March 2003

Tramadol

Metaclopramide

 

New Drugs London Ambulance service. Nubain to be discontinued when present stocks are depleted. Tramadol is to be the replacement

 

Tramadol

 

Therapeutic Effects

Is a synthetic opioid analgesic chemically similar to natural opiods.I acts upon the central nervous system by inhibiting the re-uptake of serotonin and noradranaline, which are released by the brain in response to painfil stimuli. It also binds to the CNS mu-opiod receptor sites and so may, in theory cause respiratory depression. The analgesic effects of tramadol wear off after approximately 4 hours.

Indications for use

Moderate to severe pain in adults and children over the age of 12 years.

Contraindications for use.

Head injury with decreased Glasgow Coma scale <13

Pregnancy and breast feeding

Childbirth or threatened misscarriage

patients on monoamine oxide inhibitors (MAOI's e.g Malpan, Nardil, Parnate, Parstelin ) or having taken them in the previous two weeks.

Cautions

Epileptic patients

patient who have taken alcohol

patients already receiving opiod drugs.

patients with undiagnosed abdominal pain.

Transient nausea may occour following administration. Therefore Metoclopromide 10mg IV must be given to patients over 20 Years of age Prior to the administration of tramadol. The cannula must be flushed with normal saline and a different syringe used to administer tramadol.

Side effects

Dizziness

Nausea

Headaches and drowsiness

Occasionally vomiting and agitation

convulsions may be caused by too rapid intravenous infusion, especially in epileptics. Each bolus should be given slowly over 2-3 minutes

Constipation

Presentation

Ampoule containing 100mg of tramadol in 2mls

Administration and dosage

Dilute the 2ml (100mg) ampoule with 8ml saline to make 10ml solution.

 

Initial dose of 50mg ( 5ml diluted saline) IV slowly over 2-3 minutes. A further 50mg dose may be given following reassesSment after 2-5 mins. Further boluses may be given after 15 mins. Maximum cumulative dose of 200mg (20mls dilued)

 

Metaclopramide

 

Therapeutic effects

metaclopramide is an anti-emetic whose action is closely associated with parasympathetic nervous control of the upper gastro-intestinal tract.

Indications for use.

Prevention of nausea and vomiting in adults over 20 years of age.

The treatment of severe nausea and vomiting in adults over 20 years.

Contraindications

Patients under 20 years

Avoid in first three months of pregnancy

renal failure

Previous diagnosis of renal gland tumor

Side effects

Sever extra pyramidal effect (tremor and rigidity of voluntary muscles. In extreme cases the patient may also be stiff in their walking, hand co-ordination, swallowing and speaking is impaired ), more commonly in children and young adults.

Drowsiness and restlessness.

Cardiac conduction abnormalities following IV administration.

Presentation

Ampoule containing 10mg of metoclopramide in 2mls

Administration and dosage.

10mg IV once only. given slowly over 2 mins

When administering prior to the use of tramadol, the cannula must be flushed with normal saline following administration and a different syringe used to administer tramadol.

 

Note. BP, pulse, resps, cardiac rhythm must be monitored during and after administration