Ultram dosage, forms, and strengths

Ultram (generic: tramadol) is a controlled substance used to treat moderate to severe pain. It is classified as a synthetic opioid as it acts on the central nervous system (CNS) to reduce pain receptors in the body. Currently, the exact mechanism of action for this opioid analgesic is still not well understood, but it is believed to prevent the reuptake of norepinephrine and serotonin in the brain. This increases the level of these chemicals in the bloodstream and creates a feeling of euphoria and well-being similar to codeine.

Although effective with the management of pain, it does not treat the cause. Ultram is the brand name, which is no longer available in the United States. Other brand names exist- Qdolo and ConZip—even with the discontinuation of Ultram. The generic form, tramadol hydrochloride (HCl), is still available and frequently used. This narcotic is usually taken by mouth every four to six hours when needed for pain.

RELATED: Non-narcotic pain meds and other pain management tips

Ultram forms and strengths

Prescriptions for Ultram come in either a solution, tablet, or capsule form. Here are the various treatment options available:

• Tablets: 50 milligrams (mg), 100 mg, 200 mg, or 300 mg

• Capsules: 100 mg, 200 mg, or 300 mg

• Solution: 5 mg per milliliters (mL)

Ultram dosage for adults

Prescribing Ultram properly for the management of moderate to severe pain in adults is critical to reduce potential adverse reactions.

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Ultram dosage for acute pain

Your healthcare provider may prescribe Ultram in the event that acute pain management is required. Some examples may include the management of pain after a surgical procedure or for acute trauma (fracture or soft tissue injury). Acute pain is typically treated with the immediate-release (IR) formula of Ultram.

• Standard dosage: One tablet every four to six hours can be taken when needed for pain. The lowest dose possible is usually recommended initially, which is 50 mg. 

• Maximum dosage: Do not exceed a total daily dose of 400 mg of Ultram.

• Renal impairment: Ultram should be avoided if the creatinine clearance is less than 30 mL/min or if someone is on dialysis. Others may take a max of 200 mg per day and the frequency should be given every 12 hours versus the four to six hours. No supplements required.

• Hepatic impairment: With severe impairment, the recommended dosage is 50 mg every 12 hours. 

• Seniors: People older than 75 years of age should not take more than 300 mg per day of Ultram.

Ultram dosage for chronic pain

Some health conditions may require long-term use of pain medication. Ultram may be prescribed for chronic pain management in cancer patients and those suffering with chronic pain conditions like arthritis, fibromyalgia, or neurological pain. The extended-release (ER) formula is usually a popular option for the management of these types of conditions.

• Standard dosage: One 100 mg tablet daily when needed for pain.

• Maximum dosage: The maximum amount for Ultram ER is 300 mg per day.

• Renally impaired: These patients should avoid using Ultram ER.

• Hepatically impaired: Ultram ER is not recommended for those with severe liver impairment.

RELATED: What are your chronic pain management options?

Ultram dosage for children

Currently, this form of opioid analgesic is not recommended for pediatric patients by the Food and Drug Administration (FDA) due to the potential hazards it may pose in this patient demographic. 

Ultram dosage for pets

Tramadol HCl is commonly used by veterinarians for the treatment of pain in dogs and cats. This is one of the few human pain drugs that is safe in managing pain in animals too. The amount of tramadol HCl prescribed for pets is based on the weight of the animal, so the same prescription for humans cannot be used. This medication should only be used under the guidance of a veterinarian.

• Standard dosage in dogs: 2 to 5 mg per pound orally every eight hours as needed for pain.

• Standard dosage in cats: 0.5 to 1 mg per pound orally every 12-24 hours as needed for pain. 

How to take Ultram

Ultram is usually taken by mouth as a tablet or capsule. Your healthcare provider may also inject the medication for you to provide faster relief of symptoms. Food does not alter the way Ultram is absorbed so it can be taken with or without food. Here are a few helpful tips when taking your prescription Ultram:

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.

• Make sure your hands are dry before you handle the disintegrating tablet. Peel back the foil from the blister pack, then remove the tablet. Do not push the tablet through the foil. Place the tablet in your mouth. After it has melted, swallow or take a drink of water.

• Swallow the extended-release tablet whole. Do not crush, break, or chew it.

• Drink plenty of liquids to help avoid constipation.

• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.

• 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. You can also check the DEA website for locations.

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Ultram dosage FAQs

Ultram vs. Ultram ER: What’s the difference in doses?

Ultram has both the IR and ER dosage forms to manage moderate to severe pain. Ultram ER is offered in 100 mg, 200 mg, and 300 mg tablets or capsules that are taken once daily. 

How long does it take Ultram to work?

Typically pain relief may be achieved within an hour after taking Ultram. The ER formula may take longer to start working as the medication is released gradually over time. However, the pain relief will last longer. If Ultram is taken in conjunction with another pain medication like acetaminophen or a nonsteroidal anti-inflammatory, pain relief may occur faster.

How long does Ultram stay in your system?

