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Updated October 01, 2013

What Ultram Is:

Ultram (tramadol) is an analgesic (pain killer) prescribed for moderate to severe pain. It's an opiate (narcotic), and also a monoamine uptake inhibitor, which means that it makes more of certain neurotransmitters available to your brain.

Ultram is also used to treat most types of neuralgia. It's sometimes used off-label for restless legs syndrome, migraines, and obsessive-compulsive disorder. Ultram ER (extended release) is available for controlling severe chronic pain 24 hours a day.

How Ultram Works:

Ultram appears to work in a couple of ways: impacting certain opioid receptors in the brain; and increasing available amounts of serotonin and norepinephrine, which can be low in people with fibromyalgia.

Ultram for Fibromyalgia:

Ultram is not FDA approved for treating fibromyalgia pain, but it is sometimes prescribed off-label for the condition. There are a few studies demonstrating that it may be effective, including at least one that suggests it's the only analgesic demonstrated to help. An animal study published in June 2009 shows that it may be especially effective against the hyperalgesia of fibromyalgia when combined with Savella (milnacipran), but these results have not yet been replicated in humans.

Ultram Dosage:

To lessen the risk of side effects, Ultram is generally started at a dose of 25 mg a day and increased gradually to 100-200 mg a day. Be sure to follow your doctor and pharmacist's instructions on increasing your dosage. More than 400 mg per day is considered dangerous, 300 mg per day for those older than 75.

Ultram Side Effects & Warnings:

Side effects that you should report to your doctor right away include:

  • breathing difficulties or wheezing
  • confusing
  • itching
  • light headedness or fainting
  • red, blistering, peeling or loosening skin
  • seizures

Side effects that usually don't require immediate medical attention include:

  • constipation
  • dizziness
  • drowsiness
  • headache
  • nausea or vomiting

If these side effects continue or are a problem for you, talk to your doctor about them.

If you have a history of drug or alcohol addiction, you shouldn't take Ultram. This drug has caused seizures in some people, and can make it more likely that you'll have a seizure if you have a history of seizures, head injury, a metabolic disorder, or you're taking certain medications (antidepressants, muscle relaxers, drugs for nausea and vomiting.)

You may need a special dosage or tests to safely take Ultram if you have:

  • kidney disease
  • liver disease
  • a stomach disorder
  • history of depression, mental illness, or suicide attempts
Also note: When planning to stop taking Ultram, you will need to discontinue dosages slowly to avoid withdrawal symptoms.


Goldenberg DL. Best Practice & Research. Clinical Rheumatology. 2007 Jun;(3):499-511. "Pharmacological treatment of fibromyalgia and other chronic musculoskeletal pain."

Huynh CN, Yanni LM, Morgan LA. Journal of Women's Health. 2008 Oct;17(8):1379-87. "Fibromyalgia: diagnosis and management for the primary healthcare provider."

Kim SH, et al. Korean Journal of Internal Medicine. 2009 Jun;24(2):139-42. "Effect of the combined use of tramadol and milnacipran on pain theshold in an animal model of fibromyalgia."

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