Below are the general guidelines for dosing tramadol. Note that these dosages may be adjusted on a case-by-case basis for individual patients. Always follow your prescribing physician’s instructions for taking tramadol.
The following information comes from DailyMed, an FDA label information provider.
Usual Adult Dose for:
Initiating Treatment with Tramadol Hydrochloride Tablets
Before taking tramadol it is important to remember that tramadol can be an as needed medication and can be addictive. Only take it as prescribed by a physician. Do not abruptly stop taking tramadol as serious withdrawal side effects may occur. If stopping therapy, slowly taper off tramadol in small daily increments.
For patients not requiring rapid onset of analgesic effect (pain relief), the tolerability of tramadol hydrochloride tablets can be improved by initiating therapy with the following conservative titration regimen: Start tramadol hydrochloride tablets at 25 mg/day and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg four times a day). It is common start patients on 25 mg every 8 hours or every 6 hours (three to four times a day).
Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg four times a day). After titration, tramadol hydrochloride tablets 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
For the subset of patients for whom the rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, tramadol hydrochloride tablets 50 mg to 100 mg can be administered as needed for pain relief every four to six hours, not to exceed 400 mg per day. For more information on the adverse reactions of tramadol, visit our side effects page.
Conversion from Tramadol Hydrochloride Immediate-Release to Extended-Release Tramadol
The relative bioavailability of immediate-release tramadol hydrochloride compared to extended-release tramadol is unknown, so conversion to extended-release formulations must be accompanied by close observation for signs of excessive sedation and respiratory depression. Follow your physicians recommendations closely when converting.
Dosage Modification in Patients with Hepatic (liver) Impairment
The recommended dose for adult patients with severe hepatic (liver) impairment is 50 mg every 12 hours.
Dosage Modification in Patients with Renal (kidney) Impairment
In all patients with creatinine clearance less than 30 mL/min, it is recommended that the dosing interval of tramadol hydrochloride tablets be increased to 12 hours, with a maximum daily dose of 200 mg. Since only 7% of an administered dose is removed by hemodialysis, dialysis patients can receive their regular dose on the day of dialysis. Patients on hemodialysis should not take tramadol more frequently than every 12 hours and also have a maximum daily dose of 200 mg.
Dosage Modification in Geriatric Patients
Do not exceed a total dose of 300 mg/day in patients over 75 years old. It is important to monitor elderly patients since they can be at higher risks for falls, mental status changes, and constipation.
What if I Miss a Dose of Tramadol?
Patients should not take a larger dose or take tramadol more often or for a longer period of time than prescribed. The NIH advises that if you miss a dose, take it as soon as you remember unless it is very close to the time for the next dose. Then, skip the missed dose and continue the regular schedule. It’s important to not wait too long to take your medication, as it could lead to withdrawal. However, in many patients it is prescribed to be as needed medication in which cases only take the medication when experiencing moderate-severe pain. The dosage may be increased by the doctor, but should not be increased by the patient.” NIH – National Institutes of Health. If you find that tramadol may not be the right fit for you, there are a few other options. For more information, check out our tramadol alternatives page.