Because Ultram is absorbed in the bloodstream, there is a gradual onset of pain relief that eventually will meet its peak and then begin to gradually decline in its effectiveness of pain relief. In standard forms of Ultram, pain relief peaks at about two hours after taking the medication and will last for about six hours. Ultram ER pain relief peaks at about 12 hours but the relief lasts for about 24 hours.

What happens if I miss a dose of Ultram?

It is important to take Ultram as directed by your healthcare provider. Because Ultram is used for pain on an as-needed basis, there rarely is a missed dose. If a dose is missed, do not take more of the prescribed medication than what was directed. 

How long can you take Ultram?

Ultram should only be taken when prescribed by your healthcare provider and there is pain requiring the use of the medication. The length of time this medication will be needed will be determined by your provider. If the medication is needed for longer periods of time than expected, this will need to be reviewed by your doctor so a strategic plan on how to manage your pain with the least amount of narcotic medication possible can be made. Risk factors for addiction should always be discussed.

How do I stop taking Ultram?

It is important not to stop taking Ultram suddenly on your own as it may cause withdrawal syndrome. Withdrawal symptoms to look for include nausea, diarrhea, anxiety, sweating, difficulty sleeping, shivering, pain, tremors, or hallucinations, which are rare. The best approach to discontinue the medication is to discuss how to gradually reduce the amount of medication you are taking with your provider to reduce your chances of developing serious side effects from Ultram. 

What is the maximum dosage for Ultram?

The maximum dosage for Ultram IR is 400 mg per day and 300 mg per day of the ER version. Taking more than the daily maximum dose may be life-threatening.

Can you overdose on Ultram?

Risk of opioid overdose is high with Ultram if the medication is not taken as directed. Overdose may cause serious side effects and in some cases may become life-threatening. If severe drowsiness, pinpoint pupils, slow breathing, or no breathing occurs, emergent medical attention is required. A healthcare provider may provide naloxone to reverse the overdose symptoms if they occur.

What interacts with Ultram?

Breathing problems and withdrawal symptoms may occur when Ultram is combined with other medications. Individuals already diagnosed with asthma, sleep apnea, or other respiratory conditions should avoid Ultram due to increased risk of respiratory depression. 

Risk of seizures may occur with this type of opioid, especially in high doses. It is important that the lowest possible dose be given. 

Additionally, certain medications are more prone to cause seizures when used in combination with Ultram. Carbamazepine is an example and should not be used with this type of pain management drug as it increases the drug’s metabolism and decreases the effects of tramadol.

Antidepressants such as monoamine oxidase inhibitors (MAO inhibitors), serotonin-norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs) should be avoided with concomitant use of Ultram due to an increased risk of developing serotonin syndrome. Other side effects such as dry mouth, nausea, headache, and insomnia are associated with the use of MAOIs, which are also absolutely contraindicated with Ultram, whereas the other antidepressants—SNRIs and SSRIs—may be allowed if monitored closely. 

Please inform your healthcare provider if you are currently taking other narcotics, antibiotics, antifungals, antivirals, heart or blood pressure medications, or seizure medications, as these prescription drugs may pose serious side effects when combined with Ultram. Here are some medications that should be avoided while taking Ultram due to their potential drug interactions:

• Cisapride

• Dronedarone

• Fluconazole

• Isocarboxazid

• Linezolid

• Methylene blue injection

• Methylene blue oral

• Naltrexone

• Phenelzine

• Pimozide

• Posaconazole

• Procarbazine

• Quinidine 

• Rasagiline

• Safinamide

• Selegiline

• Selegiline transdermal

• Thioridazine

• Tranylcypromine

• Yohimbe

What happens when you mix Ultram and alcohol?

Alcohol and Ultram should never be used together. Both work as CNS depressants, so this mixture may lead to increasing the side effects of the other. This may be dangerous or even potentially fatal. 

Other drugs that act similarly to alcohol when combined with Ultram are anesthetics, muscle relaxants, and any tranquilizers such as benzodiazepines. The combination of these medications may lead to severe sedation, slowed breathing, and death. 

Alcohol or benzodiazepines can be resumed when Ultram is no longer being used and are no longer in the bloodstream. This is the safest way to ensure serious side effects from the medication do not occur.

Is it safe to take Ultram during pregnancy?

It is not recommended that Ultram be taken during pregnancy. Prolonged use of this medication may cause side effects such as potential dependency of the unborn child to opioids as well as withdrawal symptoms shortly after birth. 

Taking opioids such as codeine and tramadol while breastfeeding is also not suggested. There is concern of severe adverse reactions when breastfeeding infants and taking these prescription drugs. Adverse reactions in the infant to be aware of include excessive sleepiness, difficulty breastfeeding, and serious breathing problems, which may result in death.

Related resources for Ultram dosages:

• Mixing tramadol and alcohol: Effects and dangers, American Addiction Centers 

• Serotonin syndrome: Is it a reason to avoid the use of tramadol with antidepressants? Journal of Pharmacy Practice

• Adult dosing, Epocrates

• Tramadol for dogs: Uses and side effects, American Kennel Club

• Tramadol hydrochloride (Ultram) for dogs and cats, PetPlace

• Drug interactions, Epocrates

• Use of codeine and tramadol products in breastfeeding women: Questions and answers, FDA