Tramadol HCl (Ultram®)

Tramadol HCl (Ultram®)
Tramadol HCl extended-release (Ultram ER, Ryzolt)

Tramadol HCl is a narcotic-like pain reliever for moderate to moderately severe pain, addiction may occur in some patients especially those who have abused alcohol or drug in the past.  Tramadol is not a NSAID (nonsteroidal anti-inflammatory drug), therefore, it does not increase the risk of stomach ulceration.  The maximum dose is 400 mg/day, the maximum dose for older than 75 years is 300mg/day.

For immediate release tablets; 50-100 mg  every 4-6 hours as needed for pain. 

For extended-release tablets;  100 mg per day, not to exceed 300 mg per day.

Preparations of Tramadol HCl:
  • Tablet, 50 mg for immediate release (Ultram®)
  • Tablet, 100, 200, 300 mg for extended release (Ryzolt)
  • Capsule, 100, 200, 300 mg for extended release (Ultram ER)
Tramadol HCl may cause withdrawal reaction, e.g., eyes watering, nausea, sweating, muscle pain, restlessness, if suddenly stop the medication especially in a long time or high doses users. To prevent the withdrawal effects, reduce the dose gradually.

Side effects:
  1. Dizziness, vertigo
  2. Nausea
  3. Constipation, upset stomach
  4. Headache
  5. Sleepy (Somnolence), drowsiness
  6. Vomiting
  7. Itching (Pruritus)
  8. Nervous, anxious
  9. Agitation
  10. Anxiety
  11. Tremor
  12. Spasticity (exhibiting spasm)
  13. Euphoria (elevated mood)
  14. Hallucination
  15. Weakness (Asthenia)
  16. Sweating (Diaphoresis)
  17. Indigestion (Dyspepsia)
  18. Dry mouth
  19. Diarrhea
  20. Vague feeling of discomfort (Malaise)
  21. Widening of blood vessels (Vasodilation)
  22. Confusion
  23. Contraction of the pupil (Miosis)
  24. Coordination disturbance
  25. Sleep disorder
  26. Abdominal pain
  27. Eating disorder (Anorexia)
  28. Flatulence (excessive gas in the intestinal tract)
  29. Increase tightness of muscle tone and reduce muscle capacity to stretch (Hypertonia)
  30. A red, blistering, skin rash
  31. Visual disturbance
  32. Urinary retention, urinary frequency
  33. Menopausal symptoms
  34. Allergic reaction (Swelling of the face, lips, tongue, lips or throat)
  35. Anaphylaxis
  36. Suicidal tendency
  37. Death
  38. Weight loss 
  39. Increase serotonin
  40. Serotonin syndrome (over reflexes, shivering, fever, tremor, agitation, sweating, seizures and coma)
  41. Orthostatic hypotension
  42. Partial or complete loss of conscious (Syncope)
  43. Rapid heart rate greater than 100 beats/minute (Tachycardia)
  44. Amnesia
  45. Depression
  46. Paresthesia
  47. Seizures
  48. Shortness of breath (Dyspnea)
  49. Stevens-Johnson syndrome (severe eruption of the skin and mucous membrane due to inflammation from an allergic reaction to drugs or substances)
  50. Loss sense of taste (Dysgeusia)
  51. Pain or difficulty urinating (Dysuria)
  52. Menstrual disorder
  53. Hypertension, hypotension
  54. Palpitation
  55. Pulmonary edema, pulmonary embolism
  56. Myocardial ischemia
  57. Migraine
  58. Speech disorder
  59. Gastrointestinal bleeding
  60. Hepatitis
  61. Stomatitis
  62. Liver failure
  63. Proteinuria
  64. Tinnitus, deafness
Drug interactions:

1. When combine Tramadol HCl with one of these drugs:
  • Quinidine, 
  • Fluoxetine, 
  • Paroxetine, 
  • Amitriptyline, 
  • Ketoconazole 
  • Erythromycin, 
The combination may reduce metabolic clearance of tramadol HCl, and increase the risk of serious adverse reaction such as Serotonin syndrome and seizures.

2. When combine Tramadol HCl with any of these drugs:
  • Antidepressant SSRIs and SNRIs
  • Monoamine oxidase inhibitors (MAOIs)
  • Triptans
  • Linezolid
  • Lithium
  • St.John's wart 
This combination affects the serotonergic neurotransmitter system. Physicians and dentists must carefully observe for sign of Serotonin syndrome at the initial dose and increased dose of Tramadol HCl.

3. When combine Tramadol HCl with an anticonvulsant and mood- stabilizing Carbamazepine (Tegretol, Equetro), drug used primarily for treatment of epilepsy, bipolar disorder and trigeminal neuralgia, this combination may reduce analgesic effect of Tramadol HCl by increasing metabolism of Tramadol HCl.  Because of the seizures risk associated with Tramadol HCl, co-administer of Tramadol HCl and Carbamazepine is not recommended.

4. When combine Tramadol HCl with Quinidine (Quinidine gluconate, Quinidine sulfate), an antiarrhythmic drug, this combination may increase Tramadol HCl concentration.  The clinical consequence is unknown.

5. In a rare event, the combination administration of Tramadol HCl with Digoxin and Warfarin may result in Digoxin toxicity and elevation of prothrombin times.


Before taking this pharmaceutical, consider the potential benefits and risks to other alternative options.

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