception of surrounding reality and cognitive functions, change in mood (dysphorony and euphoria), increase or reduced motor activity; Very rarely - paranoia, impaired orientation in time and space, dramatization, depersonalization, ringing in ears, paresthesia, panic attacks;
• feeling authorities: rarely blurred vision; Sometimes - mydriasis, taste disorders;
• skin: often - increased sweating; Infrequently - urticaria, rash, itching.

Additionally for the solution for injection: infrequently - disorders of the menstrual cycle, signs of menopause, anorexia; rarely - pulmonary swelling; With long-term therapy, the drug addiction, after the discontinuation of the reception - the abolition syndrome.

When applying suppositories are frequent manifestation of differentiation.

special instructions

With prolonged use of tramadol, probably addictive and development of physical and mental dependence. In patients with tendency to abuse drugs or to the development of pharmacological dependence, it is necessary to carry out therapy with extremely short courses under medical control.

Tramadol can not be used as substitution therapy in patients with diagnosed opioid dependence and is not able to deliver opioid cancellation syndrome.

During the reception period, avoid control vehicles and activities that require concentration and rapid psychomotor reactions, especially with simultaneous reception of tramadol with other psychotropic drugs.

The active ingredient of the drug penetrates through the placenta. Wherein clinical researches Do not confirm the safety of the use of tramadol during pregnancy, so its reception is not recommended. Long therapy by the drug during pregnancy is able to cause cancellation syndrome in a newborn.

During lactation, it should also be abandoned from the use of tramadol or stop breastfeeding, with the exception of one-time reception - in this case, the cancellation of breastfeeding is not required.

Alcohol consumption during therapy should be deleted.

Medicinal interaction

Tramadol in any dosage forms It can interact with other drugs or substances, which causes the following effects:

• inhibitors of Mao: When combining tramadol with them or a reception of it for 14 days after the abolition of Mao inhibitors - the life-threatening symptoms from the cardiovascular, respiratory and central nervous system;
• means depressing the activities of the central nervous system, and alcohol: strengthening adverse reactions from the CNS;
• pre- or postoperative use of anti-ansulous means related to group of blockers 5-NT 3 -Serotonin receptors (Ondansetron et al.): Increasing the need for tramadol in patients with obvious postoperative pain syndrome;
• carbamazepine: reducing the analgesic effects of tramadol and reduce its action;
• inhibitors of CYP3A4 isoenzyme (for example, erythromycin, ketoconazole): braking of tramadol metabolism in the body;
• agonist antagonists of opioid receptors (pentazocine, nalbuphine, buprenorphine, etc.): decrease in the analgesic action of tramadol;
• indirect anticoagulants - Cumarine derivatives (warfarin et al.): Risk of bleeding and ecchimosis;
• neuroleptics, selective inhibitors of serotonin reverse seizure, tricyclic antidepressants and other medicines that reduce the threshold of convulsive readiness: strengthening their action and the possible occurrence of seizures;
• serotoninergic preparations: the development of serotonin syndrome (sweating, diarrhea, myoclone, hyperreflexia, ataxia, hyperthermia, assessment, insanity of consciousness).

Analogs

Analogues of Tablets Tramadol are: Tramadol Ratiopharm, Tramaclosidol.

The analogues of the tramadol capsules are: Tramadol c, tramadol retard, Trmadol Stada, Tramadol Acry, Tramadol Ratiopharm, tram.

Analogue of rectal suppositories Tramadol is a tram.

Analogs of droplets Tramadol are: Trmadol Stada, Tramadol Ratiopharm, tram.

Analogues of the solution for injection tramadol are: Tramadol gr, Trmadol Stada, Tramadol Pletchico, Tramadol Ratiopharm, Tramaclosidol, tram, tramoline.

Analogues of tramadol according to the mechanism of action: Palecia, Zaldair, Tramacet, Munnopon, Ramplus, Forceodol, Promidol.

Terms and conditions of storage

Capsules, tablets and a solution for injection tramadol stored in a dry and darkened place at a temperature not higher than 25 ° C, take care of children.

Drops and suppositories Rectal tramadol stored at a temperature not higher than 30 ° C in the original packaging, take care of children.

The shelf life of the capsules and Tablets tramadol - 3 years.

Shelf life of drops, solution for injection and rectal suppositories - 5 years.

Conditions of vacation from pharmacies

Recommended by recipe.

