1.1.2. Dosing in Renal and Hepatic Impairment

In patients with a creatinine clearance less than 30 mL/min, the recommended dosing interval for tramadol IR is every 12 hours and the maximum recommended tramadol dose is 200 mg per day. In patients with cirrhosis, the recommended tramadol IR dose is 50 mg every 12 hours. Tramadol ER should not be given to patients with a creatinine clearance less than 30 mL/min or those with severe hepatic impairment. The tramadol/acetaminophen combination should be dosed as 2 tablets every 12 hours in patients with a creatinine clearance less than 30 mL/min and should not be used in patients with hepatic impairment^2-6,8.