(tra' ma dole)
P : Caution when used during pregnancy
L : Contraindicated in lactation
| | See TERMINOLOGY & ABBREVIATIONS |
|Indication(s)||Tramadol Hydrochloride is indicated for the management of moderate to moderately severe chronic pain in adults; Extended-Release formulations provide round-the-clock effect for an extended period of time.|
|Dosage & Administration||Tramadol Hydrochloride Immediate-Release Tablet
Adults (17 years of age and over)
For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of tramadol hydrochloride tablets can be improved by initiating therapy with a titration regimen. The total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg q.i.d.). After titration, Tramadol Hydrochloride 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
Tramadol Hydrochloride Extended-Release Tablet
Tramadol Hydrochloride Extended-Release is an extended-release formulation intended for once a day dosing in adults aged 18 years and older. Tramadol Hydrochloride Extended-Release may be available in 150mg strength. The tablets must be swallowed whole with liquid and must not be split, chewed, dissolved or crushed. Chewing, crushing or splitting the tablet could result in the uncontrolled delivery of tramadol, in overdose and death.
Do not administer Tramadol Hydrochloride Extended-Release at a dose exceeding 300 mg per day. Do not use Tramadol Hydrochloride Extended-Release more than once daily or concomitantly with other tramadol products.
Patients Not Currently on Tramadol Immediate-Release Products
Initiate treatment with Tramadol Hydrochloride Extended-Release at a dose of 100 mg once daily and titrated up as necessary to 150 mg, 200 mg and 300 mg every five days to achieve a balance between relief of pain and tolerability.
Patients Currently on Tramadol Immediate-Release Products
Calculate the 24-hour tramadol IR dose and initiate a total daily dose of Tramadol Hydrochloride Extended-Release rounded down to the next lowest 100 mg increment. The dose may subsequently be individualized according to patient need. Due to limitations in flexibility of dose selection with Tramadol Hydrochloride Extended-Release, some patients maintained on tramadol IR products may not be able to convert to Tramadol Hydrochloride Extended-Release.
Patients 65 Years of Age and Older
Initiate dosing of an elderly patient (over 65 years of age) should be initiated cautiously, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy. Tramadol Hydrochloride Extended-Release should be administered with even greater caution in patients over 75 years, due to the greater frequency of adverse events seen in this population.
Patients with Renal Impairment
The limited availability of dose strengths and once daily dosing of Tramadol Hydrochloride Extended-Release do not permit the dosing flexibility required for safe use in patients with severe renal impairment. Do not use Tramadol Hydrochloride Extended-Release in patients with creatinine clearance less than 30 mL/min.
Patients with Hepatic Impairment
The limited availability of dose strengths and once daily dosing of tramadol hydrochloride extended-release capsules do not permit the dosing flexibility required for safe use in patients with severe hepatic impairment. Do not use Tramadol Hydrochloride Extended-Release in patients with severe hepatic impairment (Child-Pugh Class C).
Discontinuation of Treatment
Withdrawal symptoms may occur if Tramadol Hydrochloride Extended-Release is discontinued abruptly. Clinical experience with tramadol suggests that withdrawal symptoms may be reduced by tapering Tramadol Hydrochloride Extended-Release.
Tramadol Hydrochloride Parenteral
Hepatic impairment: Severe: increase dosage interval to 12 hr.
Tramadol Hydrochloride Rectal
Hepatic impairment: Severe: Increase dosage interval to 12 hr.
|Overdosage||Serious potential consequences of overdosage are respiratory depression, lethargy, coma, seizure, cardiac arrest and death. Fatalities have been reported in post marketing in association with both intentional and unintentional overdose with tramadol. In treating an overdose, primary attention should be given to maintaining adequate ventilation along with general supportive treatment. While naloxone will reverse some, but not all, symptoms caused by overdosage with tramadol, the risk of seizures is also increased with naloxone administration. In animals convulsions following the administration of toxic doses of tramadol could be suppressed with barbiturates or benzodiazepines but were increased with naloxone. Naloxone administration did not change the lethality of an overdose in mice. Hemodialysis is not expected to be helpful in an overdose because it removes less than 7% of the administered dose in a 4-hour dialysis period.|
|Contraindications||Tramadol Hydrochloride should not be administered to patients who have previously demonstrated hypersensitivity to tramadol, any other component of this product or other opioids. Tramadol Hydrochloride is contraindicated in any situation where other opioids are contraindicated, including acute intoxication with any of the following: alcohol, hypnotics, narcotics, centrally acting analgesics, opioids or psychotropic drugs. Tramadol Hydrochloride may worsen central nervous system and respiratory depression in these patients.|
|Warnings & Precautions||
Seizures have been reported in patients receiving tramadol within the recommended dosage range. Spontaneous post-marketing reports indicate that seizure risk is increased with doses of tramadol above the recommended range. Concomitant use of tramadol increases the seizure risk in patients taking:
Risk of seizures may also increase in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections).
