Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Asthma and other respiratory conditions: Tramadol extended release may cause increased breathing difficulty for people having an acute asthma attack or for those with chronic obstructive pulmonary disease (chronic bronchitis, emphysema) or other conditions that affect breathing. If you have asthma or other breathing disorders, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Breathing: Tramadol extended release can suppress breathing. People at risk for breathing suppression (e.g., people with head trauma) should be closely monitored by their doctor while taking this medication.
Dependence and withdrawal: This medication may become habit-forming if taken for long periods of time. Drug abuse is not a problem for people who require this medication for pain relief. If this medication is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shaking, pain, nausea, tremors, diarrhea, and hallucinations. Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms when this medication is no longer required for pain control.
Drowsiness/reduced alertness: This medication may cause drowsiness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.
Kidney function: The kidneys are partially responsible for removing tramadol from the body. Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severely decreased kidney function should not use tramadol.
Liver function: The liver is partially responsible for removing tramadol from the body. Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver disease or reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severely decreased liver function should not use tramadol.
Seizures: This medication may cause seizures, especially when higher doses are used or when taken with other medications that may increase the risk of seizures such as:
- monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine)
- neuroleptics (e.g., haloperidol, quetiapine, olanzapine, risperidone)
- opioids (e.g., morphine, codeine, oxycodone)
- selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine, fluoxetine, citalopram)
- tricyclic antidepressants (TCAs; e.g., amitriptyline, imipramine)
The risk of seizures is also higher for people with epilepsy, a history of seizures, or who are at risk of seizures (e.g., people with head trauma).
Serotonin syndrome: Severe reactions are possible when tramadol is combined with medications used to treat depression. The combination of tramadol and MAO inhibitors must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are also possible.
Surgery: Tramadol may interact with medications used during surgery. If you are scheduled for surgery, let your doctor know that you are taking this medication.
Pregnancy: The safety for both the mother and baby if this medication is used during pregnancy has not been determined. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking tramadol extended-release, it may affect your baby. You should avoid taking tramadol if you are breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children. This medication should not be used in people under 18 years of age.
Seniors: Seniors may be more likely to experience side effects from this medication, especially seniors over 75 years of age.