When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use if you had an allergic reaction to tramadol or other narcotic medicine. Tell your doctor if you have severe asthma or other breathing problems.

How to Use This Medicine:
Liquid, Capsule, Tablet, Dissolving Tablet, Long Acting Tablet

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
• Make sure your hands are dry before you handle the disintegrating tablet. Peel back the foil from the blister pack, then remove the tablet. Do not push the tablet through the foil. Place the tablet in your mouth. After it has melted, swallow or take a drink of water.
• Swallow the extended-release tablet whole. Do not crush, break, or chew it.
• Drink plenty of liquids to help avoid constipation.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines and foods can affect how tramadol works. Tell your doctor if you are using an MAO inhibitor or medicine for depression (such as amitriptyline, fluoxetine, paroxetine).
• Tell your doctor if you are also using any of the following:
  
  • St John's wort, digoxin, erythromycin, ketoconazole, linezolid, lithium, quinidine, rifampin, promethazine, carbamazepine, or cyclobenzaprine
  • Blood thinner (such as warfarin), medicine for migraine headaches, or another narcotic medicine
• Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.
• Do not drink alcohol while you are using this medicine.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease (including cirrhosis), or breathing problems. Tell your doctor if you have a history of head injury, seizures, drug addiction, or depression or similar emotional problems.
• This medicine may cause the following problems:
  
  • High risk of overdose
  • Serotonin syndrome
• This medicine may make you dizzy or drowsy. Do not drive or doing anything else that could be dangerous until you know how this medicine affects you.
• This medicine can be habit-forming. Do not use more than your prescribed dose. Call your doctor if you think your medicine is not working.
• Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
• Tell any doctor or dentist who treats you that you are using this medicine.
• Some forms of this medicine contain phenylalanine (aspartame).
• This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Anxiety, restlessness, fast heartbeat, fever, sweating, muscle spasms, nausea, vomiting, diarrhea, seeing or hearing things that are not there
• Blistering, peeling, or red skin rash
• Lightheadedness, dizziness, or fainting
• Seizures
• Severe sleepiness or unusual drowsiness
• Trouble breathing

If you notice these less serious side effects, talk with your doctor:

• Feeling nervous or shaky
• Headache
• Mild itching
• Nausea, vomiting, constipation, loss of appetite
• Weakness

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088