In tramadol overdose, naloxone administration may increase the risk of seizure.
Serious and rarely fatal anaphylactoid reactions have been reported in patients receiving therapy with tramadol. When these events do occur it is often following the first dose. Other reported allergic reactions include pruritus, hives, bronchospasm, angioedema, toxic epidermal necrolysis and Stevens-Johnson syndrome. Patients with a history of anaphylactoid reactions to codeine and other opioids may be at increased risk and therefore should not receive Tramadol Hydrochloride Extended-Release.
Administer Tramadol Hydrochloride cautiously in patients at risk for respiratory depression. In these patients alternative non-opioid analgesics should be considered. If large doses of tramadol are administered with anesthetic medications or alcohol, respiratory depression may result. Respiratory depression should be treated as an overdose. If naloxone is to be administered, use cautiously because it may precipitate seizures.
Interaction With Central Nervous System (CNS) Depressants, Including Alcohol and Drugs of Abuse
Tramadol may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression. Use Tramadol Hydrochloride Extended-Release with caution and in reduced dosages when administered to patients receiving CNS depressants such as alcohol, opioids, anesthetic agents, narcotics, phenothiazines, tranquilizers or sedative hypnotics. Tramadol Hydrochloride Extended-Release increases the risk of CNS and respiratory depression in these patients. Alcohol-containing beverages should not be consumed by patients using Tramadol Hydrochloride Extended-Release
Serotonin Syndrome Risk
The development of a potentially life-threatening serotonin syndrome may occur with use of tramadol products, including Tramadol Hydrochloride Extended-Release , particularly with concomitant use of serotonergic drugs such as SSRIs, SNRIs, TCAs, MAOIs and triptans, with drugs which impair metabolism of serotonin (including MAOIs) and with drugs which impair metabolism of tramadol (CYP2D6 and CYP3A4 inhibitors). This may occur within the recommended dose.
Serotonin syndrome may include mental-status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).
Use Tramadol Hydrochloride Extended-Release with caution in patients with increased intracranial pressure or head injury. The respiratory depressant effects of opioids include carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure, and may be markedly exaggerated in these patients. Additionally, pupillary changes (miosis) from tramadol may obscure the existence, extent, or course of intracranial pathology. Clinicians should also maintain a high index of suspicion for adverse drug reaction when evaluating altered mental status in these patients if they are receiving Tramadol Hydrochloride Extended-Release.
Use in Ambulatory Patients
Tramadol Hydrochloride Extended-Release may impair the mental and or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. Caution patients initiating therapy with Tramadol Hydrochloride Extended-Release or those whose dose has been increased to refrain from potentially hazardous activities until it is established that their mental and physical abilities are not significantly impaired.
Use With MAO Inhibitors and SSRIs
Use Tramadol Hydrochloride Extended-Release with great caution in patients taking monoamine oxidase inhibitors. Animal studies have shown increased deaths with combined administration. Concomitant use of Tramadol Hydrochloride Extended-Release with MAO inhibitors or SSRI's increases the risk of adverse reactions, including seizure and serotonin syndrome.
Withdrawal symptoms may occur if Tramadol Hydrochloride Extended-Release is discontinued abruptly. These symptoms may include: anxiety, sweating, insomnia, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, piloerection, and rarely hallucinations. Clinical experience with other formulations of tramadol suggests that withdrawal symptoms may be reduced by tapering Tramadol Hydrochloride Extended-Release when discontinuing tramadol therapy.
Misuse, Abuse and Diversion of Opioids
Tramadol Hydrochloride Extended-Release contains tramadol, an opioid agonist of the morphine-type. Such drugs are sought by drug abusers and people with addiction disorders and are subject to criminal diversion.
