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The maximum recommended dose is 400 mg per day, so if using it alone does not provide adequate relief, other medications can be used with Ultram (tramadol) to help manage the pain. For instance, if there is throbbing pain from tight muscles, a muscle relaxant, such as Flexeril (cyclobenzaprine) or Zanaflex (tizanidine) may be beneficial. NSAIDs (non steroidal anti-inflammatory drugs), such as Aleve (naproxen) or Motrin/Advil (ibuprofen) can be added to help reduce pain caused from swelling. If there is sharp shooting pain from the nerves, a medication, such as Neurontin (gabapentin) or Lyrica (pregabalin) may stop the nerves from firing. Your doctor will know the best pain management therapy for you specific situation and may also add physical therapy, chiropractic work, or other non-drug related therapy as well. Patti Brown, PharmD
Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2B6, CYP2D6 and CYP3A4, being O- and N-demethylated to five different metabolites. Of these, desmetramadol (O-desmethyltramadol) is the most significant since it has 200 times the μ-affinity of (+)-tramadol, and furthermore has an elimination half-life of nine hours, compared with six hours for tramadol itself. As with codeine, in the 6% of the population that have reduced CYP2D6 activity (hence reducing metabolism), there is therefore a reduced analgesic effect. Those with decreased CYP2D6 activity require a dose increase of 30% in order to achieve the same degree of pain relief as those with a normal level of CYP2D6 activity.[85][86]
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Tramadol undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2B6, CYP2D6 and CYP3A4, being O- and N-demethylated to five different metabolites. Of these, desmetramadol (O-desmethyltramadol) is the most significant since it has 200 times the μ-affinity of (+)-tramadol, and furthermore has an elimination half-life of nine hours, compared with six hours for tramadol itself. As with codeine, in the 6% of the population that have reduced CYP2D6 activity (hence reducing metabolism), there is therefore a reduced analgesic effect. Those with decreased CYP2D6 activity require a dose increase of 30% in order to achieve the same degree of pain relief as those with a normal level of CYP2D6 activity.[85][86]
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