Active substanceTramadolTramadol
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  • Dosage form: & nbspDrops for oral administration.
    Composition:
    1 ml of the solution contains:

    Active ingredient: tramadol hydrochloride 100.0 mg.

    Auxiliary substances: sucrose 200.0 mg, potassium sorbate 1.5 mg, glycerol 85% 150.0 mg, sodium cyclamate 10.0 mg, sodium saccharinate 5.0 mg, propylene glycol 150.0 mg, macrogol glyceryl hydroxy stearate (polyethylene glycol glyceryl hydro stearate) 1.0 mg, peppermint leaves butter (mint oil) partially dementolized 0.5 mg,anise flavoring artificial 0.3 mg, water purified 518.7 mg.
    Description:Transparent, slightly viscous liquid from colorless to light yellow color with a characteristic smell of peppermint and a weak aroma of anise.
    Pharmacotherapeutic group:An analgesic agent with a mixed mechanism of action. Correction of the dose is usually not required. In patients older than 75 years, excretion of the drug may be delayed. Therefore, if necessary, increase the interval in the appointment of the drug in accordance with the characteristics of the patient. Renal failure / dialysis and liver failure: In renal and / or hepatic insufficiency, the excretion of tramadol is slowed. Therefore, if necessary, increase the interval in the appointment of the drug in accordance with the characteristics of the patient. How to use Tramal® Drops for ingestion are taken with a small amount of liquid or sugar, regardless of food intake. The content of tramadol in terms of the number of drops:
    ATX: & nbsp

    N.02.A.X.02   Tramadol

    Pharmacodynamics:
    Tramadol is an opioid analgesic with a central mechanism of action. It is a nonselective complete agonist of μ-, δ- and k-opioid receptors with a high affinity for μ-receptors.The second mechanism of action of tramadol, which enhances its analgesic effect, is suppression of norepinephrine reuptake by neurons and increased release of serotonin.
    Tramadol has antitussive action. In contrast to morphine, in therapeutic doses does not depress respiration and to a lesser extent affect intestinal motility. Influence on the cardiovascular system is weakly expressed. The analgesic potential of tramadol is 1/10 - 1/6 of the activity of morphine.
    Pharmacokinetics:

    After ingestion, about 90% of tramadol is absorbed, the half-absorption period is 0.38 ± 0.18 hours. The bioavailability of tramadol in oral dosage forms is on average 70% and does not depend on the intake of food. The decrease in bioavailability to 70% is due to the effect of "first passage" through the liver. After taking drops, the maximum concentration of tramadol in the plasma is observed after 1 h. In comparison with other opioid analgesics, the absolute bioavailability of tramadol in oral dosage forms is very high. Tramadol has a high affinity for tissues, the volume of distribution Vd,B = 203 ± 40 liters.Binding to plasma proteins is about 20%. Penetrates through blood-brain and placental barriers. Insignificant amounts of tramadol and its demethylated derivative (0.1% and 0.02%, respectively) are excreted in breast milk.

    In the metabolism of tramadol, isozymes CYP3A4 and CYP2D6, suppression of these isoenzymes by other substances can affect the concentration of tramadol and its active metabolite in the blood. To date, clinically significant interactions with other drugs mediated by this mechanism have not been identified.

    Tramadol and its metabolites are excreted mainly with urine, the average cumulative index of renal excretion is 90%.

    The half-life of tramadol (T1/2) is about 6 hours, regardless of the route of administration. In patients older than 75 years, the elimination half-life can be increased by a factor of 1.4; with cirrhosis of the liver to 13.3 ± 4.9 h (tramadol), 18.5 ± 9.4 h (O-demethyltramadol), in severe cases - 22.3 h and 36 h respectively. T1/2 with renal failure (creatinine clearance less than 5 ml / min) - 11 ± 3.2 h (tramadol), 16.9 ± 3 h (O-demethyltramadol), in severe cases - 19.5 h and 43.2 h respectively.

    In the liver, it is metabolized by N- and O-demethylation followed by conjugation with glucuronic acid. Only O-demethyltramadol has pharmacological activity. There are significant individual differences in the concentration of other metabolites. 11 metabolites of tramadol were found in urine.

    In therapeutic doses tramadol has a linear pharmacokinetic profile. The ratio of the concentration of tramadol in the blood serum and the analgesic effect is dose-dependent, which varies in individual individuals. The concentration of tramadol in the blood serum of 100-300 ng / ml is usually effective.

