Doctors' Answers to "Frequently Asked Questions" - Ultram

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Addiction to Ultram [posted 1/14/99]
Question: I am strongly addicted to Ultram and have been for three years. I have consistently been taking six pills a day for two years. The pills run my life! I have to have them to even be able to function during the day. When I have tried to withdraw myself from them, I cannot sleep at night. I have perspiration pour all over me and I feel like bugs are climbing on my body. It has been a total nightmare. I have been telling my doctor for a year what I have been going through, but he has ignored it up until now. He continued to tell me that it was not addictive and that it was all in my head. Well now they are putting me in a drug rehab to withdraw me from it. I don't know who to blame. Who is at fault? McNeil Pharmaceutical told my doctor that it was NOT addictive so he was going by what they said. Now that my doctor has discussed my situation with them, they are saying that there is a small percentage that are becoming addicted to it. This is very upsetting to me as I have suffered dearly. I don't know who to blame. Should my doctor have known? My pharmacist at two different locations told me that I was taking too many of those pills and they were addictive. Do you have information on Ultram that you can send me or can you direct me somewhere where I can get all the ends and outs of Ultram. Please help me any way possible.

Answer: This drug was advertised by McNeil as not being addictive, but usage has demonstrated otherwise. As to the blame, that's a legal problem. I'd focus on getting into rehab and off the medications. I've had the same problem with the drug although I don't have anyone who needs rehab. What information are you looking for on Ultram? Legal? You know its addictive capacity.

Ultram Information [posted 10/28/98]
Question: Could you send me some general info on this Rx. For instance: What class does this drug belong to (Narcotics?) and what is the dependency chance with this new medication? If any, is it physical or psychological dependency? thank you

Answer: Well, it is semi-synthetic centrally acting analgesic that appears to work at the opioid receptors in some fashing currently not completely understood. The initial information from the company showed no dependence;but, clinically, we see patients who have physical dependence on this drug. It is not currently classed as a narcotic.

Concerns About Vertigo on Ultram [posted 10/28/98]
Question: My doctor has just prescribed Ultram to handle the pain I have with Fibromylgia. I also take Zoloft (100 mg) daily, use Imitrax for migraine headaches, take Estrace for hormone and cyclobenzapr (10 mg) nightly. It works great for the pain. I have noticed that when I wake up during the night after taking it that I have a real problem with vertigo. Also I have a rash all over my face and neck. Have you had any reports of Ultram causing this?

Answer: Vertigo more commonly than the rash, both are listed as possible side effects.

Ultram Concerns [posted 10/9/98]
Question: For my real bad headaches, I sometimes receive narcotics, such as darvocet-N 100s, or hydrocodone containing pills, such as Vicoden, at other times, sence my headaches come from stress and are tension headaches I have taken fiorinal, and other barbiturates. My doctors don't want me taking the same drug because of addictive potential of some of them, so they experiment with different ones to relieve my pain. Now they gave me a drug called Ultram, and my question is can taking one drug somehow effect they way another drug could work or used to work? what I mean is, that if I take this Ultram, and it don't work as well, so I go back to Darvocet, or something that worked better before, could the Ultram chemically change the way the other drug would work, because it binds to the same receptors (opiods receptors), or does the brain have many receptors for each, or any drug for that matter?

Answer: Not usually unless you develop co-tolerance, possible with narcotics.

Very Happy With Ultram [posted 10/9/98]
Question: I have a comment to make about "ULTRAM". Thank you, McNeil Pharmaceuticals! I've had pain in my left hand for 10 years. I have had all the nerve conduction tests, fusion between 6 and 7, carpal tunnel surgery, and surgery @ the left elbow. Tried acupuncture and most medications for pain. Until my Dr. recently prescribed "Ultram",50mg, for daytime use, and "Hydrocodine", for evenings, with "Etodolac" 400mg (twice daily), I had just about given up on the possibilities of any relief from this pain! I have had no ill side effects from either of these medications, but have experienced a really "GOOD", feeling. Maybe, as suggested by others, that good feeling is no more than the subdued pain. Anyway, just wanted to say, "THANK YOU", to McNeil and my Dr. If you're looking into "Ultram", this a positive review !

Answer: Thanks for the input.

Ultram Side Effects [posted 8/5/98]
Question: The listed side effects of Ultram include urinary problems. Does this include problems getting and maintaining an erection and/or achieving orgasm? I have chronic back and hip pain and Ultram has worked very well, but the side effect above is my concern now.

Answer: Yes, an occasional problem.

