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Ultram may be used alone or with other medications. These are not all the possible side effects of Ultram. ULTRAM is indicated in adults for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. For the subset of patients for whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial doses, ULTRAM 50 mg to mg can be administered as needed for pain relief every four to six hours, not to exceed mg per day. If the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing the ULTRAM dosage. If the patient develops these signs or symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both. Dispense in a tight container. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Of these patients, were 65 years old or older.

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