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曲馬多

Tramadol

Tramadol hydrochloride

類鴉片 (mu-受體) 促效劑 / 鎮痛藥POIVEpiduralSC狗貓馬

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

由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本

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

劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。

各物種劑量

🌎 NA — North America🌍 EU — Europe

狗

適應症劑量途徑頻次療程地區
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.

貓

適應症劑量途徑頻次療程地區
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.

馬

適應症劑量途徑頻次療程地區
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.

劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。

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概覽

曲馬多是一種合成的中樞作用​類鴉片鎮痛藥​，主要用於控制輕至中度疼痛，偶爾也作為鎮咳藥使用。

​主要臨床重點：​

  • 作為弱的 ​mu-鴉片受體促效劑​，並能抑制​血清素​和​去甲腎上腺素​的再攝取。
  • 在慢性疼痛（如骨關節炎或癌症）的​多模式鎮痛方案​中非常有用（例如與 NSAIDs、加巴噴丁或金剛烷胺合併使用）。
  • 在慢性疼痛狀態下，可能需要長達​兩週​的時間才能達到完全的鎮痛效果。
  • ​臨床提示：​ 雖然藥典指出其在美國非管制藥物，但由於人類濫用的潛力，​美國 DEA 已於 2014 年將曲馬多重新分類為第四級管制物質 (Schedule IV)​。
  • 在狗中通常耐受性良好，最常見的副作用是鎮靜。貓可能會出現煩躁不安（dysphoria），且對此藥物的適口性極差。

作用機制

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.

安全性與警告

禁忌症

  • 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

不良反應

  • 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

注意事項

​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.

藥物相互作用

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

監測

  • 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

藥物動力學

半衰期

貓2.5 - 3.18 hours (parent); 4.5 - 4.8 hours (M1 metabolite)馬2-10 hours (adults); ~2 hours (foals); ~4 hours (M1 metabolite)狗1.7 hours (parent); ~2 hours (M1 metabolite)

吸收

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).

分佈

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

代謝

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.

排除

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

過量

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).

可用產品

劑型

  • 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

獸醫用

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

人用標示

  • 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

各地核准狀態

European Union✓ 已核准處方藥EMA
🐕 Dogs

Authorized veterinary chewable tablets available for dogs.

United Kingdom✓ 已核准處方藥 · Schedule 3 CDVMD
🐕 Dogs

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

暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

儲存與穩定性

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

飼主須知

寵物主人指引：

  • ​給藥方式：​ 可與食物一起給予或空腹給予。如果您的寵物在空腹服藥後嘔吐，請嘗試在未來的劑量中加入少量零食或隨餐給予。
  • ​味道：​ 此藥物味道非常苦。貓咪特別容易流口水或抗拒服藥。請勿壓碎或剝半緩釋錠。
  • ​行為改變：​ 可能會引起警覺性的改變。您的寵物可能會顯得異常嗜睡，或者相反地，變得焦慮、焦躁或愛叫（尤其是貓）。如果這些症狀很嚴重，請聯繫您的獸醫師。
  • ​需要耐心：​ 對於關節炎等慢性疾病，可能需要持續給藥長達兩週才能看到完全的止痛效果。
  • ​安全警告：​ 請放置於兒童和其他寵物接觸不到的地方。​絕對不要​給您的寵物服用含有曲馬多和乙醯胺酚（普拿疼成分，如 Ultracet）的人類藥物，因為乙醯胺酚對貓具有劇毒，通常會致命。

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