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What side effects may occur? Get emergency help immediately if any of the following symptoms of overdose occur:

- Convulsions (seizures); difficulty in breathing; pinpointed pupils of the eyes

Also, check wi th your doctor as soon as possible if any of the following side effects occur:

- Blisters under the skin; blurred vision ; change in walking and balance; convulsions (seizures); difficult urination; dizziness or lightheadedness when getting up from a lying or sitting position; fainting; fast heartbeat; frequent urge to urinate; loss of memory; numbness, tingling, pain, or weakne ss in hands or feet; seeing, hearing, or feeling things that are not there; severe redness, swelling, and itching of the skin; shortness of breath ;

Before Using This Medicine The presence of other medical problems may affect the use of tramadol. Make sure you tell your doctor if you have any other medical problems, especially:
- Abdominal or stomach conditions (severe )—Tramadol may hide signs of other medical conditions
- Alcohol or drug abuse, or history of—May increase the serious side effects of tramadol
- Head injury—Tramadol can hide signs of oth medical conditions
- Kidney disease or
- Liver disease—The chance of side effects may be increased. Your doctor will consider this when deciding on your doses.
- Seizures—The chance o convulsions (seizures) may be increased

How should you take this medication? Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
Take tramadol exactly as directed.Tramadol comes as a table t to take by mouth. It usually is taken every 4-6 hours as needed. It may be taken with or without food.
Tramadol can be habit-forming. Do not take a larger dose, take it more often, or for a lon ger period than your doctor tells you to.

Why is this drug prescribed? Tramadol is used to relieve pain, including pain after surgery. The effects of tramadol are similar to those of narcotic analgesics. Although tramadol is not classified as a narcotic, it may become ha bit-forming, causing mental or physical dependence.

Tramadol is available only with your doctor's prescription, in the following dosage form:

Before Taking This Medicine Before taking tramadol,

- tell your doctor and pharmacist if you are allergic to tramadol, codeine, or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescri ption medications you are taking, especially other pain relievers; carbamazepine (Tegretol); MAO inhibitors [phenelzine (Nardil) or tranylcypromine (Parnate)]; medications for depression; quinidine; s leeping pills; tranquilizers; and vitamins.
- tell your doctor if you have or have ever had kidney or liver disease, a history of seizures, or a history of alcohol or drug abuse.

What special precautions should I follow? This medicine will add to the effects of alcohol and other CNS depressants (medicine that causes drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other aller gies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental an esthetics. Do not drink alcoholic beverages, and check with your medical doctor or dentist before taking any of the medicines listed above while you are using this medicine.

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