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Q: Can Ultram cause serotonin syndrome? A: Ultram (tramadol) is a narcotic-like pain reliever. Ultram is approved for the management of moderate to moderately severe pain. The extended-release formulation of Ultram is indicated for the management of moderate to moderately severe chronic pain when around the clock treatment is required. According to the prescribing information, serotonin syndrome has been reported in patients taking Ultram. Serotonin syndrome may occur within the recommended dose of Ultram. However, Ultram related serotonin syndrome occurred in less than one percent of patients during clinical trials and/or post marketing research. Although there is a risk for serotonin syndrome while taking Ultram alone, it is more likely to occur with the concomitant use of other serotonergic drugs. Serotonin syndrome is a potentially life-threatening medical condition, which can be fatal if left untreated. According to the National Institutes of Health (NIH), serotonin syndrome most often occurs when a patient takes two medications that affect serotonin levels. Serotonin syndrome may develop with the concomitant use of Ultram and other serotonergic medications, such as the triptans (medications used to treat migraine headaches), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs). Serotonin syndrome may also occur, and caution is advised,
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Immediate-release: -Initial dose: 25 mg orally once a day; titrate in 25 mg increments every 3 days to reach a dose of 25 mg four times a day; thereafter increase by 50 mg as tolerated every 3 days to reach a dose of 50 mg four times a day -Maintenance dose: After titration, 50 to 100 mg orally as needed for pain every 4 to 6 hours
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