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Tramadol 50mg may be prescribed as an immediate release tablet. 

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ULTRAM® (tramadol hydrochloride) tablets is a centrally acting analgesic. The chemical name for tramadol hydrochloride is (±)cis-2-[(dimethylamino)methyl]-1-(3methoxyphenyl) cyclohexanol hydrochloride. Its structural formula is: 

The molecular weight of tramadol hydrochloride is 299.8. Tramadol hydrochloride is a white, bitter,

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, crystalline and odorless powder. It is readily soluble in water and ethanol and has a pKa of . The n-octanol/water log partition coefficient (logP) is at pH 7. ULTRAM® tablets contain 50 mg of tramadol hydrochloride and are white in color. Inactive ingredients in the tablet are pregelatinized corn starch,

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modified starch (corn), hypromellose, lactose,

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magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate, titanium dioxide and carnauba wax.  Tramadol belongs to the class of drugs known as opiate agonists. Primarily, tramadol works by changing the way the body senses pain. Some people mistakenly believe that tramadol is an NSAID (nonsteroidal anti-inflammatory drug), but it is not. Tramadol 50mg may be prescribed as an immediate release tablet.  Tramadol 100mg, Tramaodl 200mg, Tramadol 300mg are Prescribed as an extended release tablets.  For patients with moderate to moderately severe chronic pain not requiring rapid onset of analgesic effect,

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the tolerability of ULTRAM® can be improved by initiating therapy with the following titration regimen: ULTRAM® 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.),

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. 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, ULTRAM® 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, ULTRAM® 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.

Tramadol is a narcotic-like pain reliever. Tramadol is used to treat moderate to severe pain. Tramadol extended-release is used to treat moderate to severe chronic pain when treatment is needed regularly. Tramadol, the generic version of Ultram, is a synthetic analgesic medication. The exact mode of action of tramadol is unknown but it is said to work like morphine. Tramadol binds to opioid receptors in the brain - receptors that transmit the sensation of pain throughout the body. Here are 10 things you should know about tramadol to ensure its safe use,

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. The Cochrane Review stated that when tramadol is taken for up to 3 months, there may be decreased pain, improvements in function and stiffness and overall well-being. However, tramadol can cause side effects that are significant enough to require that the patient must stop taking the medication. Risks outweigh benefits for many people who have tried tramadol.

Tramadol has mu-opioid agonist activity. ULTRAM can be abused and may be subject to criminal diversion.

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial,

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, and environmental factors influencing its development and manifestations. Drug addiction is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use,

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use for non-medical purposes, and continued use despite harm or risk of harm,

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and craving. Drug addiction is a treatable disease,

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utilizing a multidisciplinary approach, but relapse is common.

“Drug-seeking” behavior is very common in addicts and drug abusers. Drug-seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing or referral,

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, repeated “loss” of prescriptions, tampering with prescriptions and reluctance to provide prior medical records or contact information for other treating physician(s). “Doctor shopping” to obtain additional prescriptions is common among drug abusers and people suffering from untreated addiction.

Abuse and addiction are separate and distinct from physical dependence and tolerance. Physicians should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of ULTRAM® can occur in the absence of true addiction and is characterized by misuse for non-medical purposes, often in combination with other psychoactive substances,

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. Concerns about abuse and addiction should not prevent the proper management of pain,

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. However all patients treated with opioids require careful monitoring for signs of abuse and addiction,

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because use of opioid analgesic products carries the risk of addiction even under appropriate medical use.

Be aware of the following possible Tramadol drug interactions: 


Carbamazepine reduces the effect of tramadol

Quinidine increases the concentration of tramadol by 50% to 60%

Combining tramadol with an MAO (monoamine oxidase inhibitor) inhibitor or SSRI (selective serotonin reuptake inhibitors) can lead to seizures or other serious side effects.

Tramadol side effects are usually temporary

Get emergency medical help if you have any of these signs of an allergic reaction to tramadol: hives;

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; difficulty breathing; swelling of your face,

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lips, tongue,

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or throat. Stop using tramadol and call your doctor at once if you have any of these serious side effects:



agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting;

seizure (convulsions);

a red,

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blistering, peeling skin rash; or

shallow breathing, weak pulse.

Less serious tramadol side effects may include:



dizziness, drowsiness,

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weakness;

nausea, vomiting, constipation, loss of appetite;

blurred vision;

flushing (redness, warmth, or tingly feeling); or

sleep problems (insomnia).

Risk of Overdosage

Patients taking tramadol should be warned not to exceed the dose recommended by their physician. Tramadol products in excessive doses, either alone or in combination with other CNS depressants, including alcohol, are a cause of drug-related deaths,

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. Patients should be cautioned about the concomitant use of tramadol products and alcohol because of potentially serious CNS additive effects of these agents. Because of its added depressant effects, tramadol should be prescribed with caution for those patients whose medical condition requires the concomitant administration of sedatives, tranquilizers, muscle relaxants, antidepressants, or other CNS depressant drugs. Patients should be advised of the additive depressant effects of these combinations.

Serious potential consequences of overdosage with ULTRAM® (tramadol hydrochloride) tablets are central nervous system depression, respiratory depression and death. Some deaths have occurred as a consequence of the accidental ingestion of excessive quantities of tramadol alone or in combination with other drugs. In treating an overdose,

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, primary attention should be given to maintaining adequate ventilation along with general supportive treatment.

What your doctor should tell you about Tramadol ?



