Tramadol use over an extended period of time can lead to habit formation. Tramadol should be taken as prescribed. Do not take it in larger amounts, more frequently, or otherwise differently than prescribed by your doctor. Discuss your pain management strategies, course of therapy, and other options with your doctor while you are taking tramadol. Inform your doctor if you or any members of your family regularly use excessive amounts of alcohol, use illicit drugs, abuse prescription drugs, or have ever experienced depression or another mental disease. If you currently have or have previously had any of these conditions, there is a larger chance that you may abuse tramadol. If you suspect that you may have an opioid addiction, speak with your doctor right away and ask for advice, or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

Breathing issues from tramadol can be severe or even fatal, especially in the first 24 to 72 hours of treatment and if the dose is raised. Throughout your therapy, your doctor will keep a close eye on you. If you have asthma or slow breathing, let your doctor know. Most likely, your doctor will advise against taking tramadol. Inform your physician if you have ever experienced lung disease, such as chronic obstructive pulmonary disease (COPD), a group of illnesses that damage the lungs and airways. Also mention any head injuries you may have had, as well as any conditions that cause your brain to become more pressurised. If you are an older adult, frail, or undernourished as a result of a sickness, your risk of developing breathing issues may be higher. Call your doctor right away or seek emergency medical attention if you have any of the following symptoms: breathing slowly, holding their breath for a lengthy time, or having trouble breathing.

Tramadol use in children has been linked to significant and fatal respiratory issues, including deaths and slow or difficult breathing. Never provide tramadol to a child under the age of 12 for pain management, and never give it to a child under the age of 18 for pain relief following surgery to remove their tonsils and/or adenoids. Tramadol should also not be administered to children between the ages of 12 and 18 who are obese, suffer from neuromuscular disorders (diseases that affect the nerves that control voluntary muscles), lung conditions, or obstructive sleep apnea (a condition in which the airway narrows or becomes blocked and breathing stops briefly while sleeping), as these conditions may increase the likelihood that they will experience breathing issues.

While receiving tramadol treatment, taking certain other medications may raise your chance of developing breathing issues or other severe, life-threatening respiratory issues, drowsiness, or coma. Inform your physician if you are now taking or intend to take any of the following drugs: benzodiazepines including alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam, and triazolam (Halcion); some antifungal drugs like itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); erythromycin (Erytab, Erythrocin); carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril); some HIV drugs, such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra); muscle relaxants, phenytoin (Dilantin, Phenytek), quinidine (in Nuedexta), rifampin (Rifadin, Rimactane, in Rifamate), sedatives, sleeping pills, or tranquillizers are examples of drugs for mental illness, nausea, or pain. Your doctor will closely monitor you and may need to adjust the dosage of your drugs. Call your doctor right away if you experience any of the following symptoms after taking tramadol with any of these drugs: unusual dizziness, lightheadedness, excessive drowsiness, slowed or laboured breathing, or unresponsiveness. If you are unable to seek treatment on your own, make sure your carer or family members are aware of any symptoms that may be dangerous so they can contact the doctor or emergency services.

You run a higher chance of developing these severe, sometimes fatal adverse effects while taking tramadol if you consume alcohol, use prescription or over-the-counter products that contain alcohol, or use illicit substances. During your therapy, refrain from drinking alcohol, using illicit substances, or taking any prescription or over-the-counter medications that include alcohol.

If you are pregnant or want to become pregnant, let your doctor know. Regular tramadol use during pregnancy increases the risk of your unborn child developing potentially fatal withdrawal symptoms. If your infant exhibits any of the following symptoms, contact your doctor straight away: irritability, hyperactivity, disturbed sleep, high-pitched crying, excessive shaking of a body part, vomiting, diarrhoea, or failure to gain weight.

Do not chew, split, divide, crush, or dissolve the tramadol extended-release pill or capsule; instead, swallow them whole. After placing each tablet in your mouth, immediately swallow it. You might consume too much tramadol at once if you ingest broken, chewed, crushed, or dissolved extended-release medications. This could result in significant issues, including overdose and death.

Do not share your medication with anybody else. Other individuals who take your drug, particularly youngsters, could be harmed or killed by tramadol.

Every time you get a tramadol prescription refill, your doctor or pharmacist will provide you the manufacturer’s patient information leaflet (Medication Guide). If you have any questions, carefully read the material and contact your doctor or pharmacist. The Medication Guide is also available on the manufacturer’s website or the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm).

