What is Tramadol ER: Uses, Warnings & Interactions

Take tramadol ER as directed. The dose may need to be changed several times before reaching the most effective dose.

Do not change the dose or take doses more often than once per day.

A Medication Guide should come with this medicine. If you don’t have one, ask the pharmacist for a copy.

Tramadol ER doses can be taken with a meal or on an empty stomach.

Doses are taken once per day. Take each day’s dose at the same time each day.

Swallow tramadol ER tablets or capsules whole. Do not crush, break, chew, dissolve, or open the tablets or capsules.

Store this medicine at room temperature out of the reach of children.

Drop off any unused narcotic medicine at a drug take-back location right away. If you do not have a drug take-back location near you, flush any unused narcotic medicine down the toilet. Check your local drug store and clinics for take-back locations. 

Skip any missed dose of tramadol ER.

Take the next day’s dose as scheduled.

Do not take two doses to make up for a missed dose.

Tramadol ER is not right for everyone. 

Do not use tramadol if you have:

• Known allergies to tramadol or other opioids

• Problems breathing 

• Acute or severe asthma

• Gastrointestinal blockage

Tell any doctor or other healthcare provider who treats you that you are using this medicine.

The prescriber will check your progress and the effects of this medicine at regular visits. Keep all appointments.

Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.

Before taking tramadol, tell the prescriber if you have a history of:

• Asthma or other lung problems

• Head injury

• Seizures

• Kidney problems

• Liver problems

• Pancreas problems

• Gallbladder problems

• Thyroid problems

• Urination problems

• Drug abuse

• Alcohol abuse

• Opioid overdose

• Mental health problems

The prescriber also needs to know if you are:

• Pregnant

• Breastfeeding

• Living with small children

• Living with anyone who has a history of substance abuse

Tramadol ER can cause serious and life-threatening problems including: 

• Respiratory depression (insufficient breathing)

• Dependence

• Abuse

• Opioid withdrawal

• Opioid withdrawal in a newborn

• Suicidal thoughts and behaviors

• Death

Other potentially severe side effects include:

• Sleep-related breathing problems (including sleep apnea and sleep-related oxygen deprivation)

• Unusual changes in mood or behavior

• Constipation or intestinal paralysis

• Serotonin syndrome 

• Low blood sugar

• Low sodium

• Severe allergic reactions

Tramadol can impair your judgment and cause drowsiness, lightheadedness, and dizziness. Do not drive or engage in any other risky activity until you know how this medicine affects you. 

Constipation is a common side effect of tramadol ER. Ask the prescriber about using laxatives to prevent or treat constipation.

Opioids can impair fertility. Talk to the prescriber if you’re trying to have a baby.

This medicine can be habit-forming. Do not use more than your prescribed dose. If the medicine doesn’t seem to be working, consult with the provider.

Tramadol is a federally controlled substance. Giving or selling this drug to anyone else is hazardous and a criminal offense.

Children and others have gotten hurt or died taking opioids. Keep this medicine locked up in a secure location out of the reach of children or visitors.

Do not use this medicine if you are using or have used an MAO inhibitor within the past 14 days.

Do not drink alcohol when taking tramadol ER.

To avoid drug interactions, tell the prescriber about all prescription drugs, over-the-counter medications, and supplements being taken, particularly:

• Other opioids including diarrhea treatments

• Drugs that make you sleepy such as sleeping pills, benzodiazepines, barbiturates, muscle relaxants, seizure medications, allergy medications, CBD, alcohol 

• Medicines that treat depression, anxiety, psychosis, or other mental health problems

• Migraine drugs called triptans

• Drugs that make you pee (diuretics)

• Macrolide antibiotics such as clarithromycin or erythromycin

• Azole antifungal drugs such as ketoconazole or itraconazole

• HIV drugs called protease inhibitors, such as ritonavir

• Anticholinergic drugs

• Digoxin, metaxalone, Paxlovid, quinidine, rifampin, warfarin

Do not start any new medications until consulting with the prescriber.