Retram - Injection Tramadol Hydrochloride - 100mg/2ml 1 Injection(s) / Injection Rephco Pharmaceuticals Ltd. Introduction: Retram is a pain relieving medicine. It is used to manage persistent, moderate to severe chronic pain that requires continuous, around-the-clock treatment. Retram is generally administered by a healthcare professional. You should not self-administer this medicine at home. The dose and duration will depend on what you are taking it for and how well it helps your symptoms. The most common side effects of this medicine include injection site reactions (such as pain, redness, and swelling), headache, drowsiness, fatigue, vomiting, constipation, dry mouth, and sweating. If any of these side effects persist or get worse, you should let your doctor... Uses of Retram: Moderate to severe pain Side effects of Retram: DizzinessSleepinessVomitingNauseaConstipation How to use Retram: Your doctor or nurse will give you this medicine. Kindly do not self administer. How Retram works: Retram is an opioid analgesic (pain reliever) which works by blocking transmission of pain signals to the brain to lower pain perception. What if you forget to take Retram?: If you miss a dose of Retram, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose. Indication: Moderate to severe pain, Postoperative pain Administration: May be taken with or without food. Adult Dose: Oral Moderate to severe pain Adult: Immediate release Chronic pain: 25 mg PO every morning initially; increased by 25-50 mg/day every 3 days up to 50-100 mg PO q4-6hr PRN; not to exceed 400 mg/day Acute pain: 50-100 mg PO q4-6hr PRN; not to exceed 400 mg/day Extended release 100 mg PO once daily initially; increased by 100 mg/day every 5 days; not to exceed 300 mg/day Parenteral Moderate to severe pain Adult: IM/IV: 50-100 mg 4-6 hrly over 2-3 min. Postoperative pain Adult: Initially, 100 mg followed by 50 mg every 10-20 min if necessary, to a total of... Child Dose: Moderate-to-Severe Pain Immediate release 17 years (acute): 50-100 mg PO q4-6hr PRN; not to exceed 400 mg/day >17 years (chronic): 25 mg PO every morning initially; increased by 25-50 mg/day every 3 days as separate doses up to 50-100 mg PO q4-6hr PRN; not to exceed 400 mg/day Extended release <18 years: Safety and efficacy not established Renal Dose: Renal impairment: CrCl (ml/min) Dosage Recommendation 10-30 Increase dosing interval to 12 hrly. <10 Contraindicated. Contraindication: Suicidal patients, acute alcoholism; head injuries; raised intracranial pressure; severe renal impairment; lactation. Mode of Action: Tramadol inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to mu-opiate receptors in the CNS. Precaution: Patients who suffer from emotional disturbance or depression, history of epilepsy or risk of seizure, head injury, increased intracranial pressure. Renal and hepatic impairment. Elderly. Pregnancy and lactation. Patient Counselling May impair ability to drive or operate machinery. Monitoring Parameters Monitor pain relief, resp rate, BP, pulse rate; signs of tolerance, abuse, or suicidal ideation. Lactation: Drug excreted at high concentration in breast milk; not recommended Side Effect: >10% Constipation (24-46%),Nausea (24-40%),Dizziness (10-33%),Vertigo (26-33%),Headache (18-32%),Somnolence (7-25%),Vomiting (9-17%),Agitation (7-14%),Anxiety (7-14%),Emotional lability (7-14%),Euphoria (7-14%),Hallucinations (7-14%),Nervousness (7-14%),Spasticity (7-14%),Dyspepsia (5-13%),Asthenia (6-12%),Pruritus (8-11%) 1-10% Diarrhea (5-10%),Dry mouth (5-10%),Sweating (6-9%),Hypertonia (1-5%),Malaise (1-5%),Menopausal symptoms (1-5%),Rash (1-5%),Urinary frequency (1-5%),Urinary retention (1-5%),Vasodilation (1-5%),Visual disturbance (1-5%) <1% Abnormal gait,Amnesia,Cognitive dysfunction,Depression,Difficulty in concentration,Dysphoria,Dysuria,Fatigue,Hallucinations,Menstrual disorder,Motor system weakness,Orthostatic hypotension,Paresthesia,Seizures,Suicidal tendencies,Syncope,Tachycardia,Tremor Frequency Not Defined Abnormal electrocardiogram (ECG),Angioedema,Bronchospasm,Flushing,Hypertension,Hypotension,Myocardial ischemia,Palpitation,Urticaria,Withdrawal syndrome Potentially Fatal: Respiratory depression. Interaction: Increased risk of convulsions or serotonin syndrome w/ SSRI, serotonin-norepinephrine reuptake inhibitors (SNRI), TCA and other seizure threshold lowering drugs (e.g. bupropion, mirtazapine, tetrahydrocannabinol). Decreased serum concentrations w/ carbamazepine. May potentiate the anti-depressant effect of norepinephrine, 5-HT agonists or lithium. Increased INR and ecchymoses w/ coumarin derivatives (e.g. warfarin). Potentially Fatal: Increased risk of seizure and serotonin syndrome w/ MAOIs.