The painkiller tramadol is used to treat mild to moderately severe pain. Only those who anticipate a constant need for pain relief should use the extended-release tablets and capsules of tramadol. The group of drugs known as opiate (narcotic) analgesics includes tramadol. It functions by altering how the nerve system and brain react to pain.

There are three oral dosage forms of tramadol: tablets, capsules, and extended-release (long-acting) tablets. The standard pill is typically taken every 4 to 6 hours as needed, with or without food. Every day, one extended-release tablet and one extended-release capsule should be taken. At roughly the same time each day, take the extended-release tablet and the extended-release capsule. You can consume the extended-release capsule either with or without food. If you’re taking an extended-release tablet, you should either take it without food or with food every time. Follow the tramadol directions exactly. Do not take more medication than your doctor has prescribed, either in a single dose or over the course of the day. Tramadol may have fatal side effects if used in excess of the specified dosage or in an unsafe manner.

If you are taking regular tablets or orally disintegrating tablets, your doctor may start you on a low dose of tramadol and gradually increase the dosage you take. If you are taking extended-release tablets or extended-release capsules, your doctor may increase the dosage every five days rather than more frequently than every three days.

Without consulting your doctor, do not discontinue taking tramadol. Your dose will likely be gradually reduced by your doctor. You may experience withdrawal symptoms if you abruptly stop taking tramadol, including anxiety, panic, sweating, difficulty falling or staying asleep, runny nose, sneezing, or coughing, pain, hair standing on end, chills, nausea, uncontrollable shaking of a part of your body, diarrhoea, and, in rare cases, hallucinations (seeing things or hearing voices that do not exist).

Ask your doctor or pharmacist for more details if you’re interested in using this drug for any other conditions.

Before taking tramadol,

• If you have any allergies, including those to any of the substances in tramadol tablets, extended-release tablets, or extended-release capsules, tell your doctor and pharmacist right away. Get a list of the components from your pharmacist.
• Any of the following monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine, should be disclosed to your doctor or pharmacist (Parnate). If you are now taking any of these drugs or have in the last two weeks, your doctor probably won’t let you take tramadol.
• Inform your doctor and pharmacist about any additional prescription and over-the-counter drugs, vitamins, and dietary supplements you are currently taking or intend to take. Incorporate any of the following: ‘Blood thinners’ or anticoagulants like warfarin (Coumadin, Jantoven);  cyclobenzaprine (Amrix), dextromethorphan (found in many cough medicines; in Nuedexta), digoxin (Lanoxin), diuretics (‘water pills,’ lithium (Lithobid), bupropion (Aplenzin, Wellbutrin, Zyban), dextromethorphan (found in many cough treatments); some migraine drugs, including almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig); promethazine; mirtazapine (Remeron); 5-HT3 receptor antagonists such alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra), fluvoxamine (Luvox); tricyclic antidepressants such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor, Zonalon), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine are also known as serotonin norepinephrine reuptake inhibitors (Surmontil). Inform your doctor about any drug you are taking, even those not on this list, as many other drugs may also interact with tramadol. The dosage of your drugs may need to be adjusted, and your health may need to be closely watched for any negative effects.
• Inform your doctor about any herbal medications you are taking, notably tryptophan and St. John’s wort.
• Inform your doctor if you have paralytic ileus, a blockage or constriction of your stomach or intestines, or any of the disorders listed in the IMPORTANT WARNING section (condition in which digested food does not move through the intestines). If you suffer from any of these diseases, your doctor could advise you to avoid taking tramadol.
• Inform your doctor if you currently have or have ever had seizures, an infection in your brain or spine, a problem urinating, suicidal thoughts or plans, or liver or kidney problems.
• Inform your doctor if you are nursing a child. Tramadol should not be taken while nursing a baby. Tramadol may result in irregular or noisy breathing, shallow breathing, disorientation, unusual tiredness, difficulties nursing, or limpness in breastfed babies.
• You should be aware that this medicine may lower both male and female fertility. The dangers of using tramadol should be discussed with your doctor.
  Inform your doctor or dentist that you are taking tramadol if you are having surgery, including dental surgery.
• It’s important to be aware that this drug may cause you to feel sleepy and may impair your coordination. Prior to understanding how this drug affects you, avoid using machinery or driving a car.
• You should be aware that tramadol can make you feel faint, woozy, or dizzy when you stand up from a reclining position. To prevent this, carefully get out of bed and sit up after putting your feet down for a while.
• You should be aware that the orally disintegrating pills contain aspartame, a source of phenylalanine, if you have phenylketonuria (PKU), a genetic disorder that requires a particular diet to be followed in order to prevent mental retardation.
• It’s important to be aware that tramadol can cause constipation. To treat or prevent constipation, discuss with your doctor modifying your diet and taking additional drugs.