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It's no secret that medical manipulations can be very painful for patients. Also, the recovery period after the operation causes a lot of unpleasant sensations that interfere with the patient to focus on their recovery. To facilitate such states, doctors prescribe a taking painkillers. Some of them belong to the category of narcotic drugs, so sold in pharmacies only by the doctor's prescription and require special care when taking. One of the most common means related to this category, which is widely used in Russian medicine, is "Tramadol". What is this drug and in what cases his appointment is justified - we will tell readers in today's article. We also inform the analogues of this medication and its contraindications.

Brief description of the drug

Many people who had in a hospital bed due to serious illness, treating doctors discharge "Tramadol". What it is - they are trying to figure out themselves according to the reviews of acquaintances or via the Internet. Unfortunately, not always the information obtained is complete, and patients may even refuse to receive medicine, making incorrect conclusions about it.

So, what is it - "Tramadol"? This drug It is characterized as an opioid analgesic, which will be bought pain syndromes of various currents. In parallel, it enhances the action of sedatives and has an antitocal effect.

A drug is prescribed with moderate and strong pains, including oncological patients. For them, there is a diagram of the reception and dosage "Tramadol". Do I need a recipe for buying this medicinal product? This question is asked by many patients who are recommended to receive the drug. Since "tramadol" is entered into the register of narcotic drugs, no one will sell it without a recipe with special seal.

There are a lot of reviews about "Tramadole", so we will definitely analyze them in one of the sections of our article.

Forms of release

The drug described by us is used in medicine very widely, due to this it is produced in a variety different forms. Although the "tramadol" in capsules and pills is most often appointed. In the article, we will tell readers about all the forms of drug release and point out the allowable dosage for them.

So, in what form can we meet "Tramadol" in pharmacies? Let's consider this question:

• Pills. Patients with pain syndrome are usually shown precisely the tableted form of the drug. Each tablet contains fifty or hundred milligrams of active and auxiliary substances. She has a round and flat shape with inflicted risks. In white color, splashes and a light strawberry fragrance are allowed. The manufacturer releases tramadol tablets in packs with different quantities. For example, when dosage in fifty milligrams, you can purchase a box with one, two, three or five blisters, each of which is located ten tablets. If the doctor assigns you a long-term reception of "Tramadol", it will be more profitable to purchase the drug in the container. It can be up to a hundred pills anesthetic. When dosage, one hundred milligrams can be in bottles, boxes, containers and cellular packs.
• Capsules. Externally, they look very hard and have a gelatinous shell. Depending on the manufacturer, the capsule may differ in size and color. Usually every capsule contains a white powder without inclusions. In pharmacies, they can be purchased in contour cellular packs, in cardboard packs or vials. The maximum number of capsules in the package is one hundred pieces.
• "Tramadol" in injections. This form of medication is produced in glass ampoules one by one and two milliliters. The substance itself does not smell and colors, also unacceptably the appearance of sediment or suspension.
• Drops. This form appeared in pharmacies not so long ago, but physicians and patients and patients were evaluated. Drops can have a brownish tint and pronounced aroma of mint. Each bottle is packaged in a cardboard box. By volume, it varies from ten to one hundred milliliters.
• Suppositories. "Tramadol" in the form of rectal suppositories has a white color and a torpedo-shaped form. In the package can be one or two blisters, each accommodated up to ten candles.

Keep in mind that every doctor chooses the necessary dosage of anesthetic "tramadol" and its shape. Usually it directly depends on the disease.

The composition of the drug

Since the drug is produced in different versions, then its composition changes depending on the release form. Only the active substance - tramadol hydrochloride remains unchanged. It is in one or another quantity in all drugs manufactured by Tramadol:

• in one millilitress of its fifty milligrams;
• in the candle - about a hundred milligrams;
• tablets and capsules may contain fifty or hundred milligrams of the main active substance;
• in one millilitra drops of one hundred milligrams of the main component.

The drug has a number of excipients, for each form of release they are also their own. For tablets, for example, this list is as follows:

• lactose;
• flavoring;
• cellulose and so on.

In solution, the number of auxiliary components is minimal:

• water for injections;
• sodium acetate.

All substances are harmless to health, but the manufacturer assumes that individual allergic reaction may occur on some components in patients.

"Tramadol": Indications for use

The drug is prescribed to relieve pain syndrome in the following cases:

• oncology;
• injuries;
• postoperative period.

Often the medicine helps to reduce painful feelings When conducting various medical manipulations.

In some cases, the use of the drug in dentistry, neurology and rheumatology is permissible. However, in any case, the expediency of its destination defines only the attending physician.

