Cases of abuse and dependence on Ultram have been reported. Ultram should not be used in opioid-dependent patients. Since Ultram can reinitiate physical dependence, it is not recommended for patients with a tendency to drug abuse, a history of drug dependence, or chronically using opioids.

   Additionally, anyone who has had an allergic-type reaction to either Ultram or any product containing an opioid medicine (like Tylenol®* with Codeine) should not take Ultram.

   Talk with your doctor if you may be pregnant, or are trying to become pregnant, before using Ultram or any other medicine. Safe use during pregnancy has not been established.

   As with all prescription medicines, you should not share your Ultram tablets with anyone else. Also, you should not take medicines that have not been prescribed specifically for you.

   All prescription medicines should be taken under the medical supervision of your doctor.
*Tylenol® is a registered trademark of McNeil Consumer Products Company.

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   Ultram may be a good choice for people who need effective relief of chronic pain. This patient group may include: People at risk of stomach ulcers. Ultram has not been associated with ulcers or stomach bleeding in medical studies. People taking certain medicines to control their high blood pressure. Ultram does not interfere with the ways in which various blood pressure medicines work. People at risk of kidney problems. Ultram does not affect the hormone-like system that helps keep the kidneys working normally; this is a special consideration in older people.

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   There are certain medications that should be used with caution while taking Ultram. These other medications include tranquilizers, sleeping pills, antidepressants, and opioid pain medicines. Be sure to talk with your doctor about all other medicines you are taking before starting your prescription for Ultram.

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   Ultram should not be taken with alcohol-containing beverages.

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   All medicines, including Ultram, can cause side effects. People who experienced side effects with Ultram in medical studies usually did so at the beginning of treatment. The most frequently reported side effects experienced with Ultram were constipation, nausea, dizziness, headache, somnolence, and vomiting. Patients should talk to their doctors about any side effects they experience while taking Ultram.

   Ultram may impair your ability to drive a car or operate machinery.

   Seizures have been reported in patients taking Ultram. The risk of seizures is increased with doses of Ultram above the recommended range. You should not take more than 400 mg of Ultram (eight 50 mg tablets) per day.

   Ultram increases the risk of seizures in patients taking certain medications for other medical conditions (e.g., tricyclic antidepressants, selective serotonin re-uptake inhibitors, or opioids). Ultram may enhance the seizure risk in patients taking MAO inhibitors, neuroleptics, or other drugs that reduce the seizure threshold or in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections).

   Patients with a history of severe, life-threatening allergic (anaphylactoid) reactions to codeine and other opioids may be at increased risk and therefore should not receive Ultram.

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   You will get the best pain relief by following your doctor's instructions and taking Ultram as it was prescribed for you. Ultram may be taken with or without food. You may find it easiest to take your Ultram tablets at the same times every day. In any case, you should not take more than the dose prescribed, and you should never take more than 2 tablets in a 4-hour period. Talk with your doctor and pharmacist about all of the medicines you are currently taking. Be sure to tell your doctor and pharmacist if you have any allergies, or if you have ever had an allergic reaction to any medicine. And report any unusual developments or problems that may appear.

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   Ultram should be stored at room temperature away from heat and direct light. Ultram should be kept in the same container in which you received it from the pharmacy. Remember, Ultram and all medications should be kept out of the reach of children.

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   Despite all of the remarkable progress in many areas of medicine in the recent past, pain remains one of the most difficult medical conditions to treat. This is especially true of chronic pain, which is prolonged pain caused by disease or pain that persists after an acute injury has healed. There are several reasons why:

• Precise medical evaluation of pain and its causes is often difficult.
• The type and intensity of pain can vary from one person to another.
• Different people respond differently to treatment.
• If you are like most people who have a chronic painful condition, your pain just won't go away and may actually make it hard for you to lead your life as you would like to.

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   Pain medication is only one way to manage pain effectively. There are some changes you can make in your daily life to help keep your pain under control. Your doctor may also recommend a number of other ways to control pain. Talk with your doctor about a daily plan that can help you.

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