Appropriate tramadol dosing by patient factors.
Immediate release: 50–100 mg every 4–6 hours. Max 400 mg/day. Elderly (>75): max 300 mg/day. CrCl < 30: 50 mg q12h, max 200 mg/day. Start low (25 mg) and titrate. Tramadol has both opioid and SNRI effects. Risk of seizures and serotonin syndrome with SSRIs. Schedule IV controlled substance.