Contraindications

In the instructions for applying to the tramadol tablets (as well as to other forms of issue), it is noted that the drug has a number of contraindications. These items must carefully read each patient, because the attending physician may not guess some of his health problems that are an obstacle to the admission of an anesthetic.

This list may look like this:

• or alcoholic intoxication organism;
• renal or liver failure;
• in the form of a medicine facilitating the "Cancellation" syndrome;
• diagnosed suicidal inclinations and depression;
• age up to a year when we are talking about drops, and the period up to fourteen years in other cases;
• pregnancy;
• increased sensitivity to opioids.

In addition to the contraindications already described above, there is a category of patients with great caution to prescribe a drug "Tramadol". Most often they suffer near the following symptoms and diseases:

• epilepsy and cramps;
• card and brain injuries;
• hypertonic disease;
• pain of an indefinite nature in the abdominal cavity.

During the treatment of "Tramadol", alcohol can not be used, it is also worth refraining from vehicle management and from working with mechanisms requiring high concentration attention.

It should be borne in mind that with the debt of the use of the drug in patients, addiction may occur. Therefore, in the treatment, it is necessary to strictly follow the dosage physician.

Instructions for the use of "Tramadol": pills and capsules

The drug must be made with a large amount of clean water, not chewing. If necessary, it can be dissolved in water. For these purposes, one hundred twenty-five milliliters of liquid will be enough.

Most often, the medication reception begins with the lowest dose. It is fifty milligrams per day. If the desired effect does not occur within an hour, you can drink another tablet.

However, a single dosage of "Tramadol" should not exceed one hundred milligrams. On a day you can take no more than four hundred milligrams of anesthetic.

It should be borne in mind that the elderly needs to do big breaks between tablets receptions. This is due to their slow metabolism. Capsules "Tramadol" are accepted by the same scheme as pills. On the body of the patient, they have an identical impact.

Dosage drops

The action "Tramadol" does not change depending on its form of release, but each has its own detection and dosage scheme. Drops should be diluted with a small amount of liquid, while it does not matter, before or after eating you will take them. You can also drip "Tramadol" on a piece of sugar, in such a form of many patients his taste seems more enjoyable.

One-time dose is twenty droplets, you can take no more than one hundred sixty drops. The drug in this form is sometimes prescribed to children under fourteen years. If your doctor found it necessary to write such a strong medicine to the child, then its amount should be calculated according to the following scheme: one or two milligrams per kilogram of weight. In recalculation, the dosage may be like this:

• one year - from four to eight drops;
• three years - twelve droplets;
• six years - from eight to sixteen drops;
• nine years - up to twenty four drops for one admission;
• from twelve to fourteen years - up to thirty six drops.

The "Tramadol" bottle is equipped with a very comfortable lid with protection against children. The child himself will not be able to open it, which is very important when it comes to such a strong preparation.

Rectal suppositories: how to apply

Usually in this form, the drug is appointed up to four times a day. The patient must enter one candle. The break between the drug intake should be at least four hours. Better if this period is six hours.

Prints: Dosage

An analgesic agent in the form of injections can be administered in three ways:

• intravenously;
• intramuscularly;
• subcutaneously.

The initial dose of the drug is one milliliter. If the relief does not occur, after an hour, you can enter the same amount of solution. With very strong pain, one-time dose increases to two milliliters.

You can take up to eight milliliters of "Tramadol" per day. The specified dosage in no way cannot be exceeded.

Instructions for the use of medication oncological patients

To find out how to take "tramadol" during oncology, you can only at your attending physician. For each patient, an individual reception scheme is drawn up, depending on the course of the disease, it is adjusted.

Usually in the case of cancer patients, one-time dosage is never less than a hundred milligrams. Therefore, it often becomes addictive to the drug and the "Cancellation" syndrome after the cessation of its reception.

Side effects

"Tramadol" and the analogues of this drug have a rather extensive list of side effects. It is necessary to know about them before starting the reception of the medicine, because in case of deterioration of the state, it must be stopped instantly.

The cardiovascular system can respond to tachycardia, hypotension and collapse on "tramadol".

From the side of the digestive system, the following range of reactions is possible:

• constipation;
• diarrhea;
• dry mouth;
• nausea;
• vomiting and flatulence.

Most actively reacts to the reception of the drug CNS. Patients can experience overall disabilities, weakness, kind of inhibition, increased sweating and fatigue. In addition, strong headaches and dizziness are possible, a sharp change of mood, anxiety and irritability, problems with sleep (drowsiness or, on the contrary, insomnia), memory loss and coordination disorders.

