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Tramadol : Uses, Side Effects, Dosage, Warnings

Tramadol is a pain reliever. Tramadol affects chemicals and receptors in the body that are associated with pain. Tramadol is used to relieve moderate to moderately severe pain. Tramadol is the generic of Ultram.

Ultram is a white, bitter, crystalline and odorless powder. Each Ultram tablet contains 50 mg of Ultram hydrochloride and is white in color.


Ultram has been given in single oral doses of 50, 100, 150 and 200 mg to patients with pain after surgical procedures and pain after oral surgery. In single-dose models of pain following oral surgery, pain relief was demonstrated in some patients at doses of 50 mg and 75 mg.

A dose of 100 mg of Ultram tended to provide pain relief superior to codeine sulfate 60 mg, but it was not effective as the combination of aspirin 650 mg with codeine phosphate 60 mg. In single-dose models of pain following surgical procedures, 150 mg provided pain relief generally equivalent to the combination of Darvocet N-100, with a tendency toward later peak effect.

Ultram has been studied in three long-term controlled trials involving a total of 820 patients, with 530 patients receiving Ultram. Patients with a variety of chronic painful conditions were studied in double-blind trials of one to three months duration.

Mean daily doses of about 250 mg of Ultram in divided doses were generally equivalent with five doses of Tylenol with Codeine #3 daily, five doses of aspirin 325 mg with codeine phosphate 30 mg daily, or two to three doses of Tylox daily.


Ultram acts on the central nervous system (CNS) and unlike codeine is a totally synthetic pain relieving compound. Although Ultram’s biological process is not completely understood, at least two complementary mechanisms appear applicable: weak inhibition of reuptake of norepinephrine and serotonin by nerves located within the (CNS) and the binding of parent compound and its metabolite to opioid receptors. Ultram-induced pain relief is only partially reversed by the opiate antagonist Narcan in several animal tests.

Ultram has been shown to reduce reuptake of serotonin and norepinephrine in vitro. These mechanisms may contribute independently to the overall pain relief profile of Ultram. Pain relief in humans begins about one hour after administration and reaches maximum effect in about two to three hours.


For the treatment of painful symptoms Ultram 50 mg to 100 mg can be given as needed for pain relief every four to six hours, not to exceed a maximum dose of 400 mg per day. For moderate pain Ultram 50 mg may be acceptable as the first dose, and for more severe pain, Ultram 100 mg is usually more effective as the first dose.

Individualization of Dose:

Patients over 75 years old:
No more then 300 mg/day in divided doses.

Patients 65 to 75 years of age:
No dose adjustment is needed.

Patients with reduced renal fuction :
The dosing interval of Ultram should be extended to twelve hours with a maximum daily dose of 200mg/day.

Dialysis patients:
These patients can receive their usual dose on the same day as dialysis treatment.

Patients with cirrhosis:
Recommended dosage is 50 mg every 12 hours.

Patients receiving chronic Tegretol:
Doses up to 800mg/day may be required, this is up to twice the recommended dose of Ultram.


Ultram has a propensity to cause physical and psychological dependence of the morphone-type. Ultram has been associated with tolerance development, craving, and drug-seeking behavior. Dependence and abuse cases of Ultram have been reported. Ultram should not be used in patients whom are opioid-dependent.

Ultram can reinitiate physical dependence in patients that have been previously dependent or chronically using other opioids. In patients with a tendency to abuse drugs, a history of chronically using opiods, or drug dependence, treatment with Ultram is not recommended.


Seizure Risk Patients receiving Ultram have reported seizures within the recommended dosage range. Concomitant use of Ultram increases the seizure risk in patients taking:-

-Selective serotonin reuptake inhibitors (SSRI antidepressants or anoretics -phentermine),
-Tricyclic antidepressants and other tricyclic compounds (e.g., cyclobenzaprine, promethazine, etc.)
-MAO inhibitors
-Any drugs that reduce the seizure threshold


Ultram may impair mental or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. Ultram should not be taken with alcohol. Ultram should be used with caution when taking medications such as tranquilizers, hypnotics or other pain relief medications.


Ultram should not be used in nursing mothers or pregnant women. Safe use in pregnancy has not been proven.

Physical dependence and post-pregnancy withdrawal symptoms in the newborn may be seen with chronic use during pregnancy.

Ultram has been shown to cross the placenta. Nonetheless, the effect of Ultram, if any, on the later growth, development, and functional maturation of the child is unknown.


Ultram was administered to 550 patients during the double-blind or open-label extension periods in U.S. studies of chronic nonmalignant pain. Of these patients, 375 were 65 years old or older. Reports the cumulative incidence rate of adverse reactions by 7, 30 and 90 days for the most frequent reactions (5% or more by 7 days). The most frequently reported events were in the CNS and gastrointestinal system.

Although the reactions may be related to Ultram administration, the reported rates also include some events that may have been due to underlying disease or concomitant medication. The overall incidence rates of adverse experiences in these trials were similar for Ultram and the active control groups, acetaminophen 300 mg with codeine phosphate 30 mg, and aspirin 325 mg with codeine phosphate 30 mg.


Respiratory depression and seizure are serious potential consequences of over dosage.