Information on Tramadol

Generic name: Tramadol hydrochloride

Why is Tramadol prescribed?

Tramadol is prescribed to relieve moderate to moderately severe pain.

Most important fact about Tramadol

You should not drive a car, operate machinery, or perform any other potentially hazardous activities until you know how this drug affects you.

How should you take Tramadol?

It's important to take Tramadol exactly as prescribed. Do not increase the dosage or length of time you take this drug without your doctor's approval.

--If you miss a dose...

Take it as soon as you remember. However, if it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at once.

--Storage instructions...

Store in a tightly closed container at room temperature.

What are the side effects of Tramadol?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Tramadol.

More common Tramadol side effects may include:

• agitation
• anxiety
• bloating and gas
• constipation
• convulsive movements
• diarrhea
• dizziness
• drowsiness
• dry mouth
• feeling of elation
• hallucinations
• headache
• indigestion
• itching
• nausea
• nervousness
• sweating
• tremor
• vomiting
• weakness

Less common Tramadol side effects may include:

• abdominal pain
• confusion
• coordination problems
• feeling of illness
• flushing
• frequent urination
• inability to urinate
• loss of appetite
• menopausal symptoms
• rash
• sleeping problems
• visual problems

Rare side effects may include:

• accidental injury
• allergic reaction
• altered taste
• amnesia
• difficult or labored breathing
• difficulty concentrating
• dizziness or light-headedness upon standing
• fainting
• feeling of "pins and needles"
• hives
• menstrual problems
• mental sluggishness or clouding
• painful urination
• rapid heartbeat
• seizures
• suicidal tendencies
• weight loss

Why should Tramadol not be prescribed?

Avoid Tramadol if it has ever given you an allergic reaction. Also avoid Tramadol after taking large doses of sleeping pills such as Halcion, Dalmane, and Restoril; narcotic pain relievers such as Demerol, morphine, Darvon, and Percocet; or psychotherapeutic drugs such as antidepressants and tranquilizers. And do not take Tramadol after drinking excessive amounts of alcohol.

Special warnings about Tramadol

If you have stomach problems such as an ulcer, make sure your doctor is aware of them. Tramadol may hide the symptoms, making them difficult to diagnose and treat.

If you have become dependent on such drugs as Percocet, Demerol, or morphine, you may experience withdrawal symptoms when you switch to Tramadol.

You can also experience withdrawal symptoms if you stop taking Tramadol abruptly. Such symptoms include anxiety, sweating, insomnia, pain, nausea, tremor, diarrhea, and respiratory problems. A gradual decrease in dosage will help prevent these symptoms.

Do not take more than the recommended dose of Tramadol, since larger doses have been known to cause seizures, especially if you have epilepsy or are taking medications that also increase the risk of seizures. Among such medications are almost all antidepressant drugs, plus narcotics and major tranquilizers such as Loxitane and Stelazine.

If you have liver or kidney disease, be sure your doctor knows about it. Your dosage may have to be reduced.

Before you have any kind of surgery, make sure the doctor knows you are taking Tramadol.

If you have experienced a head injury, consult your doctor before taking Tramadol. The medication's effects may be stronger and could hide warning signs of serious trouble.

Possible food and drug interactions when taking Tramadol

Tramadol may increase the drowsiness caused by alcohol. Do not drink alcohol while taking this medication.

If Tramadol is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Tramadol with the following:

• Carbamazepine (Tegretol)
• Cyclobenzaprine (Flexeril)
• Drugs known as MAO inhibitors, including the antidepressants Nardil and Parnate
• Serotonin-boosting antidepressants such as Paxil, Prozac, Celexa, and Zoloft
• "Tricyclic" antidepressants such as Elavil, Norpramin, and Tofranil
• Major tranquilizers such as Thorazine and Stelazine
• Narcotic pain relievers (Demerol, morphine, Darvon, Percocet)
• Promethazine (Mepergan, Phenergan)
• Quinidine (Quinidex)
• Sleeping pills (Halcion, Dalmane, Restoril)
• Tranquilizers (Valium, Xanax)

Special information if you are pregnant or breast feeding

The effects of Tramadol during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, tell your doctor immediately. Tramadol appears in breast milk and may affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breast feeding until your treatment is finished.

Recommended dosage

ADULTS

The usual starting dose for chronic pain is 25 milligrams once a day in the morning. The daily dosage is then increased every 3 days until it reaches 200 milligrams taken in four doses of 50 milligrams each. After the phase-in period, Tramadol may be taken in doses of 50 to 100 milligrams every 4 to 6 hours, depending on the severity of pain. If rapid pain relief is needed, the phase-in steps can be skipped, though side effects will be more likely. The maximum dosage under any circumstances is 400 milligrams a day (300 milligrams for those over age 75).

For people with kidney problems, the usual starting dose is 50 to 100 milligrams every 12 hours; and the maximum per day is 200 milligrams. For those with cirrhosis, the usual dose is 50 milligrams every 12 hours.

People taking the anti-seizure medication Tegretol in regular doses of up to 800 milligrams a day may need double the usual dosage of Tramadol.

CHILDREN

Safety and effectiveness in children under 16 years of age have not been established.

Overdosage

An overdose of Tramadol can be fatal. If you suspect an overdose, seek emergency medical treatment immediately.

• Symptoms of Tramadol overdose include:
  Difficult or slowed breathing, seizures