VetSheet

트라마돌

Tramadol

Tramadol hydrochloride

오피오이드 유사 (뮤-수용체) 작용제 / 진통제POIVEpiduralSC개고양이말

다른 이름: Ultram ER · Ryzolt · Rybix ODT · Ultracet · Tralieve · Tramadol ER · Zamadol · CG-315E · tramadoli hydrochloridum · U-26225A · Tramadol hydrochloride

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

5 mg/kg PO q6-8h and up to 10 mg/kg PO q6-8hPO· q6-8h
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
General/Non-responsive pain5 mg/kg PO q6-8h and up to 10 mg/kg PO q6-8hPOq6-8h—🌎 NA
Analgesic2-5 mg/kg four times dailyPOq6h—🌎 NA
Chronic pain2-5 mg/kg PO 2-3 times a dayPOq8-12h—🌎 NA
Mild acute and chronic soft tissue and musculoskeletal pain2-5 mg/kgPOq8h—🌍 EU
Perioperative acute pain2 mg/kgIVsingle dose or as needed—🌍 EU
  • General/Non-responsive pain: Maximum analgesic effects may not occur immediately and may be delayed up to 14 days for chronic pain conditions.
  • Analgesic: Suggested starting dose.
  • Chronic pain: Reasonable for mild pain; adjust for severe pain. Best used as multimodal therapy with NSAIDs or other analgesics due to erratic pharmacokinetics.
  • Mild acute and chronic soft tissue and musculoskeletal pain: Chewable tablets are authorized for this use. Sustained-release tablets are unsuitable for once-daily dosing.
  • Perioperative acute pain: Used instead of traditional opioids to provide analgesia for acute pain.

고양이

적응증용량경로빈도기간지역
Starting dose2 mg/kg twice dailyPOq12h—🌎 NA
Current dosing recommendations1-2 mg/kg PO q12hPOq12h—🌎 NA
Chronic pain1-4 mg/kg PO 2-3 times a dayPOq8-12h—🌎 NA
Analgesia2-4 mg/kgPOq8h—🌍 EU
Analgesia1-2 mg/kgIVas needed—🌍 EU
Analgesia1-2 mg/kgSCas needed—🌍 EU
  • Starting dose: Based upon the pharmacokinetics of tramadol and ODT in cats.
  • Current dosing recommendations: Maximum analgesic effects may be delayed up to 14 days for chronic pain.
  • Chronic pain: Reasonable for mild pain; dose and interval may need adjustment for more severe pain.
  • Analgesia: Oral preparations are highly unpalatable to cats. Watch for dysphoria.

말

적응증용량경로빈도기간지역
Chronic laminitis pain5 mg/kg PO twice daily for seven days, alone or with ketamine at 0.6 mg/kg/hr IV during six hours each day for the first 3 days of treatmentPO/IVq12h7 days🌎 NA
  • Chronic laminitis pain: Pain relief was enhanced.

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

트라마돌은 주로 경도에서 중등도의 통증 관리에 사용되며 때로는 진해제로도 사용되는 합성 중추 작용 ​오피오이드 유사 진통제​입니다.

​주요 임상 요점:​

  • 약한 ​뮤-오피오이드 수용체 작용제​로 작용하며 ​세로토닌​과 ​노르에피네프린​의 재흡수를 억제합니다.
  • 골관절염이나 암과 같은 만성 통증 상태를 위한 ​다중 모드 진통 프로토콜​(예: NSAID, 가바펜틴 또는 아만타딘과 병용)의 일부로 매우 유용합니다.
  • 만성 통증 상태에서 완전한 진통 효과에 도달하는 데 최대 ​2주​가 걸릴 수 있습니다.
  • ​임상 팁:​ 모노그래프에는 미국에서 통제 약물이 아니라고 명시되어 있지만, 인간의 남용 가능성 때문에 ​미국 DEA는 2014년에 트라마돌을 스케줄 IV 통제 물질로 재분류했습니다​.
  • 개에서는 일반적으로 내약성이 좋으며 진정이 가장 흔한 부작용입니다. 고양이는 불쾌감(dysphoria)을 경험할 수 있으며 약물의 기호성이 매우 떨어집니다.

작용 기전

Tramadol provides analgesia through a dual mechanism of action:

  1. ​Opioid Activity:​ Tramadol and its active metabolite ​O-desmethyltramadol (M1)​ bind to mu-opioid receptors in the central nervous system.
  2. ​Monoaminergic Activity:​ It inhibits the synaptic reuptake of ​serotonin (5-HT)​ and ​norepinephrine (NE)​ → enhancing descending inhibitory pathways of pain transmission in the spinal cord.

