IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be assumed that the use of the drug is safe, appropriate, or effective for your needs. Consult your physician or other healthcare professional before utilizing this drug.

TRAMADOL - ORAL (TRAH-muh-dall)

COMMON BRAND NAME(S): Ultram

USES: Tramadol is used for pain relief.

HOW TO TAKE TRAMADOL
 
Take tramadol exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label. Do not take more than 300 milligrams of tramadol in one day.
 
Each dose should be accompanied with a partial to full glass of fluid.
 
Tramadol can be taken with or without food, but make an effort to consume it the same way each time.
 
Avoid crushing 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 inhlation or injection can cause life-threatening side effects, overdose, or death.
 
Avoid crushing, chewing, or breaking an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.
 
If you use the tramadol extended-release tablet, the tablet shell may pass into your stools (bowel movements). This is completely normal and should not cause concern that the medicine is not at it's full dose.
 
Tramadol may be habit-forming and could result in withdrawl symptoms if stopped abruptly. Inform your doctor if you feel the medicine is not working as well in relieving your pain. Do not change your dose without talking to your doctor.
 
Do not cease this medication without talking to your orginal prescriber first. You may need to gradually titrate down the dose. Withdrawal symptoms may occur when you stop using tramadol. These ymptoms include, but are not limite to anxiety, sweating, nausea, diarrhea, tremors, chills, hallucinations, trouble sleeping, or breathing problems. Call your doctor at once if you have any of these withdrawal symptoms after you stop using tramadol.
 
Store tramadol at room temperature away from moisture and heat.
 
MORE ON DOSAGE AND ADMINISTRATION: 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 with the following titration regimen: Tramadol should be started at 25 mg/day qAM and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg q.i.d.).Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day (50 mg q.i.d.).After titration, Tramadol 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day.
 
For the subset of patients for 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 doses, Tramadol 50 mg to 100 mg can be administered as needed for pain relief every four to six hours, not to exceed 400 mg per day.
 
SIDE EFFECTS: Tramadol may cause dizziness, weakness, incoordination, nausea or vomiting, stomach upset, constipation, headache, drowsiness, anxiety, irritability, dry mouth, or increased sweating. If any of these effects persist or worsen, inform your doctor. Notify your doctor if you develop any of these serious effects while taking this medication: chest pain, rapid heart rate, skin rash or itching, mental confusion, disorientation, seizures, a sensation of tingling in your extremities, trouble breathing. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, breathing trouble. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Tell your doctor your medical history, especially if the following conditions are present: kidney disease, liver disease, seizure disorder, lung disease, history of drug or alcohol dependency, any allergies you may have. Limit alcohol as it may add to the dizziness or drowsiness effects caused by the medication. Because this drug may make you dizzy/drowsy, be sure to practice caution when driving or while doing other tasks that require a quick reaction time or an alert state. This medication should be used only when clearly needed during pregnancy. As with all medications, you may need to weigh the benefits against the risks. Tramadol is excreted into breast milk. Because the effects on a nursing infant are not known, talk with your physician first before breast- feeding.

DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription medications you may use, especially of: carbamazepine, narcotic pain relievers (e.g., codeine), drugs used to aid sleep, antidepressants (e.g., SSRI-types such as fluoxetine or fluvoxamine), MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, procarbazine, selegiline, tranylcypromine), psychiatric medicine (e.g., nefazodone), "triptan"-type drugs, anti-anxiety drugs (e.g., diazepam), sibutramine. Also, report use of certain antihistamines (e.g., diphenhydramine) which are also present in many cough-and-cold products. Do not begin or cease this or any medicine without doctor or pharmacist approval.

OVERDOSE: If Tramadol hcl overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include cold and clammy skin, low body temperature, slowed breathing, reduced heartbeat, drowsiness, dizziness or falling spells, lightheadedness, an excessively deep sleep, loss of consciousness, or seizures.

NOTES: Do not share this medication with others, even if you think it may be safe.

MISSED DOSE: If you miss a dose of Tramadol, take it as soon as remembered; do not take it if it is near the time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store this medication at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from heat, light and extreme moisture. Avoid storing this medicine in the bathroom. Keep this and all medications out of the reach of children.