additional information

Common uses

Directions

Individual dosing requirements vary considerably based on each patient's age, weight, severity and cause of pain, and medical and analgesic history. Following successful relief of pain, periodic attempts to reduce the opioid dose should be made.

Normal adult dose varies between 25 to 50 mg, once a day or up to every 4 to 6 hours, never to exceed 400 mg./day.

For rapid onset of analgesic effect and when the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, tramadol can be administered as needed for pain relief every four to six hours, not to exceed 400 mg per day. The dose should be individualized according to individual needs using the lowest beneficial dose.

For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect, the tolerability of tramadol can be improved by initiating therapy at 25 mg/day and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day. Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day. After titration, tramadol can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.

The recommended dose for adult patients with cirrhosis is 50 mg every 12 hours. In general, dose selection for an elderly patient over 65 years old should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy. For elderly patients over 75 years old, total dose should not exceed 300 mg/day.

If you miss a dose, take it as soon as remembered if it is within an hour or so. If you do not remember until later, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

Precautions

Talk with your doctor if you may be pregnant, or are trying to become pregnant, before using tramadol or any other medicine.

Tramadol may be a good choice for people who need effective relief of chronic pain. This patient group may include: people at risk of stomach ulcers; people taking certain medicines to control their high blood pressure and people at risk of kidney problems.

There are certain medications that should be used with caution while taking tramadol. These medications include tranquilizers, sleeping pills, antidepressants, and opioid pain medicines. Be sure to talk with your doctor about all other medicines you are taking before starting to take tramadol.

Tramadol should not be taken with alcohol-containing beverages.

Possible side effects

Tramadol may impair your ability to drive a car or operate machinery.

The risk of seizures is increased with doses of Ultram above the recommended range. You should not take more than 400 mg of tramadol per day.

Tramadol increases the risk of seizures in people taking certain medications for other medical conditions (e.g., tricyclic antidepressants, selective serotonin re-uptake inhibitors, or opioids). Tramadol may enhance the seizure risk in patients taking MAO inhibitors, neuroleptics, or other drugs that reduce the seizure threshold or in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure.

Overdose

Additional information

Cases of abuse and dependence on tramadol have been reported. Tramadol should not be used by opioid-dependent individuals. Since tramadol can reinitiate physical dependence, it is not recommended for individuals with a tendency to drug abuse, a history of drug dependence, or chronically using opioids.

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