​Pharmacologic Pearl:​ The M1 metabolite is 6 times more potent as an analgesic and has 20 times greater affinity for mu-receptors than the parent drug. Dogs produce very little of the M1 metabolite compared to cats and humans, which explains why tramadol's opioid-mediated efficacy in dogs is often erratic and heavily reliant on its serotonin/norepinephrine reuptake inhibition. Naloxone only partially antagonizes tramadol's analgesic effects.

안전성·주의사항

금기사항

  • Hypersensitivity to tramadol or other opioids
  • Combination products containing acetaminophen (e.g., Ultracet) are STRICTLY CONTRAINDICATED in cats
  • Concurrent use with MAOIs (e.g., selegiline, amitraz) due to risk of serotonin syndrome
  • Patients with a history of epilepsy or seizure disorders

부작용

  • Dogs: Excessive sedation, agitation, anxiety, tremor, dizziness
  • Dogs: Inappetence, vomiting, constipation, diarrhea
  • Cats: Dysphoria, mydriasis, dose avoidance (unpalatability)
  • Humans: Pruritus (approx. 10%)
  • Injectable form: Respiratory and cardiac depression
  • Sedation (especially at high doses in dogs)
  • Dysphoria (more likely in cats)
  • Nausea
  • Behavioral changes
  • Increased risk of seizures

주의

​Important Warnings:​

  • ​Seizure Risk:​ Use with caution in animals with preexisting seizure disorders or those receiving drugs that lower the seizure threshold. Tramadol has caused seizures in humans.
  • ​CNS/Respiratory Depression:​ Use cautiously with other CNS or respiratory depressants.
  • ​Geriatric/Debilitated Patients:​ Use with caution; dosage adjustments may be needed for patients with impaired renal or hepatic function.
  • ​Dependence & Withdrawal:​ Physical dependence can occur; withdraw gradually after chronic use.
  • ​Formulation Warning:​ Extended-release tablets must not be broken, crushed, or chewed, as this can lead to rapid absorption and toxicity. Dogs do not absorb ER tablets well.

약물 상호작용

Digoxin

Rarely linked to digoxin toxicity in humans.

MAO Inhibitors (amitraz, selegiline)

Potential for fatal serotonin syndrome; concurrent use should be avoided.

Ondansetron

May reduce the effectiveness of both drugs.

Quinidine

May increase tramadol concentrations and decrease M1 (active metabolite) concentrations.

SAMe (S-adenosylmethionine)

Theoretically could cause additive serotonergic effects.

Sevoflurane

Pretreatment with tramadol reduced MAC values by approximately 30% in dogs and 40% in cats.

SSRI Antidepressants (fluoxetine, sertraline, paroxetine)

Can inhibit the metabolism of tramadol to its active metabolites, decreasing efficacy and increasing the risk of toxicity (serotonin syndrome, seizures).

Tricyclic Antidepressants (clomipramine, amitriptyline)

Increased risk for seizures; amitriptyline may inhibit tramadol metabolism.

Warfarin

Increased PT and INR reported in humans (relatively rare).

AmitriptylineMajor

Increased risk of serotonin syndrome

SelegilineMajor

Increased risk of serotonin syndrome

SSRIs (e.g., Fluoxetine)Major

Increased risk of serotonin syndrome

FentanylMajor

Increased risk of serotonin syndrome

PethidineMajor

Increased risk of serotonin syndrome

BuprenorphineMajor

Increased risk of serotonin syndrome

NSAIDs

Safe and synergistic multimodal analgesia

Gabapentin

Safe and synergistic multimodal analgesia

Amantadine

Safe and synergistic multimodal analgesia

모니터링

  • Clinical efficacy (pain scoring, mobility, comfort levels)
  • Adverse effects (excessive sedation, GI upset, dysphoria, agitation)
  • Pain scores to assess efficacy
  • Signs of sedation or dysphoria
  • Signs of serotonin syndrome (hyperthermia, hypertension, agitation, tremors)
  • Seizure activity in susceptible individuals

약동학

반감기

고양이2.5 - 3.18 hours (parent); 4.5 - 4.8 hours (M1 metabolite)말2-10 hours (adults); ~2 hours (foals); ~4 hours (M1 metabolite)개1.7 hours (parent); ~2 hours (M1 metabolite)

흡수

Dogs: PO bioavailability ~65% (significant interpatient variability); Rectal ~10%. Cats: PO bioavailability ~60% (high interpatient variability). Horses: PO bioavailability ~14% (adults), 53% (neonatal foals), 20% (weaned foals).

