tramadol (Ultram)

Tramadol is a synthetic (man-made) pain reliever (analgesic). Researchers and doctors do not know the exact mechanism of action of tramadol, but it is similar to morphine. Like morphine, tramadol binds to receptors in the brain (narcotic or opioid receptors) that are important for transmitting the sensation of pain from throughout the body to the brain.

Like other narcotics used to treat pain, patients taking tramadol may abuse the drug and become addicted to it.

Tramadol is not a nonsteroidal anti-inflammatory drug (NSAID), therefore, it does not have the increased risk of stomach ulcers and internal bleeding that can occur with NSAIDs.

Doctors prescribe tramadol to manage moderate to moderately severe pain. Extended release tablets are used for moderate to moderately severe chronic pain in adults who require continuous treatment for an extended period.

Tramadol should not be used to treat pain in children younger than 12 years of age, and it should not be used to treat pain after surgery to remove the tonsils and/or adenoids in children younger than 18 years of age. Children between 12 and 18 years of age who are overweight or have breathing problems such as obstructive sleep apnea or severe lung disease should not receive tramadol.

Tramadol is generally well tolerated, and side effects are usually temporary.

Commonly reported side effects of tramadol include:

• nausea,
• constipation,
• dizziness,
• headache,
• euphoria,
• indigestion,
• spasticity,
• weakness,
• drowsiness, and
• vomiting.

Less commonly reported side effects include:

• itching,
• sweating,
• dry mouth,
• diarrhea,
• rash,
• visual disturbances, and
• vertigo.

Some patients who received tramadol have reported seizures. It may cause serotonin syndrome when combined with other drugs that also increase serotonin (see drug interactions section).

Tramadol is a narcotic and is addictive. Tramadol is a Schedule IV controlled substance that has been associated with addiction, abuse, and misuse. Tramadol may be addictive, even at the dosage your doctor has prescribed. Abuse or misuse of tramadol can lead to overdose and death.

Like other opioids, people who take tramadol for a long time will develop withdrawal symptoms if your doctor reduces the dosage, or if you suddenly stop taking tramadol.

Withdrawal symptoms that may occur include:

• Restlessness
• Excessive tear production
• Yawning
• Sweating
• Chills
• Muscle pain
• Anxiety
• Backache
• Joint pain
• Weakness
• Abdominal cramps
• Insomnia
• Nausea
• Weight loss
• Vomiting
• Diarrhea
• Increased blood pressure
• Respiratory rate
• Heart rate

Infants born to mothers who were taking tramadol during the pregnancy will develop symptoms of withdrawal and difficulty breathing.

• The recommended dose of tramadol is 50 mg to 100 mg (immediate release tablets) every 4-6 hours as needed for pain.
• The maximum dose is 400 mg/day.
• To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25 mg to 50 mg every 3 days to reach 50-100 mg/day every 4 to 6 hours.
• The recommended dose for extended release tablets is 100 mg daily, which may be increased by 100 mg every 5 days, but not to exceed 300 mg/day. To convert from immediate release to extended release, the total daily dose should be rounded down to the nearest 100 mg. Extended release tablets should be swallowed whole and not crushed or chewed.
• Tramadol may be taken with or without food.

To review how tramadol compares to other pain medications, please refer to this information.

• Tramadol vs. Oxycodone
• depression
• Tramadol vs. Hydrocodone
• Tramadol vs. Vicodin

• Carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol) reduces the effect of tramadol by increasing its inactivation in the body.
• Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50% to 60%.
• Combining tramadol with monoamine oxidase inhibitors or MAOIs (for example, tranylcypromine [Parnate]) or selective serotonin inhibitors (SSRIs) (for example, fluoxetine [Prozac]), may result in severe side effects such as seizures or a condition called serotonin syndrome.
• Tramadol may increase central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers, or sedative hypnotics. This can reduce the level of consciousness or lead to respiratory insufficiency.

Because researchers have not established the safety of tramadol during pregnancy, the safety of tramadol during pregnancy has not been established.

Mothers who are breastfeeding should not take tramadol because the infant may develop side effects, and will develop symptoms of withdrawal and difficulty breathing.

• Tablets (immediate release): 50 mg.
• Tablets (extended release): 100, 200, and 300 mg.
• Capsule (extended release): 100, 200, 300 mg.

Store tramadol at room temperature, 15 C to 30 C (59 F to 86 F), in a sealed container.

Ultram, Ultram ER, and Conzip are the current brand names available for tramadol in the US. Discontinued brands include Rebix OTD, and Ryzolt.

Tramadol is available in generic form, and you need a prescription for it from your doctor or other health care professional.

The FDA approved tramadol in March 1995.