•Drug interactions: CNS depressants (additive effect); tramadol with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome possible).
•Low-dose codeine (+acetaminophen) is available without a prescription.
•Geriatric dosing: Renal dysfunction and dehydration increases risk of toxicity due to accumulation of metabolites (especially with morphine, meperidine – thus oxycodone, hydromorphone are better choices in elderly); start low and taper up slowly.
•Narcotic patches not recommended in elderly due to risk of respiratory depression.