|Rapid intravenous administration may be associated with a higher incidence of adverse effects and therefore should be avoided.The most commonly reported adverse reactions are nausea and dizziness, both occurring in more than 10 % of patients.The frequencies are defined as follows:Very common: ≥1/10Common: ≥1/100, <1/10Uncommon: ≥1/1000, <1/100Rare: ≥1/10 000, <1/1000Very rare: <1/10 000Not known: cannot be estimated from the available data|
Cardiac disorders:Uncommon: cardiovascular regulation (palpitation, tachycardia). These adverse reactions may occur especially on intravenous administration and in patients who are physically stressed.Rare: bradycardia
Investigations:Rare: increase in blood pressure
Vascular disorders:Uncommon: cardiovascular regulation (postural hypotension or cardiovascular collapse). These adverse reactions may occur especially on intravenous administration and in patients who are physically stressed.
Metabolism and nutrition disorders:Rare: changes in appetite
Respiratory, thoracic and mediastinal disorders:Rare: respiratory depression, dyspnoeaIf the recommended doses are considerably exceeded and other centrally depressant substances are administered concomitantly (see section 4.5), respiratory depression may occur.Worsening of asthma has been reported, though a causal relationship has not been established.
Nervous system disorders:Very common: dizzinessCommon: headache, somnolenceRare: paraesthesia, tremor, epileptiform convulsions, involuntary muscle contractions, abnormal coordination, syncope, speech disorders.Convulsions occurred mainly after administration of high doses of tramadol or after concomitant treatment with medicinal products which can lower the seizure threshold (see sections 4.4 and 4.5).
Psychiatric disorders:Rare: hallucinations, confusion, sleep disturbance, delirium, anxiety and nightmares. Psychic adverse reactions may occur following administration of tramadol, which vary individually in intensity and nature (depending on personality and duration of treatment). These include changes in mood (usually elation, occasionally dysphoria), changes in activity (usually suppression, occasionally increase) and changes in cognitive and sensorial capacity (e.g. decision behaviour, perception disorders). Drug dependence may occur. Symptoms of drug withdrawal syndrome, similar to those occurring during opiate withdrawal, may occur as follows: agitation, anxiety, nervousness, insomnia, hyperkinesia, tremor and gastrointestinal symptoms. Other symptoms that have very rarely been seen with tramadol discontinuation include: panic attacks, severe anxiety, hallucinations, paraesthesias, tinnitus and unusual CNS symptoms (i.e. confusion, delusions, depersonalisation, derealisation, paranoia)
Eye disorders:Rare: miosis, mydriasis, blurred vision
Gastrointestinal disorders: Very common: nauseaCommon: constipation, dry mouth, vomitingUncommon: retching, gastrointestinal discomfort (a feeling of pressure in the stomach, bloating), diarrhoea
Skin and subcutaneous tissue disorders:Common: hyperhidrosisUncommon: dermal reactions (e.g. pruritus, rash, urticaria)
Musculoskeletal and connective tissue disorders:Rare: motorial weaknessHepatobiliary disorders:In a few isolated cases an increase in liver enzyme values has been reported in a temporal connection with the therapeutic use of tramadol.
Renal and urinary disorders:Rare: micturition disorders (dysuria and urinary retention)
Immune system disorders:Rare: allergic reactions (e.g. dyspnoea, bronchospasm, wheezing, angioneurotic oedema) and anaphylaxis
Metabolism and nutrition disorders:Not known: hypoglycaemia
General disorders and administration site conditions: Common: fatigue
Reporting of suspected adverse reactionsReporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; e-mail: firstname.lastname@example.org