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Prescribing tramadol to minimise adverse effects. The usual dose of tramadol is 50–100 mg per dose, with a maximum daily dose of 400 mg, and at least four hours between doses.5 Older patients are most at risk of developing tramadol-related adverse effects, in which case the maximum daily dose should be reduced to 300 mg.5 In patients with hepatic or renal dysfunction, who may have reduced elimination of tramadol, a low starting dose of immediate-release tramadol, e.g. 50 mg, with titration to effect and 12-hour dosing is appropriate;3,4 modified-release tramadol should be avoided in these patients.5 Tramadol should be avoided in patients with severe renal dysfunction, i.e. a creatinine clearance < 10 mL/minute. If patients experience nausea with the use of tramadol, consider lowering the dose and concurrently using paracetamol (see below) or switch the patient to codeine, dihydrocodeine or a NSAID. Modified-release tramadol may be associated with fewer adverse effects in some patients.
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Most children in our survey who were taking medication for ADHD had tried methylphenidate (84 percent) or an amphetamine (51 percent) in the past three years. A smaller percentage (17 percent) had tried a nonstimulant medication. There were no differences in the type of medication children were prescribed either by age or length of time since they had been diagnosed. Most children taking these medications had been taking them for longer than two years (35 percent overall), while 22 percent had been taking them for one to two years. Our survey found there were no major differences in effectiveness between amphetamines and methylphenidates. But there were more reports of “irritability and anger” and “high mood/energy (manic behavior)” among children who used amphetamines.
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If you experience mild to moderate pain, try to rest and take things easy while your chosen pain killer gets to work. Take your mind off things by reading, watching television, listening to music. Write down how you feel – researchers have found that writing about negative experiences seems to reduce pain perception. Rubbing the area or applying hot or cold packs can reduce pain by stimulating other nerve endings that block transmission of pain messages. Like all drugs, painkillers can have side effects. If you are not sure which analgesic is most likely to suit you, always seek advice from a pharmacist or doctor. Always read the information provided with your painkillers and never exceed the stated dose. If pain persists, or becomes worse, always seek medical advice – both to find out the cause, and to see if you need a stronger prescription-only treatment.
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