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- To be prescribed only by healthcare providers knowledgeable in use of potent opioids for management of chronic pain.
- Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
- Individualize dosing based on the severity of pain, patient response, prior analgesic experience, and risk factors for addiction, abuse, and misuse.
- Do not exceed a daily dose of 300 mg tramadol. Do not use with other tramadol products.
- For opioid-naïve and opioid non-tolerant patients, initiate ULTRAM ER at a dose of 100 mg once daily, then titrate up by 100 mg increments every 5 days according to need and tolerance.
- For patients currently on tramadol IR, calculate total 24-hr IR dose, and initiate ULTRAM ER at a dose rounded down to next lower 100 mg increment; then adjust dose according to need and tolerance. See full prescribing information for instructions on conversion, titration, and maintenance of therapy. (2.2, 2.3) • Do not abruptly
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- constipation, nausea, sleepiness, vomiting, tiredness, headache, dizziness, abdominal pain, seizure. Call your healthcare provider if you have any of these symptoms and they are severe.
- Children younger than 12 years of age.
- Postoperative management in children younger than 18 years of age following tonsillectomy and/or adenoidectomy.
- Significant respiratory depression
Acute or severe bronchial asthma in an unmonitored setting or in absence of resuscitative equipment
- Known or suspected gastrointestinal obstruction, including paralytic ileus (4) • Hypersensitivity to tramadol
• Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days.