What is Ultram? Ultram is a narcotic-like pain reliever. Ultram is used to treat moderate to severe pain. Ultram extended-release is used to treat moderate to severe chronic pain when treatment is needed around the clock. Ultram may also be used for purposes other than those listed in this medication guide. What should I discuss with my healthcare provider before taking Ultram? You should not take Ultram if you have ever been addicted to drugs or alcohol. Do not take Ultram if you are intoxicated (drunk), or if you have recently used any of the following drugs: * alcohol; * narcotic pain medicine; * sedatives or tranquilizers (such as Valium); * medicine for depression or anxiety; * medicine for mental illness (such as bipolar disorder, schizophrenia); or * street drugs. Seizures have occurred in some people taking Ultram. Your risk of a seizure may be higher if you have any of these conditions: * a history of drug or alcohol addiction; * a history of epilepsy or other seizure disorder; * a history of head injury; or * a metabolic disorder. Talk with your doctor about your individual risk of having a seizure from this medicine. Before taking Ultram, tell your doctor if you are allergic to any drugs, or if you have: * kidney disease; * liver disease; * a stomach disorder; or * a history of depression, mental illness, or suicide attempt. If you have any of these conditions, you may not be able to use Ultram, or you may need a dosage adjustment or special tests during treatment. FDA pregnancy category C. This medication may be harmful to an unborn baby. Ultram may also cause serious or fatal side effects in a newborn if the mother uses the medication during pregnancy or labor. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Ultram can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Older adults may be more sensitive to the effects of Ultram. If you are over 65, your doctor may recommend a lower dose. Ultram should not be given to a child younger than 16 years of age. How should I take Ultram? Take Ultram 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 Ultram in one day. Take each dose with a full glass of water. Ultram can be taken with or without food, but take it the same way each time. Do not crush the Ultram 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. Do not crush, chew, or break 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 Ultram 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. Ultram may be habit-forming. Tell 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 stop using this medication suddenly without talking to your doctor. You may need to gradually reduce the dose. Withdrawal symptoms may occur when you stop using Ultram. Withdrawal symptoms include 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 Ultram. Store Ultram at room temperature away from moisture and heat. What happens if I miss a dose of Ultram? Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose with Ultram? Seek emergency medical attention if you think you have used too much of this medicine. A Ultram overdose can be fatal. Symptoms of a Ultram overdose may include drowsiness, shallow breathing, slow heartbeat, extreme weakness, cold or clammy skin, feeling light-headed, fainting, or coma. What should I avoid while taking Ultram? Do not drink alcohol while you are taking Ultram. Alcohol may cause a dangerous decrease in your breathing when used together with Ultram. Avoid using drugs that make you sleepy (such as cold medicine, other pain medications, muscle relaxants, and medicine for seizures, depression or anxiety). These drugs may slow your breathing or increase drowsiness when used together with Ultram. Ultram can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. What are the possible side effects of Ultram? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Ultram and call your doctor at once if you have any of these serious side effects: * seizure (convulsions); * a red, blistering, peeling skin rash; or * shallow breathing, weak pulse. Continue taking Ultram and talk to your doctor if you have any of these less serious side effects: * dizziness, drowsiness, weakness; * nausea, vomiting, constipation, loss of appetite; * blurred vision; * flushing (redness, warmth, or tingly feeling); or * sleep problems (insomnia). Side effects other than those listed here may also occur. 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You may be more likely to have a seizure (convulsions) if you take Ultram while you are using certain other medicines. Do not take Ultram without telling your doctor if you also use any of the following: * an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam); or * an antidepressant such as amitriptyline (Elavil), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor); paroxetine (Paxil), or sertraline (Zoloft). Before taking Ultram, tell your doctor if you also use: * carbamazepine (Tegretol); * warfarin (Coumadin); * digoxin (Lanoxin, Lanoxicaps); * ketoconazole (Nizoral); * erythromycin (E-Mycin, E.E.S., Ery-Tab); * rifampin (Rifadin, Rimactane, Rifater); * St. John's wort; * quinidine (Quinaglute, Quinadex, Cardioquin, Quinora); or * drugs that make you sleepy (such as cold medicine, other pain medications, muscle relaxants, and medicine for seizures, depression or anxiety). If you are using any of these drugs, you may not be able to use Ultram or you may need dosage adjustments or special tests during treatment. There may be other drugs not listed that can affect Ultram. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Where can I get more information on Ultram? * Your pharmacist has more information about Ultram written for health professionals that you may read. What does my medication look like? Tramadol is available with a prescription under the brand names Ultram and Ultram ER. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. * Tramadol 50 mg--white, capsule-shaped, film-coated tablets. * Ultram ER 100 mg, 200 mg, 300 mg--white, round extended-release tablets. * Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. * 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.more