Keep eating normally unless your doctor instructs you otherwise.

Take the missed dose of tramadol as soon as you remember it if your doctor has prescribed it to you on a regular basis. If the next dose is soon due, skip the missed one and carry on with your regular dosing plan. To make up for a missing dose, do not take a second one.

Tramadol’s negative effects could occur. If any of these symptoms are severe or do not go away, let your doctor know right once:

• Sleepiness
• Having trouble falling or staying asleep
• Headache
• Nervousness
• Body part shaking that is uncontrollable
• Muscle tightness
• Modifications in mood
• Indigestion or heartburn
• Mouth ache

Some adverse effects may be severe. You should call your doctor right away or seek emergency medical attention if you develop any of these signs or those listed in the IMPORTANT CAUTION section:

• Seizures
• Hives
• Rash
• Blisters
• Breathing or swallowing challenges
• Swelling of the lower legs, hands, feet, ankles, face, throat, tongue, and lips
• Hoarseness
• Hallucinations (seeing or hearing objects or voices that aren’t there), agitation, sweating excessively, confusion, rapid heartbeat, shivering, extremely rigid or twitching muscles, loss of coordination, nausea, vomiting, or diarrhoea
• Nausea, vomiting, appetite loss, exhaustion, or lightheadedness
• Failure to achieve or maintain erection
• Abnormal menstruation
• Reduced sexual arousal
• Alterations in heartbeat
• Consciousness loss

You or your doctor can submit a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting programme online or by phone if you have a serious side event (1-800-332-1088).

Further negative effects of tramadol could exist. If you have any strange side effects while taking this medicine, let your doctor know right away.

Keep this medication tightly closed in the original container and out of the reach of children. Keep it away from excessive heat and moisture at room temperature (not in the bathroom).

Although many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning. http://www.upandaway.org

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the easiest approach to get rid of your medication. To find out about take-back programmes in your area, speak with your pharmacist or the garbage/recycling department in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medications website at http://goo.gl/c4Rm4p for additional information.

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Moreover, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

If you take tramadol, your doctor might advise you to keep naloxone, a life-saving drug, on hand at all times (e.g., home, office). Naloxone is used to undo an overdose’s potentially fatal consequences. To treat harmful symptoms brought on by excessive levels of opiates in the blood, it functions by inhibiting the effects of opiates. If you overdose on opiates, you probably won’t be able to heal yourself. Make sure your family, carers, or those who spend time with you are aware of the signs of an overdose, how to administer naloxone, and what to do until emergency assistance arrives. You and your family members will be shown how to use the medication by your doctor or pharmacist. For the directions, speak to your pharmacist or go to the manufacturer’s website. If someone notices that you are exhibiting overdose symptoms, they should provide your initial dose of naloxone, dial 911 right away, and stay by your side while keeping a careful eye on you until emergency medical assistance comes. After receiving naloxone, your symptoms can come back a short while later. The person should administer you another dose of naloxone if your symptoms come back. If symptoms reappear before receiving medical attention, more doses may be given every 2 to 3 minutes.

Overdose signs could include the following:

• Shrinkage of the pupil (the black circle in the centre of the eye)
• Having trouble breathing
• Extreme somnolence
• Unconsciousness
• Coma (loss of consciousness for a period of time)
• Reduced heart rate
• Muscle tremor
• Clammy, frigid skin

Keep all of your appointments with your physician and the lab. To monitor how your body is responding to tramadol, your doctor may request specific lab tests.

Inform your doctor and the lab staff that you are taking tramadol prior to any laboratory test (particularly ones involving methylene blue).

No one else should take your medication. The drug tramadol is under strict monitoring. Only a limited amount of refills are permitted for prescriptions; if you have any doubts, speak with your pharmacist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.