【藥品性質提示】 根據 2019 AGS Beers Criteria，本藥品為【潛在不適當用藥 (PIM)】，用於老年人時須謹慎使用(監測血鈉值)。 #高警訊藥品

鴉片類止痛 Relief of moderate to moderately severe pain

Opioid Analgesic
Binds to μ-opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain

1. Onset: about 1 hr; Time to peak: 2 hrs; Duration: 9 hrs
2. Plasma protein binding: 20%
3. Metabolism: Extensively metabolized in liver, has pharmacologically active metabolites
4. Elimination half-life: about 6 hrs, prolonged in elderly, hepatic or renal impairment

1. Hypersensitivity to tramadol, opioids, or any component of the formulation
2. Pediatric patients <12 years of age; postoperative management in pediatric patients <18 years of age who have undergone tonsillectomy and/or adenoidectomy
3. Significant respiratory depression; acute or severe bronchial asthma in the absence of appropriately monitored settings and/or resuscitative equipment
4. GI obstruction, including paralytic ileus (known or suspected)
5. Concomitant use with or within 14 days following monoamine oxidase inhibitor therapy

C

The safety of tramadol in infants and neonates has not been evaluated, the drug is not recommended for obstetrical preoperative medication or for post-delivery analgesia in nursing women.

Pruritus, agitation, anxiety, constipation, diarrhea, hallucination, nausea, tremor, vomiting, diaphoresis

Acute pain (eg, postoperative):
Initial 50 mg every 4 to 6 hours as needed; maximum: 400 mg/day
Chronic pain:
The ideal dosing regimen has not been established; consider restricting the initial dose to <300 mg tramadol per day ; maximum: 400 mg/day

1. CrCl ≥30 mL/minute: No dosage adjustment necessary
2. CrCl <30 mL/minute: Increase dosing interval to every 12 hours; maximum: 200 mg/day
3. Hemodialysis: Dialyzable; Lower initial doses and an extended dosing interval (eg, 25 mg twice daily) are recommended; maximum: 200 mg/day

1. Mild to moderate impairment: No dosage adjustments provided in the manufacturer's labeling
2. Severe impairment: 50 mg every 12 hours