Tramadol is available in both immediate-release and extended-release formulations.
Both the immediate-release and extended-release formulation of tramadol are available generically and can possibly save you hundreds of dollars on your prescription.
If you prefer generic medications due to cost-savings, ask your physician to only write for generic drugs whenever possible. If you cannot afford your medication, do not walk away from the pharmacy. Ask your doctor or pharmacist for more affordable alternatives.
The extended-release form of tramadol is for around-the-clock treatment of pain and not for use on an as-needed basis. Tramadol extended-release tablets must be taken whole, and not split, chewed or crushed.
A combination product of tramadol and acetaminophen (Ultracet) is also available by prescription in both brand and generic form.
Combining tramadol with acetaminophen (Tylenol) may further help with pain and allow lower doses of tramadol to be used.
However, Ultracet is not approved for use for more than 5 days.
Also, be careful not to combine Ultracet with extra acetaminophen (Tylenol), as too much acetaminophen is toxic for your liver.
Learn more about generic drugs in “Facts About Generic Drugs”.
Dose adjustments are needed in the elderly, and in those with kidney or liver problems.
Here's another good reason not to share your tramadol with others: the dose you are prescribed may not be the right dose for someone else, and could lead to serious consequences like slowed or stopped breathing, coma, or even death.
As with many medications, if you are young, elderly, or have kidney or liver disease dose adjustments are often required.
The dosing interval (how often you take the drug) may need to be adjusted, the actual dose of the drug may need to be reduced, and you may have a maximum daily dose you should not exceed.
Talk to your doctor about the need for adjusted doses with any medication, including tramadol.
Do not exceed the prescribed dose or dosing interval prescribed by your doctor.
Patients older than 65 years of age

Doses should usually start at the low end of the dosing range and can be titrated upwards slowly based on tolerance and effectiveness.
Patients older than 75 years of age
Maximum dose of regular-release tramadol oral tablets: 300 mg per day (in divided doses).
Kidney Disease and Liver Disease
Over 30% of tramadol is excreted by the kidneys as the unchanged molecule, which means it could lead to toxic blood levels in patients with kidney disease.
Tramadol is metabolized through the liver, so a patient with kidney or liver disease may require a change in dose, different dose interval, or maximum amount of drug taken each day.
Some patients with severe kidney or liver impairment may not be candidates for tramadol treatment at all.
Providers should consider monitoring renal function (such as creatinine clearance) with tramadol treatment, especially in the elderly, because this drug is substantially excreted by the kidney.
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