    Indications:Treatment of pain of medium and high intensity.
    Contraindications:
    - hypersensitivity to tramadol or any of the components of the drug;
    - acute intoxication with alcohol, hypnotics, analgesics, opioids or other psychotropic drugs;
    - contraindicated the joint use of tramadol with monoamine oxidase (MAO) inhibitors, and also within 14 days after the end of their admission;
    - epilepsy, not amenable to adequate drug control;
    - contraindicated the use of tramadol as a drug for the treatment of the syndrome of "withdrawal" of drugs;
    - contraindicated during pregnancy. During breastfeeding the drug can be prescribed only for vital indications. In the case of a single dose, there is no need to interrupt breastfeeding.
    - children under 1 year.
    - rare hereditary diseases accompanied by fructose intolerance, malabsorption of glucose and galactose, or deficiency of sugar and isomaltase (the preparation contains sucrose).
    Carefully:
    Tramadol should be used with caution:
    - in patients with opioid dependence;
    - with craniocerebral trauma, in patients with shock, in patients with impaired consciousness of unclear genesis, in patients with respiratory distress and disruption of the respiratory center, with increased intracranial pressure;
    - in patients with established severe intolerance to opioids of allergic and non-allergic genesis;
    - with epilepsy, amenable to adequate drug control, or in patients prone to developing seizures, tramadol can only be used for life indications (see "Special instructions");
    - patients with a tendency to abuse drugs or narcoticdependence treatment with tramadol should be conducted in short courses and under medical supervision (see "Special instructions").
    Pregnancy and lactation:
    Pregnancy
    Studies in animals have shown that in very high doses tramadol affects the development of internal organs, ossification and neonatal mortality. Tramadol penetrates the placental barrier. Convincing evidence of the safety of the use of tramadol during pregnancy in humans is not obtained, therefore tramadol Do not use during pregnancy. Long-term use of tramadol in pregnancy can lead to the development of symptoms of "cancellation" in a newborn. Tramadol, used before and during labor, does not affect the contractility of the uterus during childbirth. In newborns tramadol can cause a change in respiratory rate, which is usually not clinically significant.
    Lactation
    About 0.1% of the dose of tramadol administered to the mother is excreted with milk during lactation. Tramadol should not be used during lactation. After a single dose of tramadol, there is usually no need to interrupt breastfeeding.
    Fertility
    Studies on animals and post-registration observations did not reveal the effect of tramadol on fertility.
    Dosing and Administration:The doses used depend on the severity of the pain syndrome and the individual sensitivity of the patient. The recommended doses are indicative. It is necessary to select the minimum effective dose.
    Adults and adolescents over 12 years of age: 50-100 mg tramadol hydrochloride every 4-6 hours, not exceeding the total daily dose of 400 mg, in some clinical situations, it is possible that the above dose is exceeded. If after 30-60 minutes after the first administration of 50 mg of tramadol hydrochloride there is no satisfactory analgesia, a repeated single dose of 50 mg may be prescribed.
    In severe pain, a higher dose (100 mg of tramadol hydrochloride) may be given as an initial dose.
    Children from 1 year to 12 years: Single dose: 1-2 mg / kg body weight. Do not exceed the daily dose of 8 mg / kg body weight or the total daily dose of 400 mg tramadol, the calculation is carried out at the lowest value.

    Calculation of the dose by body weight for children older than one year:

    Age

    Mas

    Number of

    (approx.

    sa

    into droplets

    but)

    bodies

    in one-time



    dose (1-2



    mg / kg)

    1 year

    10

    4-8


    kg


    3 years

    15

    6-12


    kg


    6 years

    20

    8-16


    kg


    9 years

    30

    12-24


    kg


    11 years

    45

    18-36


    kg


    Elderly patients:

    In elderly patients (up to 75 years old) who do not have clinically expressed hepatic or renal insufficiency, dose adjustment is usually not required. In patients older than 75 years, excretion of the drug may be delayed. Therefore, if necessary, increase the interval in the appointment of the drug in accordance with the characteristics of the patient.

    Renal failure / dialysis and liver failure:

    With renal and / or liver failure, the excretion of tramadol is slowed down. Therefore, if necessary, increase the interval in the appointment of the drug in accordance with the characteristics of the patient.

    Mode of application

    Tramal® drops for ingestion are taken with a small amount of liquid or sugar, regardless of food intake.

    The content of tramadol in terms of the number of drops:

    Number of drops

    Tramadol content

    1 drop

    2.5 mg

    5 drops

    12.5 mg

    10 drops

    25 mg

    15 drops

    37.5 mg

    20 drops

    50 mg

    25 drops

    62.5 mg

    30 drops

    75 mg

    35 drops

    87.5 mg

    40 drops

    100 mg

    Tramal® drops for ingestion, solution in a bottle with a screw cap, with protection from opening by children. To open the bottle, press down the lid with force and then unscrew.After use, tighten the lid tightly. To remove the drops for ingestion, flip the bottle upside down and tap lightly on the bottom of the vial until the first drop appears.

