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Acute Abdominal Conditions The administration of Ultram may complicate the clinical assessment of patients with acute abdominal conditions.

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Use in Renal and Hepatic Disease Impaired renal function results in a decreased rate and extent of excretion of tramadol and its active metabolite M1. In patients with creatinine clearances of less than 30 ml/min dosing reduction is recommended (see DOSAGE AND ADMINISTRATION).

Metabolism of tramadol and M1 is reduced in patients with advanced cirrhosis of the liver, tramadol and aleve. In cirrhotic patients, dosing reduction is recommended (see DOSAGE AND ADMINISTRATION).

With the prolonged half-life in these conditions, achievement of steady state is delayed, so that it may take several days for elevated plasma concentrations to develop.

Information for Patients Patients being treated with Ultram should receive the following information:

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

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Teratogenic Effects: tramadol and aleve, Usage in Pregnancy Pregnancy Category C There are no adequate and well-controlled studies in pregnant women. Ultram should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

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