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Before taking this medicine

Titrate by 100 mg increments every 2 to 3 days if needed for pain control
Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
if you are also using certain medicines to treat migraine headaches, muscle spasms, depression, mental illness, or nausea and vomiting.
a blockage in your stomach or intestines;
liver or kidney disease;
Maximum dose: 300 mg per day
Tramadol can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take tramadol in larger amounts, or for longer than prescribed. Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose.
Your pharmacist can provide more information.
Oral disintegrating tablet (ODT):
Professional
severe asthma or breathing problems;

Tell your doctor if you are pregnant. Tramadol may cause life-threatening withdrawal symptoms in a newborn.
Some medicines can interact with tramadol and cause a serious condition called serotonin syndrome . Be sure your doctor knows if you also take medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.
Patient Tips




Titration: increase in 25 mg increments as separate doses every 3 days to reach 100 mg per day taken as 25 mg 4 times per day. Then the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg per day taken as 50 mg 4 times per day.
Extended-release formulations:

Maximum dose: 400 mg/day

a metabolic disorder; or
Maximum total daily dose is the lesser of: 8 mg/kg/day or 400 mg/day
Stop taking all other around-the-clock narcotic pain medications when you start taking tramadol.

To make sure tramadol is safe for you, tell your doctor if you have:
What should I avoid?
Tramadol is not for use in children. Seek emergency medical attention if a child has taken this medicine and has: noisy breathing, sighing, slow breathing with long pauses between breaths; being unusually sleepy or hard to wake up; blue colored lips.
Breastfeeding Warnings
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Usual Pediatric Dose for Pain:


Initial: 50 to 100 mg every 4 to 6 hours


Overview
Extended-Release Tablets:
For patients over 75 years:
See also: Side effects (in more detail) Tramadol dosing information
Initial dose: 25 mg every morning


Usual Adult Dose for Pain:
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A tramadol overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, cold and clammy skin, and fainting.
Usual Geriatric Dose for Pain:
Support Group Q & A
seizure (convulsions);
Maximum dose of regular oral tablets: 300 mg per day in divided doses
User Reviews
Common tramadol side effects may include:
Alternatively, for patients not requiring a rapid onset of effect, side effects may be decreased by initiating dosage at 50 mg/day and increasing by 50 mg every 3 days up to 50 mg 4 times a day.
16 years and older:
Tramadol side effects

Patients currently on tramadol IR (immediare release) :
Where can I get more information?
a history of head injury, epilepsy or other seizure disorder;
More about tramadol Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons En Espanol 1009 Reviews - Add your own review/rating Consumer resources Tramadol Tramadol extended-release capsules Tramadol extended-release tablets Tramadol orally disintegrating tablets Tramadol (Advanced Reading) Other brands: Ultram , ConZip , Ultram ER , Ryzolt , More (1) » Professional resources Tramadol Hydrochloride (AHFS Monograph) More (4) » Related treatment guides Back Pain Chronic Pain Anxiety Fibromyalgia Vulvodynia More (5) »
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use tramadol only for the indication prescribed.

impotence, sexual problems, loss of interest in sex; or

Initial Dose: 100 mg once daily and titrated up as necessary by 100 mg increments every five days to relief of pain and depending upon tolerability.

Take tramadol exactly as prescribed. Follow all directions on your prescription label. Tramadol can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.



More Pregnancy Warnings
You should not take tramadol if you have used alcohol, sedatives, tranquilizers, or narcotic medications within the past few hours.
You should not take tramadol if you are allergic to it, or if you have:
It is not known whether tramadol will harm an unborn baby. If you use this medicine while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.


Tramadol is a narcotic-like pain reliever.


if you have recently used alcohol, sedatives, tranquilizers, or narcotic medications.
weak or shallow breathing;
Interactions
16 years and older:
Calculate the 24-hour tramadol IR dose:

Tramadol is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated.

Drug Images

Tramadol is used to treat moderate to severe pain.
infertility, missed menstrual periods;



Maintenance: After titration, tramadol 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg per day.

Dosage
Side Effects

Tramadol may be habit forming and should be used only by the person it was prescribed for. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away tramadol to any other person is against the law.
Maximum dose: 300 mg per day
Important information


Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with tramadol. Check your food and medicine labels to be sure these products do not contain alcohol.
Store at room temperature away from moisture and heat.

