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What is Tramadol? Tramadol is analgetic for pain relief from your body. 
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Pain syndrome of medium and high intensity of various etiologies (for example, pain in cancer patients, with injuries and in the postoperative period).
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hypersensitivity to tramadol or any of the components of the drug;
acute intoxication with alcohol, analgesics, sleeping pills, opioids or other psychotropic drugs;
the simultaneous use of tramadol with monoamine oxidase inhibitors (MAO), as well as within 14 days after the end of their intake;
epilepsy not amenable to adequate drug control;
the use of tramadol as a drug for the treatment of drug withdrawal syndrome;
reception during pregnancy. During breastfeeding, the drug can be prescribed only for health reasons. In the case of a single dose, there is no need to interrupt breastfeeding;
taking the drug for children under 14 years of age;
lactase deficiency, lactose intolerance, glucose-galactose malabsorption (the drug contains lactose).
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Tramadol should be used with caution:
in patients with opioid dependence;
with traumatic brain injury, in patients in a state of shock, in patients with impaired consciousness of unknown origin, in patients with respiratory disorders and impaired respiratory center activity, with increased intracranial pressure;
the drug should be used with caution in patients with established severe intolerance to opioids of allergic and non-allergic genesis;
in case of epilepsy, amenable to adequate medication control, or in patients prone to seizures, tramadol can be used only for health reasons (see "Special Instructions");
in patients with a tendency to drug abuse or drug addiction, treatment with tramadol should be carried out in short courses and under medical supervision (see. "Special instructions").
with simultaneous use with sedatives, such as benzodiazepines or drugs with a similar effect;
in patients with high metabolic activity of the isoenzyme CYP2D6;
in pediatric patients.
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After oral administration, it is rapidly and almost completely absorbed (about 90%). The average absolute bioavailability is about 70% regardless of food intake. A decrease in bioavailability of up to 70% is due to the effect of the "first passage" through the liver. Compared with other opioid analgesics, the absolute bioavailability of the drug The maximum concentration of tramadol in blood plasma is determined 2 hours after ingestion. Object of distribution - 209 liters. Binding to plasma proteins is about 20%. Penetrates through the blood-brain and placental barriers. Minor amounts of tramadol and its demethylated derivative (0.1% and 0.02%, respectively) are excreted in breast milk.
CYP3A4 and CYP2D6 isoenzymes take part in the metabolism of tramadol; suppression of these isoenzymes by other substances can affect the concentration of tramadol and its active metabolite in the blood. To date, clinically significant interactions with other drugs mediated by this mechanism have not been identified.
Tramadol and its metabolites are excreted mainly in urine, the average cumulative indicator of renal excretion is 90%.
The half-life of tramadol (T½) is approximately 6 hours, regardless of the route of administration. In patients older than 75 years, the half-life can be increased by 1.4 times; with cirrhosis of the liver up to 13.3 ± 4.9 hours (tramadol), 18.5 ± 9.4 hours (O-demethyltramadol), in severe cases -22.3 hours and 36 hours, respectively. T½ in renal failure (creatinine clearance less than 5 ml / min) - 11 ± 3.2 hours (tramadol), 16.9 ± 3 hours (O-demethyltramadol), in severe cases - 19.5 hours and 43.2 hours, respectively . It is metabolized in the liver by N- and O-demethylation, followed by conjugation with glucuronic acid. Only O-demethyltramadol has pharmacological activity. There are significant individual differences in the concentration of other metabolites. In urine, 11 metabolites of tramadol were detected. In therapeutic doses, tramadol has a linear pharmacokinetic profile. The ratio of the concentration of tramadol in the blood serum and the analgesic effect is dose-dependent, varying among individuals. A serum tramadol concentration of 100-300 ng / ml is usually effective.
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It was found that the pharmacokinetics of tramadol and O-demethyltramadol after single and multiple oral administration in patients aged 1 to 16 years was generally similar to that in adults when adjusting the dose based on body weight, but has a higher interindividual variability in children under 8 years. The pharmacokinetics of tramadol and O-demethyltramadol in children under 1 year of age has been studied, but not fully characterized. Research data obtained with the participation of the indicated age group show that the rate of formation of O-demethyltramadol via the CYP2D6 isoenzyme gradually increases in newborns, and presumably reaches adult levels of CYP2D6 isoenzyme activity by 1 year. In addition, the immaturity of glucuronidation systems and renal function can slow the elimination and accumulation of O-demethyltramadol in children under 1 year of age.
In clinical studies involving more than 2,000 children in the age group from newborns to 17 years, the effects of enteral and parenteral administration of tramadol were studied. Indications for the treatment of pain studied in these studies included pain after surgery (mainly abdominal), after surgical extraction of teeth due to fractures, burns and injuries, as well as other conditions accompanied by pain requiring pain therapy for at least 7 days.
After a single dose of up to 2 mg / kg or multiple doses of up to 8 mg / kg per day (maximum 400 mg per day), it was found that the effectiveness of tramadol exceeds that of placebo and is greater than or equal to that of paracetamol, nalbuphine, pethidine or low doses of morphine. The studies have confirmed the effectiveness of tramadol. The safety profile of tramadol was similar in adult patients and children older than 1 year.
Tramadol is an opioid synthetic analgesic with a central mechanism of action. It is a non-selective complete agonist of µ-, δ- and k-opioid receptors, with great affinity for µ-opioid receptors. The second mechanism of action of tramadol, enhancing its analgesic effect, is the suppression of reuptake of norepinephrine by neurons and increased release of serotonin.
Tramadol also has an antitussive effect. Unlike morphine, in therapeutic doses it does not depress respiration and to a lesser extent affects intestinal motility. The effect on the cardiovascular system is poorly expressed. The analgesic potential of tramadol is 1/10 - 1/6 of the activity of morphine.
Description: tablets from white to white with a yellowish tint, flat-cylindrical, with a bevel. On the surface of the tablets marbling is allowed.
Composition: each tablet contains:: How can i buy tramadol online cheap overnight shipping by Express and EMS cod no rx needed.
active substance - tramadol hydrochloride (in terms of 100% substance) - 50 mg;
excipients - lactose monohydrate, povidone K-25, calcium stearate, microcrystalline cellulose.
Dosage form: tablets
Pharmacotherapeutic group: analgesics, other opioids.