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Tramadol should be used with caution in patients with renal or liver impairment and should be avoided if renal impairment is severe. Removal by haemodialysis is reported to be very slow.
Tramadol should be used with care in patients with a history of epilepsy or those susceptible to seizures.
Anesthesia: Do not take tramadol during light planes of general anesthesia because of possible intra-operative awareness, although it may be used intra-operatively provided anesthesia is maintained by the continuous administration of a potent volatile or intravenous anesthetic.
Dependence and withdrawal: Tramadol may have lower potential for producing dependence than morphine.
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