Tramadol can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing Tramadol Hydrochloride Extended-Release in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion.
Tramadol Hydrochloride Extended-Release could be abused by crushing, chewing, snorting, or injecting the dissolved product. These practices will result in the uncontrolled delivery of the opioid and pose a significant risk to the abuser that could result in overdose and death.
Concerns about abuse, addiction, and diversion should not prevent the proper management of pain. The development of addiction to opioid analgesics in properly managed patients with pain has been reported to be rare. However, data are not available to establish the true incidence of addiction in chronic pain patients.
Healthcare professionals should contact their State Professional Licensing Board, or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product.
Risk of Overdosage
Serious potential consequences of overdosage with Tramadol Hydrochloride Extended-Release are central nervous system depression, respiratory depression and death. In treating an overdose, primary attention should be given to maintaining adequate ventilation along with general supportive treatment.
|Adverse Drug Reactions||An orally swallowed immediate release tablet of tramadol was administered to 550 patients during the double-blind or open-label extension periods in U.S. studies of chronic nonmalignant pain. Of these patients, 375 were 65 years old or older. Table 2 reports the cumulative incidence rate of adverse reactions by 7, 30 and 90 days for the most frequent reactions (5% or more by 7 days). The most frequently reported events were in the central nervous system and gastrointestinal system. Although the reactions listed in the table are felt to be probably related to tramadol administration, the reported rates also include some events that may have been due to underlying disease or concomitant medication. The overall incidence rates of adverse experiences in these trials were similar for tramadol and the active control groups, acetaminophen 300 mg with codeine phosphate 30 mg, and aspirin 325 mg with codeine phosphate 30 mg, however, the rates of withdrawals due to adverse events appeared to be higher in the tramadol groups.
Incidence 1% to less than 5%, possibly causally related:
the following lists adverse reactions that occurred with an incidence of 1% to less than 5% in clinical trials, and for which the possibility of a causal relationship with tramadol exists.
Body as a Whole: Malaise.
Central Nervous System: Anxiety, Confusion, Coordination disturbance, Euphoria, Miosis, Nervousness, Sleep disorder.
Gastrointestinal: Abdominal pain, Anorexia, Flatulence.
Special Senses: Visual disturbance.
Urogenital: Menopausal symptoms, Urinary frequency, Urinary retention.
Incidence less than 1%, possibly causally related: the following lists adverse reactions that occurred with an incidence of less than 1% in clinical trials and/or reported in post-marketing experience.
Body as a Whole: Accidental injury, Allergic reaction, Anaphylaxis, Death, Suicidal tendency, Weight loss, Serotonin syndrome (mental status change, hyperreflexia, fever, shivering, tremor, agitation, diaphoresis, seizures and coma).
Cardiovascular: Orthostatic hypotension, Syncope, Tachycardia.
Central Nervous System: Abnormal gait, Amnesia, Cognitive dysfunction, Depression, Difficulty in concentration, Hallucinations, Paresthesia, Seizure, Tremor.
Skin: Stevens-Johnson syndrome/Toxic epidermal necrolysis, Urticaria, Vesicles.
Special Senses: Dysgeusia.
Urogenital: Dysuria, Menstrual disorder.
Other adverse experiences, causal relationship unknown: A variety of other adverse events were reported infrequently in patients taking tramadol during clinical trials and/or reported in post-marketing experience. A causal relationship between tramadol and these events has not been determined. However, the most significant events are listed below as alerting information to the physician.
Cardiovascular: Abnormal ECG, Hypertension, Hypotension, Myocardial ischemia, Palpitations, Pulmonary edema, Pulmonary embolism.
Central Nervous System: Migraine, Speech disorders.
Gastrointestinal: Gastrointestinal bleeding, Hepatitis, Stomatitis, Liver failure.
Laboratory Abnormalities: Creatinine increase, Elevated liver enzymes, Hemoglobin decrease, Proteinuria.
Sensory: Cataracts, Deafness, Tinnitus.
|Drug Interactions||In vitro studies indicate that tramadol is unlikely to inhibit the CYP3A4-mediated metabolism of other drugs when tramadol is administered concomitantly at therapeutic doses. Tramadol does not appear to induce its own metabolism in humans, since observed maximal plasma concentrations after multiple oral doses are higher than expected based on single-dose data. Tramadol is a mild inducer of selected drug metabolism pathways measured in animals.
