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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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 other 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 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

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 Inform your doctor if you are taking any of the following:
- Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], s elegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—The chance of convulsions (seizures) may be increased
- Carbamazepine (e.g., Tegretol)—May decrease the effects of tramadol by decrea sing the amount of medicine in the body
- Central nervous system (CNS) depressants (medicines that cause drowsiness)—Using these medicines with tramadol may increase the chance of serious side ef fects or increase the risk of convulsions (seizures)

Special warnings about this medication 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.

Before Using This Medicine Breast-feeding—Tramadol passes into breast milk and may cause unwanted effects in nursing babies. It may be necessary for you to take another medicine or to stop breast-feeding during treatment. Be su re you have discussed the risks and benefits of the medicine with your doctor.

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.

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