What is tramadol?
Tramadol is a narcotic-like pain reliever.
Tramadol is used to treat moderate to severe pain
in adults.

The extended-release form of tramadol is for
around-the-clock treatment of pain. The extended-
release form of tramadol is not for use on an as-
needed basis for pain.

Important Information

Seizures have been reported in patients taking
tramadol. Your risk of seizures is higher if you are
taking higher doses of tramadol over what is
recommended. Seizure risk is also higher in those
with a seizure disorder or those taking certain
antidepressants or opioid medications.
Tramadol should not be used if you are suicidal or
prone to addiction.

You should not take tramadol if you have severe
breathing problems, a blockage in your stomach or
intestines, or if you have recently used alcohol,
sedatives, tranquilizers, narcotic medication, or an
MAO inhibitor (isocarboxazid, linezolid, methylene
blue injection, phenelzine, rasagiline, selegiline,
tranylcypromine, and others).

Tramadol can slow or stop your breathing, and may
especially in a child or other person using the
medicine without a prescription.
Tramadol should not be given to a child younger
than 12 years old. Ultram ER should not be given
to anyone younger than 18 years old.

Taking tramadol during pregnancy may cause life-
threatening withdrawal symptoms in the newborn.
Fatal side effects can occur if you use this
medicine with alcohol, or with other drugs that
cause drowsiness or slow your breathing.

Before taking this medicine
You should not take tramadol if you are allergic to
it, or if you have:
severe asthma or breathing problems;
a blockage in your stomach or intestines;
if you have recently used alcohol, sedatives,
tranquilizers, or narcotic medications; or
if you have used an MAO inhibitor in the past
14 days (such as isocarboxazid, linezolid,
methylene blue injection, phenelzine, rasagiline,
selegiline, or tranylcypromine.

Tramadol should not be given to a child younger
than 12 years old. Ultram ER should not be given
to anyone younger than 18 years old.
Do not give this medicine to anyone younger than
18 years old who recently had surgery to remove
the tonsils or adenoids.
Avoid giving this medicine to children between 12
to 18 years of age who have conditions that may
cause breathing problems.
Seizures have occurred in some people taking
tramadol. Talk with your doctor about your seizure
risk, which may be higher if you have ever had:
a head injury, epilepsy or other seizure
f you also use certain antidepressants, muscle
relaxants, opioids, or other medications.
If you use tramadol while you are pregnant, your
baby could become dependent on the drug. 
can cause life-threatening withdrawal symptoms in
the baby after it is born. Babies born dependent on
habit-forming medicine may need medical
treatment for several weeks. Tell your doctor if you
are pregnant or plan to become pregnant.

Do not breast-feed while taking tramadol. This
medicine can pass into breast milk and cause
drowsiness, breathing problems, or death in a
nursing baby.

To make sure tramadol is safe for you, tell your
doctor if you have ever had:
liver or kidney disease;
urination problems;
problems with your gallbladder, pancreas, or

a stomach disorder; or
mental illness, or suicide attempt.
How should I take tramadol?
Take tramadol exactly as prescribed. Follow all
directions on your prescription label. Tramadol can
slow or stop your breathing, especially when you
start using this medicine or whenever your dose is

Never take this medicine in larger
amounts, or for longer than prescribed. Tell your
doctor if the medicine seems to stop working as
well in relieving your pain.

Tramadol may be habit-forming, even at regular
doses. Never share this medicine with another
person, especially someone with a history of drug
abuse or addiction. MISUSE OF PAIN MEDICATION
especially in a child or other person using the
medicine without a prescription. Selling or giving
away this medicine is against the law.

Stop taking all other around-the-clock narcotic pain
medications when you start taking tramadol.
Tramadol can be taken with or without food, but
take it the same way each time.

Do not crush, break, or open an extended-release
tablet or capsule (ConZip, Ultram ER). Swallow it
whole to avoid exposure to a potentially fatal dose.
Never crush or break a tablet inhale the powder or
mix it into a liquid to inject the drug into your vein.
This practice has resulted in death.

