Tramadol belongs to a group of medications called opioid analgesics. It is used to manage moderate to moderately severe pain for people who need several days or more of pain control. It decreases pain by acting on the central nervous system.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended starting dose of tramadol is 25 mg taken once daily. Depending on how effective it is, the dose may be gradually increased every 3 to 5 days to up to a dose of 50 mg to 100 mg taken every 4 to 6 hours as needed for pain. The maximum daily dose is a total of 400 mg every 24 hours. The lowest effective dose for controlling pain should be used for the shortest duration of time.

The medication may be taken with or without food. Swallow the tablets whole with a glass of water. Do not crush, break, or chew the tablets, since doing so may cause too much medication to be absorbed into the body at one time and may be fatal.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Do not stop taking this medication without talking with your doctor. If this medication is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shakiness, nausea, tremors, diarrhea, or hallucinations.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. 

Store this medication at room temperature and keep it out of the reach of children. Accidental ingestion of this medication by a child can result in severe harm or even death.

Each white, capsule-shaped, coated tablet imprinted "ULTRAM" on one side and "06 59" on the scored side, contains 50 mg of tramadol hydrochloride. Nonmedicinal ingredients: carnauba wax, corn starch, hypromellose, lactose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate, and titanium dioxide.

Do not take tramadol if you:

• are allergic to tramadol or any ingredients of the medication
• are allergic to other opioid medications (e.g., codeine, morphine)
• are intoxicated with alcohol or taking other medications that can depress breathing and consciousness, such as hypnotics, other opioids (e.g., codeine or morphine), or psychotropic medications (certain medications for mental health conditions)
• are experiencing acute alcoholism or delirium tremens
• are experiencing acute asthma or other obstructive airway disease
• are experiencing acute respiratory depression
• are experiencing sudden, severe abdominal pain that may require surgery (e.g., appendicitis, pancreatitis)
• are less than 18 years old and have had surgery to treat sleep apnea syndrome
• have a blockage or narrowing of the gastrointestinal tract
• have a head injury, brain tumour, or increased pressure inside the head or spinal cord
• have any condition that reduces the movement of masses through the digestive tract, such as ileus
• have mild pain, pain that comes and goes, or pain which can be treated with other pain medications
• have severe kidney function impairment
• have severe liver function impairment
• have convulsive (seizure) disorders
• have cor pulmonale
• have taken monoamine oxidase (MAO) inhibitor medications (e.g., phenelzine, tranylcypromine) within the last 14 days

Do not give this medication to children less than 12 years old.

Do not give this medication to children less than 18 years of age who have undergone surgery for obstructive sleep apnea syndrome.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• blurred vision
• constipation
• decreased interest in sexual activity
• decreased sexual ability
• dizziness
• drowsiness
• dry mouth
• fainting
• headache
• itchy skin
• loss of appetite
• muscle weakness
• nausea
• sweating
• trouble sleeping
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• decreased coordination
• fast, slow, or irregular heartbeat
• low blood pressure (e.g., dizziness, fainting, light-headedness)
• symptoms of a bowel blockage (e.g., abdominal pain, severe constipation, nausea)
• symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
• withdrawal symptoms (e.g., nausea, vomiting, diarrhea, anxiety, shivering, cold and clammy skin, body aches, sweating)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a severe allergic reaction (e.g., hives; difficulty breathing; or swelling of the lips, mouth, throat, or tongue)
• signs of serotonin syndrome (e.g., agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching)
• shallow or weak breathing
• signs of too much medication (e.g., decreased breathing rate, severe dizziness, unconsciousness, vomiting, seizures, hallucinations, cold and clammy skin)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abdominal conditions: Tramadol slows down bowel motility. This may make the diagnosis of abdominal conditions more difficult or it may worsen these conditions. If you have an abdominal condition such as inflammatory or obstructive bowel disease, acute cholecystitis, or pancreatitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Accidental use: When tramadol is used by anyone other than the person for whom it was prescribed, the effects of the medication may be fatal. Keep this medication out of sight and reach of children.

Alcohol and other medications that cause drowsiness: People taking this medication should not combine it with alcohol and avoid combining it with other medications, such as narcotic pain relievers, that cause drowsiness. Doing so can cause additive drowsiness and reduced breathing as well as other side effects, which can be dangerous.

Alcohol and other medications that can cause drowsiness: Do not combine this medication with alcohol or other medications (e.g., antidepressants, sleeping pills, anxiety medications) that cause drowsiness, since additive drowsiness and decreased breathing can occur and be dangerous and possibly even fatal.

Asthma and other respiratory conditions: Tramadol may cause increased breathing difficulty for people having an acute asthma attack or for those with chronic obstructive pulmonary disease (chronic bronchitis, emphysema) or other conditions that affect breathing. If you have asthma or other breathing disorders, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dependence and withdrawal: This medication may become habit-forming if taken for long periods of time. People with a history of past or current substance use problems may be at greater risk of developing abuse or addiction while taking this medication. Drug abuse is not a problem for people who require this medication for pain relief. If this medication is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shaking, pain, nausea, tremors, diarrhea, and hallucinations. Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms when this medication is no longer required for pain control. Do not stop taking this medication without talking to your doctor or pharmacist.