Use With Carbamazepine
Patients taking carbamazepine may have a significantly reduced analgesic effect of tramadol. Because carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol, concomitant administration of Tramadol Hydrochloride and carbamazepine is not recommended.
Use With Quinidine
Tramadol is metabolized to M1 by CYP2D6. Quinidine is a selective inhibitor of the isoenzyme, so that concomitant administration of quinidine and tramadol results in increased concentrations of tramadol and reduced concentrations of M1. The clinical consequences of these findings are unknown. In vitro drug interaction studies in human liver microsomes indicate that tramadol has no effect on quinidine metabolism.
Use With Inhibitors of CYP2D6
In vitro drug interaction studies in human liver microsomes indicate that concomitant administration with inhibitors of CYP2D6 such as fluoxetine, paroxetine, and amitriptyline could result in some inhibition of the metabolism of tramadol.
Use With Cimetidine
Concomitant administration with cimetidine does not result in clinically significant changes in tramadol pharmacokinetics. Therefore, no alteration of the Tramadol Hydrochloride dosage regimen is recommended.
Use With MAO Inhibitors
Interactions with MAO Inhibitors, due to interference with detoxification mechanisms, have been reported for some centrally acting drugs.
Use With Digoxin and Warfarin
Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity and alteration of warfarin effect, including elevation of prothrombin times.
|Food Interaction||Tramadol Hydrochloride Extended-Release may be taken without regard to food.|
|Use in Special population & Pregnancy Category (FDA)||Pregnancy, Teratogenic Effects: Pregnancy Category C.
Tramadol has been shown to be embryotoxic and fetotoxic in mice, (120 mg/kg or 360 mg/m2), rats (â‰¥25 mg/kg or 150 mg/m2) and rabbits (â‰¥75 mg/kg or 900 mg/m2) at maternally toxic dosages, but was not teratogenic at these dose levels. These dosages on a mg/m2 basis are 1.4, â‰¥0.6, and â‰¥3.6 times the maximum daily human dosage (246 mg/m2) for mouse, rat and rabbit, respectively.
No drug-related teratogenic effects were observed in progeny of mice (up to 140 mg/kg or 420 mg/m2), rats (up to 80 mg/kg or 480 mg/m2) or rabbits (up to 300 mg/kg or 3600 mg/m2) treated with tramadol by various routes. Embryo and fetal toxicity consisted primarily of decreased fetal weights, skeletal ossification and increased supernumerary ribs at maternally toxic dose levels. Transient delays in developmental or behavioral parameters were also seen in pups from rat dams allowed to deliver. Embryo and fetal lethality were reported only in one rabbit study at 300 mg/kg (3600 mg/m2), a dose that would cause extreme maternal toxicity in the rabbit. The dosages listed for mouse, rat and rabbit are 1.7, 1.9 and 14.6 times the maximum daily human dosage (246 mg/m2), respectively.
Tramadol was evaluated in peri- and post-natal studies in rats. Progeny of dams receiving oral dose levels of 50 mg/kg (300 mg/m2 or 1.2 times the maximum daily human tramadol dosage) or greater had decreased weights, and pup survival was decreased early in lactation at 80 mg/kg (480 mg/m2 or 1.9 and higher the maximum daily human dose).
There are no adequate and well-controlled studies in pregnant women. Tramadol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Neonatal seizures, neonatal withdrawal syndrome, fetal death and still birth have been reported during post-marketing.
Labor and Delivery
Tramadol Hydrochloride 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. Tramadol has been shown to cross the placenta. The mean ratio of serum tramadol in the umbilical veins compared to maternal veins was 0.83 for 40 women given tramadol during labor.
The effect of tramadol if any, on the later growth, development, and functional maturation of the child is unknown.
Tramadol Hydrochloride is not recommended for obstetrical preoperative medication or for post-delivery analgesia in nursing mothers because its safety in infants and newborns has not been studied. Following a single IV 100 mg dose of tramadol, the cumulative excretion in breast milk within 16 hours postdose was 100 Âµg of tramadol (0.1% of the maternal dose) and 27 Âµg of M1.
The safety and efficacy of Tramadol Hydrochloride in patients under 16 years of age have not been established. The use of Tramadol Hydrochloride in the pediatric population is not recommended.