Alternatively, for patients not requiring a rapid onset of effect, side effects may be decreased by initiating dosage at 25 mg/day and increasing by 25 mg every 3 days up to 25 mg 4 times a day. Dosage may then be increased by 50 mg every 3 days as tolerated to 50 mg 4 times a day.

headache, dizziness, drowsiness, tired feeling;



Since tramadol is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with tramadol.


The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an as-needed basis for pain.
Dose: 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours, not to exceed 400 mg per day.

Do not crush the tramadol tablet. This medicine is for oral (by mouth) use only. Powder from a crushed tablet should not be inhaled or diluted with liquid and injected into the body. Using this medicine by inhalation or injection can cause life-threatening side effects, overdose, or death.


Do not stop using tramadol suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.
Patients not currently treated with tramadol immediate-release (IR):


Maximum: 400 mg/day
Initial dose: 100 mg once daily and titrated up as necessary by 100 mg increments every 5 days to relief of pain and individualized according to patient need and tolerability.
Call your doctor at once if you have:

itching, sweating, flushing (warmth, redness, or tingly feeling).
Maximum: 300 mg/day



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feeling nervous or anxious.


Many drugs can interact with tramadol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.
4 to 16 years:
Initial dose: Round down to the next lowest 100 mg increment. The dose may subsequently be individualized according to patient need and tolerability.
Do not crush, break, or open an extended-release tablet or capsule ( ConZip, Ultram ER ). Swallow it whole to avoid exposure to a potentially fatal dose.




Seizures have occurred in some people taking tramadol. Talk with your doctor about your seizure risk, which may be higher if you have:



See also: Dosage Information (in more detail) What happens if I miss a dose?
Seizures (convulsions) have occurred in some people taking this medicine. Tramadol may be more likely to cause a seizure if you have a history of seizures or head injury, a metabolic disorder, or if you are taking certain medicines such as antidepressants, muscle relaxers, narcotic, or medicine for nausea and vomiting
For the management of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time:

Initial dose: 50 to 100 mg every 4 to 6 hours
What other drugs will affect tramadol?
If you use the tramadol extended-release tablet, the tablet shell may pass into your stools (bowel movements). This is normal and does not mean that you are not receiving enough of the medicine.
Tramadol can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are taking this medicine.

Pricing & Coupons
on immediate release products may not be able to convert.
For patients in whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial dose:
a history of drug or alcohol addiction;
Slideshow



Do not give this medication to anyone younger than 16 years old without the advice of a doctor. Ultram ER should not be given to anyone younger than 18 years old.
Immediate release formulations: 1 to 2 mg/kg/dose every 4 to 6 hours

low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or

Maximum Dose: Extended-release tablets should not be administered at a dose exceeding 300 mg per day.




Tramadol may be habit-forming, even at regular doses. Take this medicine exactly as prescribed by your doctor. Never share the medicine with another person. MISUSE OF NARCOTIC PAIN MEDICATION CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.
Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking tramadol with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Tramadol Extended-Release (ER):
For mild to moderate severe chronic pain not requiring rapid onset of analgesic effect:
Tramadol may also be used for purposes not listed in this medication guide.
Tramadol can be taken with or without food, but take it the same way each time.
a stomach disorder; or



For patients over 65 years:
How should I take tramadol?

What happens if I overdose?
Tramadol may impair your thinking or reactions. Avoid driving or operating machinery until you know how this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.
Dose selection 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.
a history of drug abuse, alcohol addiction, mental illness, or suicide attempt.

Maximum: 400 mg/day

constipation, diarrhea, nausea, vomiting, stomach pain; or

Due to limitations in flexibility of dose selection with tramadol ER, some patients maintained

Never crush or break a tramadol pill to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death with the misuse of tramadol and similar prescription drugs.
Keep track of the amount of medicine used from each new bottle. Tramadol is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Some medicines can cause unwanted or dangerous effects when used with tramadol. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.

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severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.


16 years and older:
What is tramadol?


Initial: 100 mg once daily


Get emergency medical help if you have any signs of an allergic reaction to tramadol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Maximum single dose: 100 mg
Generic Name: tramadol (TRAM a dol) Brand Names: ConZip, Ultram

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