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Misuse and dependence are possible with tramadol. Tramadol is not suitable for drug substitution.
If the recommended parenteral dose is exceeded, as occasionally occurs particularly during general anesthesia, respiratory depression should be expected. Similarly if the recommended dosage is exceeded, or other central nervous depressant drugs are simultaneously used, respiratory suppression should be allowed for. The duration of action is prolonged in patients with disorders of hepatic or renal function. The dosage interval should therefore be prolonged in such cases, if necessary allowing for recurrence of pain.
Intravenous injections should be given slowly.
Caution should be taken in patients with hypersensitivity to morphine-like analgesic, patients with head injury and history of seizures. In patients with myxedema, hypothyroidism or hypoadrenalism, dose reduction may be required.
Effects on drivers and operators of machinery: Even when tramadol is used appropriately, the capacity to drive in traffic or operate machinery may be abolished.