In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy. In patients over 75 years of age, daily doses in excess of 300 mg are not recommended .
A total of 455 elderly (65 years of age or older) subjects were exposed to tramadol in controlled clinical trials. Of those, 145 subjects were 75 years of age and older.
In studies including geriatric patients, treatment-limiting adverse events were higher in subjects over 75 years of age compared to those under 65 years of age. Specifically, 30% of those over 75 years of age had gastrointestinal treatment-limiting adverse events compared to 17% of those under 65 years of age. Constipation resulted in discontinuation of treatment in 10% of those over 75.
|ATC Classification||N02AX02 - tramadol; Belongs to the class of other opioids. Used to relieve pain.|
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|ANADOL||Square Pharmaceuticals Ltd.||Tramadol 50mg||Capsule||4x10's: 322.80 MRP|
|ANADOL INJ||Square Pharmaceuticals Ltd.||Tramadol 100mg/2 ml||IM/IV Injection||2x5's: 201.40 MRP|
|ANADOL SR||Square Pharmaceuticals Ltd.||Tramadol 100mg||Capsule||3x10's: 362.70 MRP|
|ANADOL SUPP||Square Pharmaceuticals Ltd.||Tramadol 100mg||Suppository||4x5's: 302.00 MRP|
|DOLAN||Techno Drugs||Tramadol hydrochloride 50mg||Capsule||30's: 180.00 MRP|
|DOLAN Injection||Techno Drugs||Tramadol hydrochloride INN 100mg/2ml||Injection||10 amps: 180.00 MRP|
|DOLONIL||The Acme Laboratories Ltd.||Tramadol hydrochloride 50mg||Capsule||20's: 150.60 MRP|
|DOLONIL Injection||The Acme Laboratories Ltd.||Tramadol hydrochloride (I/V) 100mg/2ml||Injection||5 amps:100.35 MRP|
|DOLONIL SR||The Acme Laboratories Ltd.||Tramadol hydrochloride 100mg||Capsule (sustained release)||16's: 224.96 MRP|
|DOLORAN||Sandoz/Novartis||Tramadol Hydrochloride BP 50mg||Capsule||30's: MRP 255.00|
|DOLORAN Injection||Sandoz/Novartis||Tramadol Hydrochloride 100mg/2ml||Injection||5 amps: 200.00 MRP|
|DOLORAN PRT||Sandoz/Novartis||Tramadol Hydrochloride BP 100mg||Tablet (per rectal)||30's: MRP 450.00|
|DOLORAN SUPPOSITORY||Sandoz/Novartis||Tramadol hydrochloride 100mg||Suppository||10's: MRP 200.00|
|DOLOREX||Biopharma Laboratories Ltd||Tramadol hydrochloride 50mg & 100mg||Capsule||50mg x30's, 100mg x10's: 225.90 & 130.50 MRP|
|DOLOREX Injection||Biopharma Laboratories Ltd||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 100.40 MRP|
|DOLOTRAM||Sun Pharmaceutical (Bangladesh) Ltd.||Tramadol hydrochloride 50mg||Capsule||30's: 195.00 MRP|
|FUDOL||Pharmasia Limited||Tramadol hydrochloride 50mg||Capsule||30's: 225.90 MRP|
|IMADOL 50||Delta Pharma Limited||Tramadol hydrochloride 50mg||Capsule||30's: 225.00 MRP|
|KADOL||Kemiko Pharmaceuticals Ltd||Tramadol hydrochloride 50mg||Capsule||30's: 210.00 MRP|
|LUCIDOL||Beximco Pharmaceuticals Ltd||Tramadol Hydrochloride 50mg||Capsule||30's: 225.00 MRP|
|LUCIDOL INJECTION||Beximco Pharmaceuticals Ltd||Tramadol Hydrochloride 100mg/2ml Ampoule||Injection||5's: 100.00 MRP|
|LUCIDOL SUPPOSITORY||Beximco Pharmaceuticals Ltd||Tramadol Hydrochloride 100mg||Suppository||5's: 75.00 MRP|
|MURTRUM||Monico Pharma Limited||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 100.00 MRP|
