Ultram Frequently Asked Questions

What is ULTRAM?

Ultram (Tramadol hydrochloride) is a white, bitter, crystalline and odorless powder. Each ULTRAM tablet tablet tablet contains 50 mg of tramadol hydrochloride and is white in color. Ultram is supplied as a 50 mg (white, film-coated capsule-shaped tablet) which is engraved with "McNeil" on one side and on one side and "659" on the other side.

HOW DOES ULTRAM WORK?

ULTRAM acts on the central nervous system and unlike codeine and its derivative medications is a totally synthetic analgesic compound. Although its mode of action is not completely understood, from animal tests, at least two complementary mechanisms appear applicable: the binding of parent compound and its metabolite to opioid receptors and weak inhibition of reuptake of norepinephrine and serotonin by nerves located within the central nervous system. ULTRAM-induced analgesia is only partially reversed by the opiate antagonist naloxone in several animal tests. ULTRAM has been shown to inhibit reuptake of norepinephrine and serotonin in vitro. These mechanisms may contribute independently to the overall analgesic profile of ULTRAM. Analgesia in humans begins approximately within one hour after administration and reaches a peak in approximately two to three hours.

HOW EFFECTIVE IS ULTRAM?

ULTRAM has been given in single oral doses of 50, 75, 100, 150 and 200 mg to patients with pain following surgical procedures and pain following oral surgery (extraction of impacted molars). In single-dose models of pain following oral surgery, pain relief was demonstrated in some patients at doses of 50 mg and 75 mg. A dose of 100 mg of ULTRAM tended to provide analgesia superior to codeine sulfate 60 mg, but it was not effective as the combination of aspirin 650 mg with codeine phosphate 60 mg. In single-dose models of pain following surgical procedures, 150 mg provided analgesia generally comparable to the combination of acetaminophen 650 mg with propoxyphene napsylate 100 mg, with a tendency toward later peak effect. ULTRAM has been studied in three long-term controlled trials involving a total of 820 patients, with 530 patients receiving ULTRAM. Patients with a variety of chronic painful conditions were studied in double-blind trials of one to three months duration. Average daily doses of approximately 250 mg of ULTRAM in divided doses were generally comparable with five doses of acetaminophen 300 mg with codeine phosphate 30 mg (Tylenol with Codeine #3) daily, five doses of aspirin 325 mg with codeine phosphate 30 mg daily, or two to three doses of acetaminophen 500 mg with oxycodone hydrochloride 5 mg (Tylox) daily.

HOW DO I USE ULTRAM?

For the treatment of painful conditions ULTRAM 50 mg to 100 mg can be administered as needed for relief every four to six hours, not to exceed 400 mg per day. For moderate pain ULTRAM 50 mg may be adequate as the initial dose, and for more severe pain, ULTRAM 100 mg is usually more effective as the initial dose.

Individualization of Dose:

Patients 65 to 75 years of age: No dose adjustment is necessary.

Patients over 75 years old: No more then 300 mg/day in divided doses

Patients with kidney impairment: The dosing interval of ULTRAM should be increased to 12 hours with a maximum daily dose of 200 mg.

Dialysis patients: These patients can receive their regular dose on the day of dialysis.

Patients with cirrhosis: Recommended dosage is 50 mg every 12 hours.

Patients receiving chronic carbamazepine: Doses up to 800 mg daily may be required, this is up to twice the recommended dose of ULTRAM.

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