Allergic reactions to the drug are also possible. They show themselves itching, burning and rash.

Some patients noted violations of taste and vision, as well as problems with urination.

Most doctors argue that the drug cannot be canceled sharply. His dosage decreases gradually, otherwise patients begin to feel degradation of well-being.

Overdose

In some cases, tramadol intoxication is possible. What is it and how does it manifest? From the point of view of medicine, this situation can be called poisoning. It is expressed by vomiting, convulsions, breathing retention and can go to the coma stage.

At the first symptoms of intoxication drug It is necessary to immediately hospitalize the patient. To give him qualified assistance at home is impossible.

How should "Tramadol" have to be stored?

The manufacturer recommends storing the medicine away from sunlight and high humidity. Also cannot be placed the medicine in places where children can easily get it. The shelf life of the drug in different forms will also be divided. For example, the ampoules may be stored under five years under the observance of the above measures. At the same time, the temperature should not exceed twenty-five degrees Celsius.

Tablets and capsules have a similar (with already described) shelf life. But drops even in a closed bottle can be stored for no more than three years. Temperature, recommended by the manufacturer, is indicated within twenty-five degrees of heat.

Suppositories are suitable for approximately three years, the storage temperature can reach thirty degrees of heat.

Additional Information

"Tramadol" is strictly forbidden to consume with other drugs. Together they can cause an absolutely unpredictable reaction that can lead to a fatal outcome.

It is noted that patients, long-time carbamazepine, are less sensitive to the active component of "Tramadol". It is usually prescribed in an enlarged dosage or a different effective drug is designed.

Analogs of the drug

The analogues of "tramadol" is known quite a lot, however, they are not too often. Since the original drug cannot be attributed to expensive, it is rarely searched for cheaper replacement.

Most often, the theme of the analogues are interested in patients who have been identified allergies to "Tramadol". They can advise the following drugs:

• "Baldiar".
• "Tram".
• "Tramadol-M".
• "Para-trawl."

Each of the listed drugs is sold only by the doctor's prescription.

Tramadol is an analgesic synthetic production, belongs to a group of opioid tools, has a positive effect on the central nervous system and the back of the brain, causing membranes hyperpolarization, and inhibits the transmission of pain pulses. It has a strong analgesic effect that can last up to 12 hours. Activates opiate receptors in the brain and gastrointestinal. Slows down the destruction and stabilizes the concentration of catecholamines in the central nervous system. Instructions for the use of tramadol in ampoules and pills in our article.

The drug is produced in tablet form and in the form of a solution. Tablets have white or slightly yellowish hue flat-cylindrical, with a chamfer.

Active substance of this drug: tramadol hydrochloride 100 mg. Auxiliary components: Potato starch - 100 mg, milk sugar - 295 mg, magnesium - 5 mg. The preparation has a mixed mechanical action.

In which cases, the medicine is shown in the back pain

Indications for receiving quite strong analgesics, only strong pains:

1. Stages Neuralgia.
2. Postoperative period.
3. Recent stages.
4. Mechanical injuries.
5. Diseases of the heart and blood vessels.
6. Availability inflammatory processes in organism.

How to apply tramadol in tablets and in ampoules

Tramadol can be taken only to achieve one year of life. The one-time dose of means for intake is 50 mg, intramuscularly or intravenously 50-100mg. If oral administration The drug does not have a positive result 30 minutes after the reception, you can take another dose. But no more than 50 mg. Despite the simplicity of instructions for the use of tramadol in injections and tablets, it is possible to apply the drug only by agreement with the doctor.

In case of unbearable pain, the doctors prescribe 500 mg every 4-5 hours.

It is important to know that in this case only inpatient treatment is acceptable under strict observation by a specialist and in the presence of specialized medical equipment.

Children from year to 14 years old daily dose analgesics is 2 mg per kilogram of weight. In independence from age, the minimum daily dose is 400 mg. The duration of the entire course of receiving tramadol is determined only by the doctor.

Principle of operation of the drug

Tramadol activates opiate receptors in spin and brain, gastrointestinal tract. The anesthetic effect of the drug is due to a decrease in the activity of nociceptive and increasing antinocyptive functions in the human body.

This drug may cause the following negative effects:

• funding states;
• tachycardia;
• collapse;
• diarrhea or on the contapulation;
• bloating;
• headache in the field of temples;
• strong sweating;
• bad Son.;
• depressive states;
• causes lower extremities;
• memory disorders.