분포

Dogs: Vd ~3.8 L/kg. Cats: Vd ~2 L/kg.

대사

Extensively metabolized via several hepatic pathways. The active metabolite O-desmethyltramadol (M1) has potent agonist activity but is a minor metabolite in dogs. Cats produce more of the M1 metabolite.

배설

Dogs: Total body clearance ~55 mL/kg/min. Cats: Clearance ~12 mL/min/kg.

과다투여

Acute oral overdoses may cause either CNS depressive signs or serotonin syndrome.

  • ​Clinical Signs:​ Lethargy, mydriasis, ataxia, and vomiting are most common. Stimulatory signs such as tachycardia, tremors, vocalization, agitation, and seizures may also occur. Cats frequently show mydriasis, hypersalivation, and tachycardia.
  • ​Treatment:​ Primarily supportive (maintaining respiration, treating seizures with benzodiazepines or barbiturates).

  • ​Important:​ Naloxone may NOT be useful in tramadol overdoses. It only partially reverses effects and may actually increase the risk of seizures. Cyproheptadine and phenothiazines can be used to treat stimulatory signs (serotonin syndrome).

제품

제형

  • Oral tablets (immediate release)
  • Extended-release tablets
  • Oral disintegrating tablets
  • Injection (available commercially outside the USA)
  • 50 mg tablets
  • 100 mg, 200 mg, 300 mg immediate-release tablets
  • 20 mg, 80 mg chewable tablets (veterinary)
  • 10 mg, 25 mg tablets
  • Sustained-release tablets (various sizes)
  • 5 mg/ml oral liquid
  • 50 mg/ml injectable solution

동물용의약품

  • None commercially available in the USA.
  • Tralieve 20 mg, 80 mg chewable tablets
  • Zamadol

인용의약품

  • Tramadol HCl Oral Tablets (film-coated) 50 mg (Ultram, generic)
  • Tramadol HCl Extended-Release Tablets 100 mg, 200 mg, 300 mg (Ultram ER, Ryzolt, generic)
  • Tramadol HCl Oral Disintegrating Tablets 50 mg (Rybix ODT)
  • Tramadol HCl 37.5 mg / Acetaminophen 325 mg tablets (Ultracet) - WARNING: DO NOT USE IN CATS
  • Tramadol ER
  • 50 mg immediate-release tablets

규제 현황

European Union✓ 승인됨처방전의약품EMA
🐕 Dogs

Authorized veterinary chewable tablets available for dogs.

United Kingdom✓ 승인됨처방전의약품 · Schedule 3 CDVMD
🐕 Dogs

POM-V, POM CD Schedule 3. Subject to safe custody requirements.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Store tablets at room temperature 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Dispense in tight, light-resistant containers.

보호자 정보

반려동물 보호자를 위한 안내:

  • ​투여 방법:​ 음식과 함께 또는 빈속에 투여할 수 있습니다. 반려동물이 빈속에 약을 먹고 토하는 경우, 다음부터는 소량의 간식이나 식사와 함께 투여해 보십시오.
  • ​맛:​ 이 약은 매우 쓴맛이 납니다. 특히 고양이는 침을 많이 흘리거나 약 먹기를 거부할 수 있습니다. 서방형 정제를 부수거나 쪼개지 마십시오.
  • ​행동 변화:​ 각성 상태에 변화를 일으킬 수 있습니다. 반려동물이 평소보다 졸려 하거나, 반대로 불안해하거나, 안절부절못하거나, 소리를 많이 낼 수 있습니다(특히 고양이). 이러한 증상이 심하면 수의사에게 연락하십시오.
  • ​인내심이 필요합니다:​ 관절염과 같은 만성 질환의 경우, 완전한 진통 효과를 보려면 최대 2주 동안 꾸준히 투여해야 할 수 있습니다.
  • ​안전 경고:​ 어린이와 다른 반려동물의 손이 닿지 않는 곳에 보관하십시오. 아세트아미노펜(타이레놀 성분)은 고양이에게 매우 독성이 강하고 치명적일 수 있으므로, 트라마돌과 아세트아미노펜이 혼합된 인체용 약물(예: 울트라셋)을 반려동물에게 ​절대​ 주지 마십시오.

VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.