chance of convulsions (seizures) may be increased
- 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 tram adol
- Head injury—Tramadol can hide signs of other medical conditions

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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.

How to Use Tramadol comes as a tablet to take by mouth. It usually is taken every 4-6 hours as needed. It may be taken with or without food. Follow the directions on your prescription label carefully, and ask yo ur doctor or pharmacist to explain any part you do not understand. Take tramadol exactly as directed.

Tramadol can be habit-forming. Do not take a larger dose, take it more often, or for a lo nger period than your doctor tells you to.

Before Using This Medicine Before taking tramadol,

- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking tramadol, call your doctor.
- if you a re having surgery, including dental surgery, tell the doctor or dentist that you are taking tramadol.
- you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
- remember that alcohol can add to the drowsiness caused by this drug.

What is this Drug Tramadol is used to relieve moderate to moderately severe pain. It also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain.

Tell your doctor if you have any other medical problems, especially:
- Kidney disease or
- Liver disease—The chance of side effects may be increased. Your doctor will consider this when deciding on your doses.
- Seizures—T When you are taking tramadol, it is especially important that your health care provider know if you are taking any of the following:

- Carbamazepine (e.g., Tegretol)—May decrease the effect s of tramadol by decreasing the amount of medicine in the body
- Central nervous system (CNS) depressants (medicines that cause drowsiness)—Using these medicines with tramadol may increase the ch ance of serious side effects or increase the risk of convulsions (seizures)
- Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e .g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—The chance of convulsions (seizures) may be increased

What side effects can this medication cause? Although side effects from tramadol are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

- dizziness
- headache
- drowsiness
- blurred vision
- upset stomach
- vomiting
- diarrhea

If you experience any of the following symptoms, call your doctor immediately:

- fast heartbeat
- rednes s, swelling, and itching of the face
- numbness or tingling of the hands and feet
- difficulty breathing
- changes in urination
- seizures

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