In severe cases, the use of drugs leads to a violation of taste receptors, vision is reduced, unstable may be observed menstrual cycle.

The sharp abolition of the drug can lead to a breakdown of sleep, diarrhea, nausea or even vomiting, headaches.

Contraindications for the use of analgesic

Like any other medication Tramadol has a number of contraindications that should be strictly observed:

• individual intolerance to the components of the drug;
• constant attacks of choking;
• oppressed states, depression;
• abuse of alcoholic beverages, drugs or psychotropic drugs;
• strong renal failure;
• pregnancy period 1 trimester;
• lactation period;
• age up to one year.

Overdose

With severe intoxication of the body by this drug, a person can observe rather unpleasant symptoms. Such as: cramps in the muscles, myiosis, vomiting call, in running cases can reach a coma. The overdose treatment is to maintain the cardiovascular system and respiratory tract. In order to eliminate convulsions, experts recommend taking benzodiazepine, but to relieve general status Man use naloxone.

But it is not necessary to do it yourself, the patient needs to be urgently transported to the nearest department of medical care.

Similar preparations for pain relief

Simdoladol on the personal code ATX: Tramaclosidol, Saint-Drain, Tram, Tramoline, Protradon. It is important to know, it is not necessary to decide to notice the drug analogue without testimony of a doctor.

special instructions

With great care, doctors prescribe painkillers to people who suffer from intracranial hypertension, alcoholism, epilepsy. A sufficiently long acceptance of this analgesic can cause addictive, while the use of tramodol under strict ban, all alcohol-containing drinks.

Cost of medication

The price of tramadol in ampoules is about 60 rubles per pack. In tablet form, the cost is 70 rubles. But it is important to know that Tramadol is released only by a doctor's prescription. A doctor is appointed on a special form for powerful analgesics.

Medicinal interaction with other drugs

Analgesic cannot be used in conjunction with diclafenac and indomethacin, nitroglycyrine. In addition, the painkillers cannot be used with alcoholic beverages. Since it increases the negative effect of the drug.

Lactation and pregnancy period

During pregnancy and breastfeeding, it will be better to avoid using the drug, and if necessary to accept analgesics of plant origin. When lactation is also better not to take tramadol, because even in small quantities it will stand out with breast milk.

Why do not be taking painkillers without consulting a doctor, look at the video:

Tramal, or Tramadol - a medical preparation, in high doses causing addiction and dependence after the first reception. Its constant use leads to an irreversible destruction of the body and psyche.

In medicine, tramal and tramadol are equally used - the differences in their composition are minimal, they practically do not differ. The main active ingredient in both cases is the tramadol hydrochloride. Dependence causes equally tram and tramadol - what the difference between the effect depends mainly on the concentration of drugs. The attitude to them should be equally critical.

Definitely say that tramadol is a drug, it is impossible. The main active ingredient refers to a potent medicinal preparations. Designed as a synthetic analogue of opioid painkillers, it was originally appointed patients at the last stages of oncological diseases suffering from pain.

However, experts are convinced that Tramadol, like the tram - drug, as, in fact, it is an artificially synthesized analogue of opium. Oral capsules, ampoules and candles are gradually made of turnover or sell strictly by recipe, despite the recognized effect of analgesic. At the slightest exceeding the dosage physician, the tram causes a dependence. According to the degree of impact, it is in second place after trimethylpentamine.

History of emergence and use in medicine

Tramal and Tramadol appeared in the early 60s. Twentieth century. In 1962 in pharmaceutical firm Grünenthal was developed by Tramadol. Due to the poor, the safe dose of funds was difficult to choose. This led to frequent overdose and the fact that the narcotic effect was noticeable when taking.

Sales of medicines have grown multiple times, and during the epidemic, about 350 million people died from an overdose. In the early 60s, every day was recorded up to 25 thousand "ambulance" trips, but helped managed less than a third of patients. Today, Tramadol and the tram, 10-15 people take lives every minute. Around the world there are more than 120 million people dependent on it.

Now the drug is produced and sold under the stringent control of the authorities. Each country decides independently: Tramadol is a drug or not:

• Russia did not include the drug in the list of narcotic drugs, but limits its turnover: in the Russian Federation, Tramadol is a medicine that is prescribed by a special recipe;
• Ukraine, Belarus, Uzbekistan officially determined: Tramadol - Drug, banning his free appeal;
• Sweden and some other countries sell tramadol or tram according to standard medical recipes.

