What is Tramadol?


Information regarding the drug tramadol hydrochloride, otherwise known as Ultram. A common pain reliever and alternative to narcotic pain killers. Tramadol is one of the more widely-prescribed drugs these days as an alternative to more potent pain relievers.


  • Tramadol, or Ultram, is a popular synthetic pain killer used in the treatment of moderate to moderately severe pain. Although not considered a narcotic pain killer, Tramadol is nonetheless addicting especially in the elderly population, in whom this drug is commonly prescribed.

Expert Insight

  • Tramadol's dosing recommendations set out by the manufacturer, Ortho-McNeil-Janssen Pharmaceuticals, is very specific: In adults, the initial dose is a 25 mg tablet in the morning which may be increased every three days by 25 mg until a 100 mg dose per day is reached. After this dose is reached, patients may be prescribed an increase of 50 mg every three days until a 200 mg dose per day is reached. The last increase, thereafter, may be 50 to 100 mg every 4 to 6 hours as needed, with a maximum dose per day of 400 mg. In elderly patients, it is important to maintain a no greater than 300 mg per day dose of Tramadol.
    If creatinine clearance levels reach less than 30 ml per minute, prescribers should increase dosage time intervals to every 12 hours with a maximum daily dose of 200 mg. If patients suffer from cirrhosis of the liver, only 50 mg every 12 hours should be prescribed.


  • Tramadol may increase the level of liver enzymes and may decrease creatinine and hemoglobin levels due to Travmadol's potentially toxic effect on the liver. Monitoring of these levels should be done in patients who take Tramadol on a regular basis. Caution should be used in patients who are also prescribed a selective serotonin reuptake inhibitor (SSRI) as Tramadol may increase the risk of serotonin syndrome.


  • People with an allergy to opiods and breastfeeding women should not take Tramadol. Serious allergic reactions usually occur after the initial dose and patients should be monitored closely. People who have ever experienced anaphylactic reactions, such as those with codeine or other opiods are at a higher risk for an allergic reaction with Tramadol. Patients at risk for respiratory compromise, those suffering from a head injury, or kidney or liver problems should also not take Tramadol.

Expert Insight

  • A patient's pain level should be reassessed 30 minutes after taking Tramadol. If a patient's respiratory rate falls below 12 breaths per minute, any scheduled dose should be withheld and the doctor, notified. Patient's may have an increased need for a laxative if more than three days pass and the patient does not have a bowel movement. Patients should be monitored for signs of dependence. Tramadol is a drug that requires tapering off as withdrawal symptoms may occur if the Tramadol is stopped suddenly. Advise the patient to consult their doctor before taking an over-the-counter drug while taking Tramadol as serious drug interactions may occur.

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