Positive evidence of fetus risks but benefits may outweigh risks in some cases
How it works
Mechanism information is still being processed. Check the DailyMed link in the sidebar for the official prescribing information.
Dosing & administration
Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
Renal impairment
Consult protocols for adjustment.
Liver impairment
Consult protocols for adjustment.
Use during pregnancy
1st trimester
Avoid. Use acetaminophen.
2nd trimester
Avoid.
3rd trimester
Avoid. Risk of neonatal opioid withdrawal and neonatal seizures.
Clinical note
Avoid in pregnancy. Tramadol is a synthetic opioid and norepinephrine-serotonin reuptake inhibitor. Associated with Neonatal Opioid Withdrawal Syndrome (NOWS) and neonatal seizures when used near delivery. Contraindicated during breastfeeding (FDA 2017, same warning as codeine). No established teratogenicity at therapeutic doses but risk-benefit strongly favors alternatives.
Breastfeeding
Contraindicated during breastfeeding. FDA 2017 contraindication applies.
