PijnvizierPain relief in dental care
EN
OpioidsLimited role

Tramadol

In case of severe acute pain after re-evaluation.

Prescription options

Limited role

If severe pain is not responding adequately, reassess the cause first. The Farmacotherapeutisch Kompas lists short-term tramadol as an option in general pain management. After a simple extraction, the ADA recommends no opioid.

Counselling and when to stop

Agree when to stop in advance and discuss driving, drowsiness and dependence.

Contraindications and interactions

Do not use in poorly controlled epilepsy, during treatment with MAO inhibitors or within two weeks of stopping them.

Check for serotonergic agents, agents that lower the seizure threshold, benzodiazepines, other opioids and alcohol. Renal or hepatic impairment and older age may require a different interval or agent.

Prescription options

Draft for your prescribing system. Check patient details, contraindications and medication safety before prescribing.

Tramadol with paracetamol

An option in exceptional cases of severe acute pain after re-evaluation, if non-opioid treatment is insufficient. This initial example applies to adults without frailty who weigh more than 55 kg and have no renal or hepatic impairment or risk factors for hepatotoxicity. The ADA advises against opioids after simple extraction.

Checks before prescribing

Check contraindications and interactions, with emphasis on the risk of sedation and respiratory depression with sedating medicines. Use two separate medicines, include all paracetamol in the total, and discuss when to stop and whether it is safe to drive.

  • R/ Paracetamol 500 mg tablet

    Per dose
    1,000 mg by mouth (2 tablets)
    Frequency and interval in this example
    If necessary up to 3 times a day, approximately 8 hours between intakes
    Maximum per 24 hours
    3,000 mg (6 tablets)
    Quantity in this draft
    Maximum 12 tablets

  • R/ Tramadol hydrochloride 50 mg immediate-release capsule

    Per dose
    50 mg by mouth (1 capsule)
    Frequency and interval in this example
    NHG starting option: as needed 1 to 2 times daily, about 12 hours apart in this example
    CBG RVG 18941, SmPC §4.2: Standard every 4 to 6 hours.
    Maximum per 24 hours
    100 mg (2 capsules) in this starting example
    Quantity in this draft
    Maximum 4 capsules

Duration in this example: 2 days. Stop earlier if the medicine is no longer needed. Reassess if pain relief is inadequate or pain worsens.

Sources for this topic

Reference for dentists on acute dental pain and pain after treatment.