Tramapan Dosage/Direction for Use

The tablets should be taken orally, whole, not divided or chewed, with sufficient liquid, without regard to food. TRAMAPAN should under no circumstances be administered for longer than absolutely necessary. If long-term pain treatment with TRAMAPAN is necessary in view of the nature and severity of the illness, then careful and regular monitoring should be carried out (if necessary with breaks in treatment) to establish whether and to what extent further treatment is necessary.
Dosage - Adults and children 16 years of age and over: The maximum single dose of TRAMAPAN is 1 to 2 tablets every 4 to 6 hours as needed for pain relief up to a maximum of 8 tablets per day. The lowest effective dose should be used for the shortest period of time.
Treatment withdrawal: Do not stop use of TRAMAPAN abruptly. Withdrawal symptoms may be relieved by tapering the medication (see Treatment Withdrawal under Precautions).
Children below 16 years of age: The use of TRAMAPAN is contraindicated in children below 12 years of age (see Contraindications).
The safety and effectiveness of TRAMAPAN in children aged 12 to below 16 years of age has not been established (see Contraindications and Other risk factors for life-threatening respiratory depression in children under Precautions). Therefore, treatment is not recommended in this population.
Elderly (75 years of age and older): Elimination of the active components may be prolonged in elderly patients over 75 years of age. Therefore, if necessary the dosage interval may be extended according to the patients requirements.
Renal Insufficiency/Dialysis/Hepatic Insufficiency: The pharmacokinetics of the tramadol/paracetamol combination in patients with renal impairment has not been studied. Experience with tramadol suggests that impaired renal function results in a decreased rate and extent of excretion of tramadol. In patients with creatinine clearances of less than 30mL/min, it is recommended that the dosing interval of TRAMAPAN be increased not to exceed 2 tablets every 12 hours. The pharmacokinetics and tolerability of TRAMAPAN in patients with impaired hepatic function has not been studied. Tramadol and paracetamol are both extensively metabolized by the liver. The use of TRAMAPAN in patients with severe hepatic impairment is not recommended.