Tramadol is a synthetic analgesic that relieves moderate to chronic pain. Tramadol is available in the market under the trade name Ultram or Ultram-ER. Although not classified as a narcotic, tramadol works similiarly to morphine. It relieves pain by acting on opiod receptors in the brain and disrupting the transition of pain. There have been reports of tramadol addiction and abuse. However, it is not classified as a controlled substance because of tramadol’s low addiction and abuse potential.
In the United States, Tramadol is a prescription drug that is taken orally. Tramadol tablets can either be immediate release or extended release. The maximum dose for Tramadol is 400 mg/day. For immediate release tablets, the recommended dose is 50 to 100 mg every 4 to 6 hours. For extended-release tablets, 100 mg/day s the recommended dose. Ultram extended release tablets should not be curshed or chewed, but swallowed hole. Oral doses of tramadol are well tolerated by the general population. However, there have been some questions regarding tramadol and pregnancy as well as tramadol and breastfeeding.
There have been several studies and clinical trials that investigated the relationship of tramadol and pregnancy. For instance, reproductive studies on male and female rats showed that oral tramadol has no effects on fertility. There were also a study that involved giving 120mg/kg of tramadol to mice, 25 mg/kg to rats, and 75 mg/kg to rabbits. While there were toxic effects to the embryos and fetuses at high doses (315 times the maximum human dose), there was no toxicity observed with lower doses. Extremely high tramadol doses resulted in decreased weight, skeletal calcification and increased supernumerary ribs among the fetuses of lab animals. Nonetheless, such theoretical high doses of 315 times the normal human dose are never given to humans in the clinical setting.
In discussing tramadol and pregnancy, it is important to know that tramadol can cross the placenta and reach the fetus. FDA has assigned tramadol to pregnancy category C. Under this category, tramadol can be taken by a pregnant women if its pain relief benefits outweight the risks. While there were reported toxic effects to animal fetuses, there have been no controlled data about tramadol and pregnancy among humans. Additionally, there has only been one reported case of a newborn experiencing withdrawal symptoms because of the mother’s long-term analgesic use. The withdrawal symptoms reported were high-pitched cry, trembling and short sleeping hours at 35 hours of age.
Women who breastfeed their babies may also want to know about the effects of tramadol to the child. Research reveals that about 0.1% of the total tramadol dose can be passed on to the milk. There is no evidence to suggest that such minute amounts of tramadol are capable of causing harmful effects to the baby. There are no known effects or cited incidents of a nursing infant experiencing any symptoms assocated with the mother’s tramadol use. Nonetheless, women who are currently pregnant, or with plans to be pregnant, should consult with a doctor regarding the safe use of tramadol during pregnancy and breastfeeding. Each woman’s health situation is different and talking with a health professional can enable the woman to make an informed choice.