Patients should be informed that ULTRAM® may cause seizures and/or serotonin syndrome with concomitant use of serotonergic agents (including SSRIs, SNRIs, and triptans) or drugs that significantly reduce the metabolic clearance of tramadol.

ULTRAM® may impair mental or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery.

ULTRAM® should not be taken with alcohol containing beverages.

ULTRAM® should be used with caution when taking medications such as tranquilizers, hypnotics or other opiate containing analgesics.

The patient should be instructed to inform the physician if they are pregnant,

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think they might become pregnant, or are trying to become pregnant.

The patient should understand the single-dose and 24-hour dose limit and the time interval between doses, since exceeding these recommendations can result in respiratory depression, seizures and death.Before you use tramadol,

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you must know following information:
 
Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make,

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the following should be considered: 

Allergies 

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals,

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. For non-prescription products, read the label or package ingredients carefully. 

Pediatric 

There is no specific information on the relationship of age to the effects of tramadol tablets in patients less than 16 years of age,

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, and tramadol extended-release tablets in patients less than 18 years of age . 

Geriatric 

Studies in older adults show that tramadol stays in the body a little longer than it does in younger adults,

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. Your doctor will consider this when deciding on your doses. 

Pregnancy

  Pregnancy Category Explanation All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women,

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Breastfeeding 

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. 

Drug Interactions 

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. 



Rasagiline

Selegiline

2 - Tramadol is available in immediate release and extended release formulations.

Tramadol may be prescribed as an immediate release tablet (50 mg.) or as an extended release tablet (100, 200, or 300 mg.). The extended release tablets are usually reserved for patients with chronic pain who require continuous, long-term treatment,

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. Your doctor will determine the appropriate dosage schedule for you.  

3 - Tramadol extended release tablets must be taken whole, not split, chewed or crushed. 

It is important to take tramadol properly and to follow prescribing instructions. If taken improperly or in a way that is not recommended, serious side effects and even death can result.  

4 - Tramadol can be habit-forming for some people. 

Do not take more tramadol than has been prescribed for you. Taking more tramadol or taking it more often can cause dependency on it. You should also not stop taking tramadol without first consulting your doctor,

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. You may experience withdrawal symptoms if you stopped it suddenly. You doctor will likely decrease your dose of tramadol gradually.  

5 - Drug interactions are possible with tramadol. 

Be aware of the following possible drug interactions:  



Carbamazepine reduces the effect of tramadol

Quinidine increases the concentration of tramadol by 50% to 60%

Combining tramadol with an MAO (monoamine oxidase inhibitor) inhibitor or SSRI (selective serotonin reuptake inhibitors) can lead to seizures or other serious side effects.

 Tramadol is a synthetic analog of the phenanthrene alkaloid codeine and,

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, as such, is an opioid and also a prodrug (codeine is metabolized to morphine,

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tramadol is converted to O-desmethyltramadol),

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. Opioids are chemical compounds which act upon one or more of the human opiate receptors. The euphoria and respiratory depression are mainly caused by the ?1 and ?2 receptors; the addictive nature of the drug is due to these effects as well as its serotonergic/noradrenergic effects. The opioid agonistic effect of tramadol and its major metabolite(s) are almost exclusively mediated by the substance's action at the ?-opioid receptor. This characteristic distinguishes tramadol from many other substances (including morphine) of the opioid drug class, which generally do not possess tramadol's degree of subtype selectivity.

Once you notice that you have difficulty in breathing or tightness of the chest,

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, swelling of eyelids, face or lips, develop rash or hives,

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then it is high time that you tell your doctor about it the soonest possible time. It is also important that you avoid alcohol when taking tramadol. Meanwhile, women who are planning on becoming pregnant must consult it first with a doctor so he can discuss the benefits and risks of using tramadol during pregnancy,

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. Tramadol is excreted in breast milk so it is only logical for women to avoid breastfeeding while taking tramadol. 

The dosage of tramadol or any change in the prescription should only be done after consulting with your doctor. If you notice any unpleasant side effects caused by this drug, then you need to talk to your doctor about it,

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. It is better to be honest about any adverse reactions of your present medication so that immediate remedy can be provided. 

The most commonly reported adverse drug reactions are nausea, vomiting, sweating and constipation. Drowsiness is reported, although it is less of an issue than for non-synthetic opioids. Patients prescribed tramadol for general pain relief with or without other agents have reported withdrawal symptoms including uncontrollable nervous tremors, muscle contracture,

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, and 'thrashing' in bed (similar to restless leg syndrome) if weaning off the medication happens too quickly,

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. Anxiety, 'buzzing', 'electrical shock' and other sensations may also be present,

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similar to those noted in Effexor withdrawal. Anecdotally, tramadol is widely regarded by chronic pain sufferers as being among the most difficult of the pain medications to stop after prolonged administration, as withdrawal from both the serotonergic/noradrenergic and the mu-opioid effects is present. Respiratory depression, a common side-effect of most opioids, is not clinically significant in normal doses. By itself, it can decrease the seizure threshold. When combined with SSRIs,

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tricyclic antidepressants, or in patients with epilepsy, the seizure threshold is further decreased,

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. Seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg). However,

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there have been several rare cases of people having grand-mal seizures at doses as low as 100–400 mg orally.

Tramadol can also be taken in combination with Carbamazepine and it is normally prescribed for the treatment of epilepsy and bipolar disorder. Carbamazepine also lessens the effect of tramadol,

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. However, you should be careful about drug interactions as it can lead to unwanted side effects or prevent the medicine in easing your pain,

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. When this happens, you need to consult a health care professional if you have questions on drug interactions with tramadol. 



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