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Ultram acts on the central nervous system (CNS) and unlike codeine is a totally synthetic pain relieving compound. Although Ultram’s biological process is not completely understood, at least two complementary mechanisms appear applicable: weak inhibition of reuptake of norepinephrine and serotonin by nerves located within the (CNS) and the binding of parent compound and its metabolite to opioid receptors. Ultram-induced pain relief is only partially reversed by the opiate antagonist Narcan in several animal tests.

Ultram has been shown to reduce reuptake of serotonin and norepinephrine in vitro. These mechanisms may contribute independently to the overall pain relief profile of Ultram. Pain relief in humans begins about one hour after administration and reaches maximum effect in about two to three hours.


For the treatment of painful symptoms Ultram 50 mg to 100 mg can be given as needed for pain relief every four to six hours, not to exceed a maximum dose of 400 mg per day. For moderate pain Buy Tramadol 50 mg may be acceptable as the first dose, and for more severe pain, Ultram 100 mg is usually more effective as the first dose.

Individualization of Dose:

Patients over 75 years old:
No more then 300 mg/day in divided doses.

Patients 65 to 75 years of age:
No dose adjustment is needed.

Patients with reduced renal fuction :
The dosing interval of Ultram should be extended to twelve hours with a maximum daily dose of 200mg/day.

Dialysis patients:
These patients can receive their usual dose on the same day as dialysis treatment.

Patients with cirrhosis:
Recommended dosage is 50 mg every 12 hours.

Patients receiving chronic Tegretol:
Doses up to 800mg/day may be required, this is up to twice the recommended dose of Ultram.


Ultram has a propensity to cause physical and psychological dependence of the morphone-type. Ultram has been associated with tolerance development, craving, and drug-seeking behavior. Dependence and abuse cases of Ultram have been reported. Ultram should not be used in patients whom are opioid-dependent.

Ultram can reinitiate physical dependence in patients that have been previously dependent or chronically using other opioids. In patients with a tendency to abuse drugs, a history of chronically using opiods, or drug dependence, treatment with Ultram is not recommended.

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