Ultram contains the active ingredient tramadol hydrochloride, which is available in tablet form for oral administration. Tramadol is an opioid agonist and each tablet contains 50 mg of tramadol hydrochloride. Inactive ingredients include pregelatinized starch, lactose anhydrous, magnesium stearate, and microcrystalline cellulose.

How should I use this medication?

Take this medication by mouth with a full glass of water. Take it as directed on the prescription label. You can take it with or without food. If it upsets your stomach, take it with food. Do not take it more often than directed. A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time. Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once. NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

Where should I keep my medication?

Keep this medication out of reach of children and pets. Store it out of sight in a safe place. Do not share it with others. Misuse of this medication is dangerous and against the law. Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Get rid of any unused medication after the expiration date. This medication may cause harm and death if it is taken by other adults, children, or pets. It is important to get rid of the medication as soon as you no longer need it or it is expired. To get rid of this medication: -Take the medication to a take-back program. Check with your pharmacy or law enforcement to find a location. -Follow the steps given to you by your pharmacy. You may be given a pre-paid mail-back envelope or disposal product to safely get rid of your medication. -If other options are not available, check the package insert or medication guide to see if it should be flushed down the toilet or put in your trash at home. If you are not sure, ask your care team. If it is safe to put it in your trash, empty the medication out of the container. Mix it with cat litter, dirt, used coffee grounds, or another unwanted substance. Seal the mixture in a container, such as a plastic bag. Put it in the trash.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible: -Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat -CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, difficulty staying awake -Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness -Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision -Low blood sugar (hypoglycemia)—tremors or shaking, anxiety, sweating, cold or clammy skin, confusion, dizziness, rapid heartbeat -Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion -Redness, blistering, peeling, or loosening of the skin, including inside the mouth -Seizures Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome): -Constipation -Dizziness -Drowsiness -Dry mouth -Headache -Nausea -Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions: -Brain tumor -Frequently drink alcohol -Head injury -Kidney disease -Liver disease -Lung or breathing disease, such as asthma -Seizures -Stomach or intestine problems -Substance use disorder -Suicidal thoughts, plans, or attempt by you or a family member -Taken an MAOI, such as Marplan, Nardil, or Parnate in the last 14 days -An unusual or allergic reaction to tramadol, other medications, foods, dyes, or preservatives -Pregnant or trying to get pregnant -Breastfeeding

What may interact with this medication?

Do not take this medication with any of the following: -Linezolid -MAOIs, such as Marplan, Nardil, and Parnate -Methylene blue -Ozanimod This medication may also interact with the following: -Alcohol -Antihistamines for allergy, cough, and cold -Atropine -Certain antibiotics, such as erythromycin, clarithromycin, rifampin -Certain antivirals for HIV or hepatitis -Certain medications for anxiety or sleep -Certain medications for bladder problems, such as oxybutynin, tolterodine -Certain medications for depression, such as amitriptyline, bupropion, fluoxetine, paroxetine, sertraline -Certain medications for fungal infections, such as ketoconazole, itraconazole, or posaconazole -Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan -Certain medications for Parkinson disease, such as benztropine, trihexyphenidyl -Certain medications for seizures, such as carbamazepine, phenobarbital, primidone -Certain medications for stomach problems, such as dicyclomine, hyoscyamine -Certain medications for travel sickness, such as scopolamine -Digoxin -Diuretics -General anesthetics, such as halothane, isoflurane, methoxyflurane, propofol -Ipratropium -Medications that relax muscles for surgery -Other opioid medications for pain -Phenothiazines, such as chlorpromazine, mesoridazine, prochlorperazine, thioridazine -Quinidine -Warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Tell your care team if your pain does not go away, if it gets worse, or if you have new or a different type of pain. You may develop tolerance to this medication. Tolerance means that you will need a higher dose of the medication for pain relief. Tolerance is normal and is expected if you take this medication for a long time. Taking this medication with other substances that cause drowsiness, such as alcohol, benzodiazepines, or other opioids can cause serious side effects. Give your care team a list of all medications you use. They will tell you how much medication to take. Do not take more medication than directed. Call emergency services if you have problems breathing or staying awake. Long term use of this medication may cause your brain and body to depend on it. This can happen even when used as directed by your care team. You and your care team will work together to determine how long you will need to take this medication. If your care team wants you to stop this medication, the dose will be slowly lowered over time to reduce the risk of side effects. Naloxone is an emergency medication used for an opioid overdose. An overdose can happen if you take too much of an opioid. It can also happen if an opioid is taken with some other medications or substances such as alcohol. Know the symptoms of an overdose, such as trouble breathing, unusually tired or sleepy, or not being able to respond or wake up. Make sure to tell caregivers and close contacts where your naloxone is stored. Make sure they know how to use it. After naloxone is given, the person giving it must call emergency services. Naloxone is a temporary treatment. Repeat doses may be needed. This medication may affect your coordination, reaction time, or judgment. Do not drive or operate machinery until you know how this medication affects you. Sit up or stand slowly to reduce the risk of dizzy or fainting spells. Drinking alcohol with this medication can increase the risk of these side effects. This medication may cause serious skin reactions. They can happen weeks to months after starting the medication. Contact your care team right away if you notice fevers or flu-like symptoms with a rash. The rash may be red or purple and then turn into blisters or peeling of the skin. Or, you might notice a red rash with swelling of the face, lips, or lymph nodes in your neck or under your arms. This medication will cause constipation. If you do not have a bowel movement for 3 days, call your care team. Your mouth may get dry. Chewing sugarless gum or sucking hard candy and drinking plenty of water may help. Contact your care team if the problem does not go away or is severe. Talk to your care team if you may be pregnant. Prolonged use of this medication during pregnancy can cause temporary withdrawal in a newborn. Talk to your care team before breastfeeding. Changes to your treatment plan may be needed. If you breastfeed while taking this medication, seek medical care right away if you notice the child has slow or noisy breathing, is unusually sleepy or not able to wake up, or is limp. Long-term use of this medication may cause infertility. Talk to your care team if you are concerned about your fertility.

What are the most serious risks of this medication?

Tell your healthcare provider if you are pregnant or trying to get pregnant. If you take this medicine while pregnant, your newborn baby may have withdrawal symptoms that can be life-threatening. Your baby will need special care after delivery. This medicine can cause serious breathing problems that need emergency treatment. Do not use this medicine in children under 12 years of age. In Adolescents 12 to 18 years of age, do not use this medicine for pain after tonsil or adenoid surgery or if the patient has risks for breathing problems like asthma or sleep apnea. Using this medicine, even when using it as directed, can lead to misuse, abuse, or addiction. Misuse, abuse, or addiction can result in overdose and death. This medicine is a CNS depressant. It should be used carefully with other CNS depressant medicines. Taking more than one CNS depressant has a risk of deadly breathing problems. CNS depressants include: opioid pain medicines; opioid cough medicines; benzodiazepines; certain other sleep medicines and tranquilizers; muscle relaxants; antipsychotics; and alcohol in drinks or medicines. A healthcare provider can help identify which prescriptions, over-the-counter medicines, and supplements are CNS depressants. Get emergency medical help right away for anyone taking more than one CNS depressant who has unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. This medicine has a risk of overdose. Starting or stopping certain medicines may increase this risk. Talk to your healthcare provider about all medicines you take before making any changes. Get emergency help if you take too much of this medicine. Never give it to anyone else. They can have a deadly overdose from just 1 dose of this medicine. Store it in a safe place and away from children.