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Tramadol is a synthetic, centrally-acting analgesic used parenterally and orally for the treatment of moderate to severe pain. While tramadol was not granted marketing consent in New Zealand until 1997, and it is not currently listed in the Pharmaceutical Schedule, experience in other countries dates back more than 20 years. In 1998, tramadol became the most used centrally-acting analgesic worldwide; outselling morphine in dollars turned over.1 The success of tramadol is mainly a result of its favourable side effect profile, which differs significantly from that of other opioids.
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Possible uses of Tramadol
Tramadol is an analgesic used to treat or prevent pain.

How to take Tramadol
Follow the directions for using this medicine provided by your doctor. Store this medicine at room temperature, away from heat and light. If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Side Effects
Side effects, that may go away during treatment, include dizziness, nausea, drowsiness, dry mouth, constipation, headache, or sweating. If they continue or are bothersome, check with your doctor. Check with your doctor as soon as possible if you experience skin rash, itching, seizures, or hallucinations. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist.

Precautions
Do not exceed the recommended dose or take this medicine for longer than prescribed. If you experience difficulty breathing or tightness of chest; swelling of eyelids, face, or lips; or develop a rash or hives, tell your doctor immediately. Do not take any more of this medicine unless your doctor tells you to do so. Avoid alcohol while you are using this medicine. This medicine will add to the effects of alcohol and other depressants. Do not drive, operated machinery, or do anything else that could be dangerous until you know how you react to this medicine. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Before you begin taking any new medicine, either prescription or over-the-counter, check with your doctor or pharmacist. For women: if you plan on becoming pregnant, discuss with your doctor the benefits and risks of using this medicine during pregnancy. This medicine is excreted in breast milk. Do not breast-feed while taking this medicine.

Drug Interactions
Inform your doctor about all the medicines you take with and without a prescription.

Missed Dose
If you miss a dose, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the amount used to catch up.

Storage
Store at room temperature away from sunlight. Keep this and all medications out of the reach of children.

Notes
DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS PRODUCT out of the reach of children. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out.

Tramadol

Why is Tramadol prescribed?

Tramadol is used to relieve moderate to moderately severe pain. It may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain. Tramadol is in a class of medications called opiate (narcotic) analgesics. It works by decreasing the body's sense of pain.

How should this medicine be used?

Tramadol comes as a tablet to take by mouth. It may be taken with or without food. Your doctor may start you on a low dose of tramadol and gradually increase your dose not more often than every 3 days. Tramadol may be taken every 4¨C6 hours as needed. If you take too much tramadol, you may experience serious side effects.Ask your doctor about the maximum number of tablets that you may take for each dose or for a 24-hour period.Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take tramadol exactly as directed.

Tramadol can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Call your doctor if you find that you want to take extra medication or notice any other unusual changes in your behavior or mood.

Do not stop taking tramadol suddenly without talking to your doctor. If you suddenly stop taking tramadol, you may experience side effects. Your doctor will probably decrease your dose gradually.If you suddenly stop taking tramadol you may experience withdrawal symptoms such as nervousness; panic; sweating; difficulty falling asleep or staying asleep; runny nose, sneezing, or cough; numbness, pain, burning, or tingling in your hands or feet; hair standing on end; or rarely, hallucinations (seeing things or hearing voices that do not exist).

Other uses for this medicine

Tramadol is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking tramadol,

tell your doctor and pharmacist if you are allergic to tramadol or other narcotic pain medications such as meperidine (Demerol), morphine, codeine (or medications that contain codeine such as Tylenol with Codeine), hydrocodone (e.g., Vicodin), hydromorphone (e.g., Dilaudid), oxycodone (e.g., Percocet), propoxyphene (e.g., Darvon, Darvon N), any other medications, or corn.
tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); antihistamines; bupropion (Wellbutrin);celecoxib (Celebrex); cimetidine (Tagamet);cyclobenzaprine (Flexeril); digoxin (lanoxin); doxorubincin (Adriamycin);haloperidol (Haldol); imipenem and cilastatin (Primaxin); methadone (Dolophine, Methadose); monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate); medications for anxiety, mental illness, nausea, pain; medications for seizures, such as carbamazepine (Tegretol); metoclopramide (Reglan); nefazodone; promethazine (Phenergan); quinidine (Quinaglute; Quinidex); ranitidine (Zantac); ritonavir (Norvir, in Kaletra); sedatives; sleeping pills; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); ticlopidine (Ticlid); tranquilizers; tricylic antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil);venlafaxine (Effexor);warfarin (Coumadin). Many other medications may also interact with tramadol, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you have or have ever had seizures, head injury, infection in your brain or nervous system, increased intracranial pressure (increased pressure within the skull), diabetes, breathing problems or lung disease, or kidney or liver disease. Also tell your doctor if you drink or have ever drunk large amounts of alcohol, use or have ever used street drugs, or have overused prescription medications.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking tramadol, call your doctor.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking tramadol.
you should know that this drug may make you drowsy and may affect your coordination. Do not drive a car or operate machinery until you know how this drug affects you.
remember that alcohol can add to the drowsiness caused by this drug. The manufacturer states that tramadol should not be taken with alcohol containing beverages.
you should know that tramadol may cause dizziness, lightheadedness, and fainting when you get up from a lying position. To avoid this, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can Tramadol cause?

Tramadol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

dizziness
weakness
headache
nervousness or anxiety
agitation
shaking hands that you cannot control
increased muscle tightness
changes in mood
drowsiness
blurred vision
heartburn or indigestion
upset stomach
vomiting
diarrhea
constipation
itching
sweating
flushing
dry mouth

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

hives
rash
sores on the inside of your mouth, nose, eyes, or throat
flu-like symptoms
itching
difficulty swallowing or breathing
swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
fast heartbeat
hoarseness
difficulty swallowing or breathing
changes in urination
seeing things or hearing voices that do not exist (hallucinating)
seizures

What storage conditions are needed for this medicine?

Keep Tramadol in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

confusion
vomiting
decreased size of the pupil (the black circle in the center of the eye)
difficulty breathing
extreme drowsiness
unconciousness
coma
seizure
heart attack

What other information should I know?

Keep all appointments with your doctor.

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Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

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

The molecular weight of tramadol hydrochloride is 299.8.Tramadol hydrochloride is a white, bitter, crystalline and odorless powder. It is readily soluble in water and ethanol and has a pKa of 9.41.The n-octanol/water log partition coefficient (logP) is 1.35 at pH 7. ULTRAM tablets contain 50 mg of tramadol hydrochloride and are white in color. Inactive ingredients in the tablet are corn starch, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80,sodium starch glycolate, titanium dioxide and wax.

ULTRACET (tramadol hydrochloride/acetaminophen) Tablets combines two analgesics, tramadol 37.5 mg and acetaminophen 325 mg.

The chemical name for tramadol hydrochloride is (±)cis-2-[(dimethylamino)methyl]-1-(3-methoxyphenyl) cyclo-hexanol hydrochloride. Its structural formula is:

The molecular weight of tramadol hydrochloride is 299.84. Tramadol hydrochloride is a white, bitter, crystalline and odorless powder.

The chemical name for acetaminophen is N-acetyl-p-aminophenol. Its structural formula is:

　 Ultracet

The molecular weight of acetaminophen is 151.17. Acetaminophen is an analgesic and antipyretic agent which occurs as a white, odorless, crystalline powder, possessing a slightly bitter taste.