Ultram [posted 7/30/98]
Question: My husband has been using ultram every since it came out. His doctor put him on it, and he wanted to wean him off of narcotics. My husband had a injury at work and then a car wreck three weeks after his surgery. That wreck re-injured his back, and he had to go in for another surgery on his lower back in 1995. In 1996 someone in a car was on top of a hill on our side of the road and hit our car. That wreck re-injured his lower back again. He needs to have a back fusion done, but due to the car insurance resistance he is having to wait until the mess can be straightened out. He has had so much bad luck with his back, they don't know what part of it is their responsibility even though the doctor has explained it. I wanted to let you know the situation before I told you my reason for writing. When they started him out on ultram, they didn't want him back on any narcotics. The doctors said the effects of this drug were good because it was not addictive. Now they come out saying it is addictive and can cause seizures, just by taking it with no other medicine. We did not know any of this until three weeks ago. He had a seizure in 1996, and no one could figure out why. Since then he has not had any. These doctors gave him a prescription with 12 refills and 240 pills a month. He has been addicted to them for over a year. I've seen it the whole time, but my husband did not believe me. Neither did the doctor who gave it to him. He gets very hateful after the effects of the medicine wear off. His concentration is always shot when he is on it. I have to watch out for him. They do not want you to take narcotics, afraid you will get addicted to them. So what is the option for people who are in constant pain? Why did the makers of this drug not alert us to this problem sooner? Is there any way that a person can get compensated for their mistake? I know if the person taking it could see the problems they should quit, but when they get attached to something like that, they cannot see it. Sometimes people do not argue with a doctor because you would think they knew everything about the medicine they are prescribing. If there is any information about the new releases on ultram, please let me know. It's hard to find any information on this when they are trying to keep it quiet.

Answer: The manufacturers of this drug tried to represent it as a non-narcotic alternative. Many physicians, including myself, took this in, in the early days of the drug. I think if you look at earlier questions in this column you will see that I addressed a similar problem on Ultram -corrected by a reader - as a non-narcotic alternative. I have a lot of ethical problems with the way that the drug was marketed and I suspect someone will take them to court for this approach. However, if your husband has not seen a pain specialist it needs to happen. Unfortunately, the only way to hold most pain is through narcotics. This leads to potential addiction. However, there is often no choice for the patient in marked pain. If your doctor is not understanding about the need to abolish your husband's pain, I would look for additional medical help.

Ultram [posted 7/16/98]
Question: Are they going to change Ultram to a narcotic?

Answer: Do you mean change the schedule? I doubt this and haven't heard of a change.

Ultram for Fatigue
Question: I have been taking a drug called Ultram for the past year for aching muscles and fatigue. This drug is usually prescribed for pain, which my physician prescribed for headaches, but I found it to be so effective for my lack of mental energy, muscle aching and general fatigue that I take it once every day and it works like a miracle. Can you tell me why? Also, do you know of any long term side effects?

Answer: There are no obvious long term side effects to date, although it has only been available for 5 years or so. I have several patients who take it for Restless Leg Syndrome and it really helps their sleep patterns, possibly the reason you are having the increased mental alertness. I doubt the drug itself would have this effect unless it affected some other part of your metabolism/sleep cycle.

Ultram
Question: My doctor has started me on a medication called Ultram. I am taking it for chronic headaches. It seems to help really well. Can you tell me more about this medication?

Answer: Ultram goes by the generic name tramadol, and it is an analgesic, or pain reliever, that has several reported possible mechanisms of action. In part, this medication works by effecting the brain's metabolism of two chemicals known as serotonin and norepinephrine. In addition, it also likely has some effect at an opioid center in the brain. The body clears this drug via the urinary tract and its half life (or, time it takes for the body to remove 50% of the drug) is 6-8 hours. This medication has proven to be effective in the treatment of pain, but it has several side effects that you should be aware of. It should, firstly, not be used in conjunction with narcotics, alcohol, or psychotropic drugs (medications used for conditions such as schizophrenia, depression, mania, bipolar disorder, etc.). There is a risk of patients on this medication experiencing seizures. This risk is increased in patients taking the drugs just mentioned, as well as in those who already have some form of seizure condition. Allergic reactions are rare but have been reported and can be severe. Therefore, any individual with a history of allergy to this medication or any narcotic should take this medication only after a thorough discussion with their health care provider. There are several other side effects which are also not common but include low blood pressure, anxiety, confusion, insomnia, nausea and/or vomiting, headache, constipation, dry mouth, heartburn due to acid reflux, urinary symptoms, rash, liver problems, and mild anemia. Overuse or abuse of this medication can obviously be very harmful. The typical dosing of this medication is 50mg to 100mg every 4 to 6 hours, not to exceed 400mg per day. This limit is reduced to 300mg per day in the elderly. As is always the case, when you are on any medication prescribed by your health care provider, regular follow up is the best way to ensure that the medication is not only successfully treating the condition for which it was intended, but also to ensure that no harmful side effects are occurring.

Ultram Side Effects
Question: I would like to know about the drug ultram. Is it habit forming and does it have side effects.

Answer: Ultram(tramadol hydrochloride) is a centrally acting analgesia which is different from opiates. However, it appears to have affinity for opiate receptors in the brain and possibly in the body as well. Vertigo, constipation, headache, confusion, nausea are the most common side effects. Currently, it is not thought to be addictive.



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