|OPIDOL||Navana Pharmaceuticals Limited||Tramadol hydrochloride 50mg & 100mg||Capsule||50mg x30's, 100mg x20's: 180.60 & 200.80. MRP|
|PENDOL||Alco Pharma Ltd||Tramadol hydrochloride 50mg||Capsule||30's: 180.00 MRP|
|RAPIDOL||Renata Limited||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 125.00 MRP|
|SYNDOL||Healthcare Pharmacuticals Ltd.||Tramadol Hydrochloride 100mg/2ml||Injection||30's MRP 255 Tk|
|SYNDOL Injection||Healthcare Pharmacuticals Ltd.||Tramadol Hydrochloride BP 50 mg||Injection||5's: 125.00 MRP|
|TAMADOL||Mystic Pharmaceuticals Limited||Tramadol hydrochloride 50mg||Capsule||30's: 217.50 MRP|
|TENDIA||ACI Ltd.||Tramadol hydrochloride 50mg||Capsule||30's: 225.90 IP|
|TENDIA ER||ACI Ltd.||Tramadol hydrochloride 100mg||Capsule||30's: 421.50 MRP|
|TENDIA Injection||ACI Ltd.||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 100.35 IP|
|TRAMAL||Grunenthal/UniMed||Tramadol hydrochloride 100mg||Suppository||5's: 204.02 MRP|
|TRAMAL Rtd||Grunenthal/UniMed||Tramadol hydrochloride 100mg||Capsule||30's: 791.50 MRP|
|TRAMANIL||Ziska Pharmaceuticals Ltd.||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 100.00 MRP|
|TRANAL||Opsonin Pharma Limited||Tramadol hydrochloride 50mg||Capsule||20's: 150.00 MRP|
|TRANAL Injection||Opsonin Pharma Limited||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 100.00 MRP|
|TRANAL Suppository||Opsonin Pharma Limited||Tramadol hydrochloride 100mg||Suppository||10's: 150.00 MRP|
|TROL||Apex Pharmaceuticals Ltd.||Tramadol hydrochloride 50mg||Capsule||30's: 135.00 MRP|
|TRUMEN||General Pharmaceuticals Ltd||Tramadol hydrochloride 50mg||Capsule||40's: 301.20 MRP|
|ULTRADOL||Ad-din pharmaceuticals Ltd.||Tramadol hydrochloride 50mg||Capsule||30's: 225.00 MRP|
|UTRAMAL||Unimed & Unihealth Manufacturers Ltd.||Tramadol hydrochloride 50mg||Capsule||30's: 300.00 MRP|
|UTRAMAL Injection||Unimed & Unihealth Manufacturers Ltd.||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 225.00 MRP|
|UTRAMAL Rtd.||Unimed & Unihealth Manufacturers Ltd.||Tramadol hydrochloride 100mg||Capsule (extended release)||30's: 600.00 MRP|
|Winpain 1||Incepta Pharmaceuticals Limited||Tramadol Hydrochloride 50 mg/ml||Injection||1x5's:MRP 75 Tk|
|Winpain 2||Incepta Pharmaceuticals Limited||Tramadol Hydrochloride 100mg/2ml||Injection||1x5's:MRP 100 Tk|
|Winpain 50||Incepta Pharmaceuticals Limited||Tramadol Hydrochloride BP 50 mg||Capsule||40's:MRP 300 Tk|
|Winpain ER||Incepta Pharmaceuticals Limited||Tramadol Hydrochloride BP 100mg||Capsule||20's:MRP 280 Tk|
|XTRAPEL||Beacon Pharmaceuticals Limited||Tramadol hydrochloride 50mg & 100mg||Capsule||50ml: 90.00 MRP|
|XTRAPEL-100||Beacon Pharmaceuticals Limited||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 100.35 MRP|
|ZYDOL||Novo Healthcare and Pharma Ltd.||Tramadol hydrochloride 100mg/2ml||Injection||5 amps: 90.00 MRP|
|ZYDOL 50||Novo Healthcare and Pharma Ltd.||Tramadol hydrochloride 50mg||Capsule||30's: 225.00 MRP|
|ZYDOL SR||Novo Healthcare and Pharma Ltd.||Tramadol hydrochloride 100mg||Capsule (sustained release)||30's: 360.00 MRP|
|| See Brand Manufacturer's Prescribing Information |||| Latest mph edition: 04 December 2013 |||| Back to top ||