If you use the tramadol 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.

Do not stop using this medicine suddenly, or you
could have unpleasant withdrawal symptoms. Ask
your doctor how to safely stop using this medicine.

Store at room temperature away from moisture and
heat. Keep track of your medicine. Tramadol is a
drug of abuse and you should be aware if anyone
is using your medicine improperly or without a

Do not keep leftover opioid medication. Just one
dose can cause death in someone using this
medicine accidentally or improperly. Ask your
pharmacist where to locate a drug take-back
disposal program. If there is no take-back program,
flush the unused medicine down the toilet.

What happens if I miss a dose?
Since tramadol is used for pain, you are not likely
to miss a dose. Skip any missed dose if it is
almost time for your next scheduled dose. Do not
take extra medicine to make up the missed dose.
What happens if I overdose?

Seek emergency medical attention or call the
Poison Help line at 1-800-222-1222. A tramadol
overdose can be fatal, especially in a child or other
person using the medicine without a prescription.
Overdose symptoms may include slow heart rate,
severe drowsiness, cold and clammy skin, very
slow breathing, or coma.

What should I avoid while taking
Do not drink alcohol. Dangerous side effects or
death could occur.

This medicine may impair your thinking or
reactions. Avoid driving or operating machinery until
you know how this medicine will affect you.
Dizziness or severe drowsiness can cause falls or
other accidents.

Tramadol side effects
Get emergency medical help if you have signs of
an allergic reaction to tramadol (hives, difficult
breathing, swelling in your face or throat) or a
severe skin reaction (fever, sore throat, burning in
your eyes, skin pain, red or purple skin rash that
spreads and causes blistering and peeling).

Like other narcotic medicines, tramadol can slow
your breathing. Death may occur if breathing
becomes too weak.

A person caring for you should seek emergency
medical attention if you have slow breathing with
long pauses, blue colored lips, or if you are hard to
wake up.

Call your doctor at once if you have:
noisy breathing, sighing, shallow breathing;
a slow heart rate or weak pulse;
a light-headed feeling, like you might pass out;
seizure (convulsions);
missed menstrual periods;
impotence, sexual problems, loss of interest in
sex; or
nausea, vomiting, loss of appetite, dizziness,
worsening tiredness or weakness.

Seek medical attention right away if you have
symptoms of serotonin syndrome, such as:
agitation, hallucinations, fever, sweating, shivering,
fast heart rate, muscle stiffness, twitching, loss of
coordination, nausea, vomiting, or diarrhea.
Serious side effects may be more likely in older
adults and those who are overweight, malnourished,
or debilitated.

Long-term use of opioid medication may affect
fertility (ability to have children) in men or women.
It is not known whether opioid effects on fertility
are permanent.

Common tramadol side effects may include:
constipation, nausea, vomiting, stomach pain;
dizziness, drowsiness, tiredness;
headache; or

What other drugs will affect
You may have breathing problems or withdrawal
symptoms if you start or stop taking certain other
medicines. Tell your doctor if you also use an
antibiotic, antifungal medication, heart or blood
pressure medication, seizure medication, or
medicine to treat HIV or hepatitis C.

Tramadol can interact with many other drugs and
cause dangerous side effects or death. Be sure
your doctor knows if you also use:
cold or allergy medicines, bronchodilator
asthma/COPD medication, or a diuretic ("water
es for motion sickness, irritable bowel
syndrome, or overactive bladder;
other narcotic medications - opioid pain
medicine or prescription cough medicine;
a sedative like Valium - diazepam, alprazolam,
lorazepam, Xanax, Klonopin, Versed, and

drugs that make you sleepy or slow your
breathing - a sleeping pill, muscle relaxer,
medicine to treat mood disorders or mental
illness; or
drugs that affect serotonin levels in your body -
a stimulant, or medicine for depression,
Parkinson's disease, migraine headaches,
serious infections, or nausea and vomiting.