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Tramadol (Ultram)



Tramadol is a unique pain medication which works partially as a weak opioid, and also helps to regulate serotonin and norepinephrine to decrease pain. It is available in extended release and regular release forms and is used to treat moderate and severe pain.



How to Use


Take this medication by mouth with water, it can be taken with or without food.


If stomach upset occurs, you can take it with food or milk to decrease this effect.


Take it exactly as directed, do not take it more than directed.


If you miss a dose, take it as soon as you can. If it is already almost time for your next dose, take only that next dose. Do not double up on any dose.



Important Information


Contact your doctor if your pain gets worse, or if you notice a new type of pain.


Do not suddenly stop taking this medication, this can cause a risk of serious adverse events. As you use this medicine over time, your body can develop tolerance and may require more medicine in order to achieve the same effect previously experienced. This dose not mean that you are addicted to this medication however, it is important to slowly decrease the dose over time and not stop taking it suddenly.


Contact an emergency line if you have trouble breathing while taking this medication.


Take exactly as directed, do not take more than directed.


Be sure that your doctor is aware of all medications that you are currently taking.


Do not operate heavy machinery, drive a car, or engage in other activity that requires fine motor skills until you are sure of how this medication affects you.


Stand and sit slowly when first starting this medication to avoid dizziness.


Avoid alcohol consumption, alcohol can increase chance of dizziness or drowsiness.


This medication causes constipation. If you do not have a bowel movement for more than 3 days, contact your healthcare professional.


This medication can make your mouth dry, drinking water, chewing sugarless gum, or sucking on candy can help this side effect.



Be sure that your prescribing doctor is aware if you have any of the the following conditions before taking this medication


Brain tumor, drug addiction or abuse, depression, head injuries, frequent alcohol consumption, kidney disease, trouble passing urine, liver disease, lung disease, asthma, trouble breathing, seizures, suicidal thoughts or actions, family history of suicidal thoughts or actions, history of allergic reactions to all medications including pain medications, pregnancy, breastfeeding, trying to become pregnant.



Side effects that should be immediately reported to your healthcare provider


Allergic reactions(hives, itching, rashes, swelling of the face or mouth), trouble breathing, wheezing, confusion, itching, light headedness, fainting, seizures, any red, blistering or peeling skin.



Other Side Effects


Constipation, dizziness, headache, drowsiness, nausea, vomiting,



Adult Dose



Moderate Pain or Moderately Severe Pain (such as lower back pain, pain following dental procedures, and bone pain)


Immediate Release Tablets(Ultram): 25 mg by mouth once daily as a starting dose. The dose is then titrated by 25 mg at intervals of no less than 3 days to 100 mg per day. The dose may then be increased by 50 mg at intervals no less than 3 days up to 200mg per day(50 mg 4 times daily).  If more rapid pain relief is necessary, 50-100 mg by mouth every 4-6 hours as needed can be given.


Immediate Release Orally Disintegrating Tablets (Rybix ODT): 50 mg dissolved under the tongue (sublingually) once daily. The dose is then titrated by 50 mg at intervals of no less than 3 days to reach a dose of 200 mg per day(50 mg four times daily). After this titration, 50-100 mg sublingually every 4-6 hours as needed may be given. If more rapid pain relief is necessary, 50-100 mg sublingually every 4-6 hours as needed may be given


Extended Release Tablets(Ryzolt): 100 mg by mouth once daily. The dose can be titrated up by 100 mg every 2-3 days. (This is for patients on no other forms of tramadol such as immediate release formulations)


Extended Release Tablets or Capsules(UltramR or ConXip): 100 mg by mouth once daily. The dose can be titrated up by 100 mg every 5 days. (This is for patients on no other forms of tramadol such as immediate release formulations)





1. Ultram (tramadol) [package insert]. Titusville, NJ: Janssen Pharmaceuticals; 2014.


2. .Tramadol Hydrochloride (tramadol) [package insert]. Sellersville, PA: Teva Pharmaceuticals; 2010.


3. .Rybix ODT (tramadol) [package insert]. San Diego, CA: Victory Pharma; 2010.


4. .Ultram ER (tramadol) [package insert]. Raritan, NJ: PriCara; 2014.


5. .ConZip (tramadol) [package insert]. Sayreville, NJ: Vertical Pharmaceuticals Inc; 2014.


6. Ultram (tramadol) [package insert]. Titusville, NJ; Janssen Pharmaceuticals, Inc.; 2014.


7. ConZip(TM) oral extended release capsules, tramadol HCl oral extended release capsules[package insert]. Sayerville, NJ: Vertical Pharmaceuticals, (Per DailyMed); 2011.


8. Ultram® ER oral extended-release tablets, tramadol HCl oral extended-release tablets[package insert]. Raritan, NJ:  PriCara; 2008.


9. Ryzolt (TM) oral extended release tablets, tramadol HCL oral extended release tablets[package insert]. Saint-Hubert, QC: Canada: Confab Laboratories;2008.

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