Ultram (tramadol) Special Warnings

Ultram and Ultram ER and Seizure Risk

Seizures have occurred in people taking Ultram within the recommended dosage range. Your risk of seizure increases if you take doses above the recommended range.

Your risk of seizures also increases if you take Ultram along with any of the following:

  • Selective serotonin re-uptake inhibitors (SSRI anti depressants or appetite suppressants),
  • Tricyclic antidepressants (TCAs), and other tricyclic compounds (such as cyclobenzaprine, promethazine, etc.)
  • Other opioids
  • MAO inhibitors
  • Neuroleptics
  • Other drugs that may make you susceptible to seizures.

Your risk of seizures may also increase if you have

  • Epilepsy
  • A history of seizures
  • A recognized risk for seizure (such as head trauma,
  • metabolic disorders, alcohol and drug withdrawal, or central nervous system infections).


Ultram and Ultram ER and Suicide Risk

You should not take Ultram if you are suicidal or prone to addiction. If you are suicidal or prone to addiction you should consider using nonnarcotic pain relievers.

You should take Ultram with caution if your are:

  • Taking tranquilizers
  • Taking depression medicine
  • Drinking alcohol in excess
  • Suffer from emotional problems or depression

Tramadol (the main active ingredient in Ultram)-related deaths have occurred in people with histories of emotional problems, suicidal thoughts or attempts, and misuse of tranquilizers, alcohol and other central nervous system drugs.

Ultram and Ultram ER and Serotonin Syndrome


A rare, but potentially life-threatening condition called

serotonin syndrome may occur if you take Ultram with other medicines:

  • Serotonergic drugs such as SSRIs, SNRIs, TCAs, MAOIs, and triptans
  • Drugs which impair metabolism of serotonin (including MAOIs)
  • Drugs which impair metabolism of tramadol (CYP2D6 and CYP3A4 inhibitors)

This may occur even when you are taking the recommended dose of Ultram.

Serotonin syndrome may include symptoms such as:

  • Agitation
  • Hallucinations
  • Coma
  • Blood pressure changes
  • Nausea
  • Vomiting
  • Diarrhea
  • Feeling cold
  • Muscle rigidity

Written & reviewed by: Lisa Erwin R.Ph. CGP | Last review date: Dec 2010. Click the References Link below for a complete list of references.

Written & reviewed by: Lisa Erwin R.Ph. CGP | Last review date: Dec 2010.
View References