Posology : מינונים

4.2 Posology and method of administration

The dose should be adjusted to the intensity of the pain and the sensitivity of the individual patient. The lowest effective dose for analgesia should generally be selected.
Unless otherwise prescribed, Tramadex drops should be administered as follows: 
Adults and adolescents above the age of 14 years:
50 to 100 mg tramadol hydrochloride (20 to 40 drops), 4-6 hourly.
The lowest analgesically effective dose should generally be selected.
Daily doses of 400 mg active substance should not be exceeded, except in special clinical circumstances.

Elderly patients:
A dose adjustment is not usually necessary in elderly patients (up to 75 years) without clinically manifest hepatic or renal insufficiency. In elderly patients (over 75 years) the elimination may be prolonged. Therefore, if necessary, the dosage interval is to be extended according to the patients requirements.

Patients with renal insufficiency/dialysis and hepatic insufficiency: In patients with renal and/or hepatic insufficiency the elimination of tramadol is delayed. In these patients the prolongation of the dosage interval should be carefully considered according to the patients requirements.
In cases of severe renal and/or severe hepatic insufficiency Tramadex drops are not recommended.

Children:
Tramadex drops are not suitable for children below the age of 14 years.

Method of administration
Drops are to be taken with a little liquid or dripped on some sugar, independent of meals.
Duration of administration
Tramadol should under no circumstances be administered for longer than absolutely necessary. If long-term pain treatment with tramadol 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.