Diabetes: Tramadol may cause a decrease in blood sugar levels (may cause a loss of blood glucose control) and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: This medication may cause drowsiness or affect the mental abilities needed to perform hazardous tasks. Combining this medication with alcohol or other medications that cause drowsiness (e.g., antidepressants, sleeping pills, anxiety medications) should be avoided, since additive drowsiness and dizziness can occur and be dangerous. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.

Head injury: People with head injuries or increased pressure in the head may have a higher risk of experiencing side effects (breathing problems or seizures) or worsening of their condition while taking this medication. These people should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart rhythm: Tramadol can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Your doctor may want to monitor your heart rhythm periodically while you are taking this medication with a test called an electrocardiogram (ECG). You should not take this medication if your ECG already shows that you have QT prolongation or if you are taking a medication that can cause QT prolongation.

Kidney function: The kidneys are partially responsible for removing tramadol from the body. Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severely decreased kidney function should not use tramadol.

Liver function: The liver is partially responsible for removing tramadol from the body. Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver disease or reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severely decreased liver function should not use tramadol.

Low blood pressure: Occasionally, blood pressure drops too low after taking tramadol. This is more likely to occur for those who take water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not drinking enough liquids. Get up slowly when rising from a sitting or lying down position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Seizures: This medication may cause seizures, especially when higher doses are used or when taken with other medications that may increase the risk of seizures.  The risk of seizures is also higher for people with epilepsy, a history of seizures, or who are at risk of seizures (e.g., people with head trauma). If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when tramadol is combined with other medications that affect serotonin, such as anti-depressants and "triptan" migraine medications. The combination of tramadol and MAO inhibitors must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are also possible.

If you are taking antidepressants, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Surgery: Tramadol may interact with medications used during surgery. If you are scheduled for surgery, let your doctor know that you are taking this medication.

Pregnancy: The safety for both the mother and baby if this medication is used during pregnancy has not been determined. Taking this medication during pregnancy may affect the developing baby, causing dangerous withdrawal symptoms when the baby is born. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking tramadol extended-release, it may affect your baby. You should avoid taking tramadol if you are breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children less than 12 years of age. Adolescents between the ages 12 and 18 who are obese or have had surgery for obstructive sleep apnea syndrome should not use this medication.

Seniors: People over the age of 75 are more likely to experience side effects of taking tramadol. Doses for seniors should generally be lower and increase more slowly than for other adults.

There may be an interaction between tramadol and any of the following:

• abiraterone
• aclidinium
• alcohol
• amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• anti-Parkinson's medications (e.g., amantadine, apomorphine, bromocriptine, entacapone, levodopa, pramipexole, ropinirole)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, quetiapine, olanzapine, risperidone)
• apalutamide
• atropine
• azelastine
• "azole" antifungal medications (e.g., fluconazole, itraconazole, ketoconazole)
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• belladonna
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• benztropine
• bosentan
• brimonidine
• bupropion
• buspirone
• cabergoline
• cannabis
• chloral hydrate
• chloroquine
• cinacalcet
• clonidine
• conivaptan
• deferasirox
• desmopressin
• dextromethorphan
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• domperidone
• eluxadoline
• enzalutamide
• ergot derivatives (e.g., dihydroergotamine, ergoloid mesylates, ergonovine, ergotamine, methylergonovine)
• flavoxate
• flibanserin
• general anesthetics (medications used to put people to sleep before surgery)
• glycopyrrolate
• guanfacine
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., darunavir, indinavir, lopinavir, ritonavir, saquinavir)
• ipratropium
• isoniazid
• kava kava
• linezolid
• lithium
• lumacaftor
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• methadone
• methylene blue
• methylphenidate
• metoclopramide
• mifepristone
• mirabegron
• mirtazapine
• mitotane
• modafinil
• monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine, moclobemide, selegiline, rasagiline)
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• nabilone
• naltrexone
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
• octreotide
• oxybutynin
• pegvisomant
• protein kinase inhibitors (e.g., dabrafenib, imatinib, nilotinib)
• quinidine
• rifabutin
• rifampin
• rotigotine
• St. John's wort
• scopolamine
• seizure medications (e.g., carbamazepine, gabapentin, levetiracetam, phenytoin, topiramate)
• selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine, fluoxetine, citalopram)
• serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• siltuximab
• solifenacin
• suvorexant
• terbinafine
• thalidomide
• ticlopidine
• tiotropium
• tocilizumab
• tolterodine
• trazodone
• tricyclic antidepressants (TCAs; e.g., amitriptyline, desipramine, imipramine)
• "triptan" migraine medications (e.g., sumatriptan, naratriptan)
• tryptophan
• umeclidinium
• warfarin
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.