    Duration of application

    Under no circumstances should the duration of therapy exceed the optimal one. With long-term use of tramadol, due to the etiology and severity of the pain syndrome, regular monitoring (if necessary with interruptions in therapy) is necessary to optimize the duration of therapy and the dose used.

    Side effects:

    The most frequent adverse reactions are nausea and dizziness, noted in more than 10% of patients.

    The frequency is defined as follows:

    Often: >1/10;

    Often: >1/100, <1/10;

    Infrequently: >1/1000, <1/100;

    Rarely: >1/10 000, <1/1000;

    Very rarely: <1/10 000;

    Frequency is unknown: can not be determined on the basis of available data.

    Heart Disease:

    Infrequently: influence on cardiovascular regulation (palpitation, tachycardia). These undesirable reactions are mainly observed with intravenous administration of the drug or with significant physical exertion.

    Rarely: aetiology.


    Vascular disorders:

    Infrequently: effects on cardiovascular regulation (orthostatic hypotension or collapse). These undesirable reactions are mainly observed with intravenous administration of the drug or with significant physical exertion.


    Disorders from the metabolism and nutrition:

    Rarely: changes in appetite.


    Disturbances from the respiratory system, chest and mediastinal organs:

    Rarely: respiratory depression, shortness of breath.

    At a significant excess recommended doses with simultaneous application of other drugs,

    oppressing the central nervous system (CNS), possible respiratory depression. There was a deterioration in bronchial asthma, but there was no causal relationship with the drug.


    Impaired nervous system:

    Very often: dizziness.

    Often: headache, drowsiness.

    Rarely: speech disorders, paresthesia, tremor, epileptiform seizures, involuntary muscle contractions, coordination disorders, fainting. Epileptiform seizures are possible after applying high doses of tramadol and with simultaneous use with drugs that lower the threshold of convulsive readiness.

    Disorders of the psyche:

    Rarely: hallucinations, confusion, sleep disturbances, anxiety, delirium and nightmares. After the use of tramadol, various rarely observed undesirable reactions from the psyche are possible (depending on the personality characteristics of the patient and the duration of treatment). These unwanted reactions include mood changes (usually euphoria, sometimes dysphoria), changes in activity (usually a decrease, sometimes an increase), impairment of cognitive functions and perception (eg, decision-making, perceptual disorders). Perhaps the development of drug dependence. Possible symptoms of "cancellation" are similar to the symptoms of opioid withdrawal: agitation, anxiety, nervousness, sleep disorders, hyperkinesia, tremor and gastrointestinal symptoms. Other symptoms that are very rare with tramadol cancellation include: panic attacks, severe anxiety, hallucinations, paresthesia, ringing in the ears and other symptoms from the side of the central nervous system (confusion, hallucinations, depersonalization, derealization, paranoia).

    Disorders from the side of the organ of vision:

    Rarely: miosis, mydriasis, blurred vision.

    Disorders from the gastro-intestinal tract:

    Very often: nausea.

    Often: constipation, dry mouth, vomiting.

    Infrequent: vomiting, gastrointestinal,intestinal symptoms (eg, pain in the belly, bloating), diarrhea.

    Disturbances from the skin and subcutaneous fabrics:

    Often: sweating.

    Infrequently: skin reactions (eg, itching, redness, hives).

    Disorders from the side of the skeletal-muscular and connective tissue:

    Rarely: muscle weakness.

    Disorders from the liver and bile ducts:

    In some cases, it was noted increased activity of liver enzymes, on time coinciding with therapy

    tramadol.

    Infringements from kidneys and urinary tract:

    Rarely: urinary disorders (dysuria and urine retention).

    Immune system disorders:

    Rarely: allergic reactions (dyspnea, bronchospasm, wheezing, angioedema) and anaphylaxis.

    General disorders and disorders at the site of administration:

    Often: fatigue.

    Laboratory and instrumental data:

    Rarely: increased blood pressure.

    Frequency unknown: hypoglycaemia.

    If undesired reactions appear in the manual, or if other undesirable reactions are noted that are not listed in the instructions, tell your doctor.

    Overdose:

    In case of an overdose of tramadol, symptoms characteristic of narcotic analgesics should be expected.

    Possible Symptoms: miosis, vomiting, collapse, consciousness up to coma, convulsions, depression of the respiratory center to apnea.

    Treatment: Providing airway patency. Maintain respiration and cardiovascular activity depending on the symptomatology. If breathing is disturbed, enter naloxone. When convulsions should be administered intravenously diazepam. When an overdose of the drug in oral dosage forms, it is necessary to wash the stomach and prescribe Activated carbon within the first two hours after an overdose. After taking especially large doses of the drug in capsules, removing the contents of the stomach can be effective at a later date. Hemodialysis and hemofiltration are ineffective in overdose.