Composition, mechanism of action and effect

So, Tramadol - what is it? The tool is a synthesized opiate. The tram is often replaced by heroin. Addressing and overdose of drugs on the negative effect is comparable to the opium, so the question of "Tramadol - Drugs or Not" has to be responsible. The exception is to take the drug precisely by purpose (for example, in palliative therapy).

What is the difference between tramadol tram and what is the difference between the forms of their release? The key active ingredient in them is general, but for each of the commercial drugs use special components. Sodium acetate is added to the injection solution, in capsules - milk sugar and magnesium stearate, and so on. Without a thorough analysis of the state and characteristics of the patient, the doctor will not be able to determine what to use, tram or tramadol - what is better, experts decide individually.

The mechanism of action in drugs is similar. The active substance when entering systemic blood flow, acts as an analgesic, blocking the transmission of pain impulses. The patient becomes better after 20 minutes after taking medication in the form of tablets / capsules. Facility feel sick, taking and tram, and tramadol - the difference between the mechanism of action is almost imperceptible. Preparations affect the CNS, when the dosage is exceeded, causing:

• the ability of reactions;
• the appearance of hallucinations;
• heartbearance;
• dizziness and so on.

How Tramadol use drug addicts - a narcotic effect and addiction to tramadol

As a drug, tram is, as a rule, pills and capsules. Injection solutions are used mainly for the manufacture of a concentrated preparation in liquid form in handicraft conditions. Action drug addicts is felt after 1-5 minutes after the reception. Euphoric state similar to the effect of "Ecstasy" lasts up to 36 hours. It is accompanied by unnatural emotional susceptibility, sympathy and sympathy for all people, tide of strength and discharge. The effect and tramadol and the tram are also the difference between the means, from the point of view of drug-dependent, it does not matter. The punishment for them is much softer than for the "traditional" drugs.

The dependence that tramadol causes - what is it? The mechanism "launches" through one or two days after the "non-chosen" dose of the drug (7-8 capsules), when its action comes down. A person suffers from nightmares, is afraid to remain alone. His hallucinations appear, which makes it take another dose. Using the time of the drug decreases, the place of euphoria occupy paranoid and manic states. That's what a tram is, and a psychological action is not the only side effect.

Signs of application and consequences

In the therapeutic dosage, Tramadol may not cause physical or psychological dependence, but it develops with minor tests. If the drug is used for more than three months in a row, it becomes the only drug accepted. The abolition of its heavy - to overcome psychological traction is required up to 15 years, decay products are derived within 20-25 years.

Tramal or tramadol - what is more destroying the body? Negative effect in drugs is identical. In such powerful analgesics, like tram and tramadol, side effects during abstinence are also strong. These are gloomy and realistic hallucinations, mental disorders (hysterics, depression, aggressiveness). The body of a person hosting tramadol suffers: the photo of patients in heavy stages demonstrate the consequences of addiction. This is depletion due to the lack of appetite, pale leather with bullous rash, clouding eyes, expansion of pupils and so on.

Signs, "outstanding" person who consumes the tram - what is it? Dependence is manifested as follows:

• reluctance to communicate with close, falsehood and indifference;
• breaking sleep, the usual level of activity;
• excessive gesture, instability of the gait;
• harsh mood change;
• intense headaches, fainting, hair loss and so on.

How to get rid of dependence

Psychological problems caused by the fact that a person takes the tram, side effects And threatening in the future, the full destruction of the body makes it look for ways to get rid of dependence. But in practice, three quarters of patients after inpatient treatment continue to take Tramadol - how to quit, they do not know.

The Narconon program, unlike traditional medication courses, does not imply the use of replacement drugs. This is a step-by-step procedure, the effect of which is achieved after 8-10 weeks. It includes unique phased methods overcoming dependence:

• non-drug excommunication - near the patient there are constantly specialists who follow its condition and apply physical methods-assistors that reduce pain;
• "New Life" - a decrease in physical traction to drugs with the help of run, sauna, reception of vitamin and mineral complexes with niacin and precise doses of nutrients;
• "Objective processes", "overcoming climbs and recessions in life" - the restoration of social skills and the ability to clearly see the world around themselves;
• "Personal Values" and "Changing States in Life" - acceptance of responsibility for their actions, the adoption of the past for the opportunity to move forward.

Final part of the program - "Life skills". These are classes to achieve the long-term result necessary not to return to drugs and start a full life again.

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