keep your eye on patients who request lots of refills of Ultram (tramadol)

A year ago we suggested you keep your eye on patients who request lots of refills of Ultram (tramadol). Now there have been enough cases of dependence that the manufacturer now recommends avoiding Ultram in patients who are opioid dependent...or have a history of dependence.

There's also a greater risk of anaphylactoid reaction in patients who are allergic to codeine and other opioids. Don't use Ultram in these patients.

There are also reports that Ultram is causing seizures. Use caution when you combine Ultram with drugs that lower the seizure threshold...tricyclic antidepressants...the tricyclic muscle relaxant, Flexeril (cyclobenzaprine)...SSRIs...and antipsychotics.