    Interaction:
    Tramadol can not be administered simultaneously or within 14 days after the abolition of monoamine oxidase inhibitors (MAO). Patients treated with MAO inhibitors within 14 days before the opioid analgesic of pethidine were administered life-threatening drug interactions manifested by symptoms from the central nervous system system, respiratory and cardiovascular systems. Similar interactions with MAO inhibitors are possible with the administration of tramadol.
    The simultaneous use of tramadol and substances that suppress the activity of the central nervous system, including alcohol, can enhance unwanted reactions from the central nervous system. It is noted that with the joint or previous use of cimetidine (an inhibitor of microsomal liver enzymes) clinically significant interactions are unlikely.
    The simultaneous or previous use of carbamazepine (an inductor of microsomal liver enzymes) can reduce the analgesic effect of tramadol and shorten its duration. Tramadol can cause seizures and enhance the action of selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SSRIs), tricyclic antidepressants, neuroleptics and other drugs that lower the threshold of convulsive readiness (for example, bupropion, mirtazapine), thus leading to the development of seizures. Simultaneous application of tramadol with other serotonergic drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SSRIs), MAO inhibitors, tricyclic antidepressants, and mirtazapine can lead to the development of serotonin syndrome. The probability of developing a serotonin syndrome exists when one of the following symptoms / syndromes is observed:
    - spontaneous muscular clone
    - inducible or ocular myoclonus with excitation or increased sweating
    - tremor and hyperreflexia
    - hypertension, an increase in body temperature> 38 ° C and inducible or ocular myoclonus.
    The abolition of serotonergic drugs causes rapid disappearance of symptoms. The necessary therapy is determined by the clinical picture and the severity of the symptoms.
    When using tramadol and coumarin derivatives (for example, warfarin), careful monitoring of patients is necessary, as some of them have experienced an increase the international normalized relationship (MHO) with the development of bleeding and ecchymosis. Other inhibitors of the isoenzyme CYP3A4, for example, ketoconazole and erythromycin, can slow down the metabolism of tramadol (N-demethylation) and, possibly, active O-demethyltramadol.
    Clinical value this interaction has not been studied. There is limited evidence that pre-or post-operative use of the 5-HTZ receptor blocker -ondansetron has increased the need for tramadol in patients with postoperative pain syndrome.
    Special instructions:In patients with opioid dependence, head trauma, shock, with unclear etiology, breathing disorders or respiratory center damage, increased intracranial pressure tramadol should only be used with extreme caution.
    The drug should be used with caution in patients with known cases of severe intolerance to opioids of allergic and non-allergic origin.
    There have been cases of seizures in patients taking tramadol in recommended doses. The risk of seizures may increase if the recommended maximum daily dose of the drug is exceeded (400 mg). The administration of tramadol may increase the risk of seizures in patients taking drugs that reduce the convulsive threshold.Patients with epilepsy and patients prone to developing seizures should take tramadol only for life indications.
    Tramal® has a low potential for drug dependence. However, with prolonged use, addiction, physical and mental dependence are possible. In patients prone to drug abuse, or to the development of drug dependence, treatment with Tramal® should only be carried out with short courses and under medical supervision.
    Tramal® is not applicable as a substitute therapy for patients with opioid dependence. Although tramadol is an agonist of opioid receptors, it can not suppress the symptoms of "withdrawal" of morphine.
    Effect on the ability to drive transp. cf. and fur:Even at recommended doses tramadol can cause effects such as drowsiness and dizziness and can therefore disrupt the reaction of car drivers and machine operators. At reception of Tramal it is necessary to refrain from management of motor transport and employment by potentially dangerous kinds of activity demanding the raised concentration of attention and fast psychomotor reactions,especially when combined with other psychotropic drugs or alcohol.
    Form release / dosage:Drops for ingestion 100 mg / ml.
    Packaging:For 10 ml in a bottle of dark glass, equipped with a dropper. Vial with instructions for use in cardboard pack.
    Storage conditions:At a temperature of no higher than 25 ° C. In a place inaccessible to children.
    Shelf life:4 years. Do not use after the expiration date indicated on the package.
    Terms of leave from pharmacies:On prescription
    Registration number:П N014289 / 02-2002
    Date of registration:11.12.2008
    Date of cancellation:2016-02-15
    The owner of the registration certificate:Grünenthal GmbHGrünenthal GmbH Germany
    Manufacturer: & nbsp
    Representation: & nbspSTADA CISASTADA CISARussia
    Information update date: & nbsp19.09.2015
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