chance of convulsions (seizures) may be increased
- Abdominal or stomach conditions (severe)—Tramadol may hide signs of other medical conditions
- Alcohol or drug abuse, or history of—May increase the serious side effects of tram adol
- Head injury—Tramadol can hide signs of other medical conditions

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How should you take this medication?
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
Take tramadol exactly as directed.Tramadol comes as a table t to take by mouth. It usually is taken every 4-6 hours as needed. It may be taken with or without food.
Tramadol can be habit-forming. Do not take a larger dose, take it more often, or for a lon ger period than your doctor tells you to.

Precautions Before Using This Medicine
Before taking tramadol,

- tell your doctor and pharmacist if you are allergic to tramadol, codeine, or any other drugs.
- tell your doctor and pharmacist what prescription and nonprescri ption medications you are taking, especially other pain relievers; carbamazepine (Tegretol); MAO inhibitors [phenelzine (Nardil) or tranylcypromine (Parnate)]; medications for depression; quinidine; s leeping pills; tranquilizers; and vitamins.
- tell your doctor if you have or have ever had kidney or liver disease, a history of seizures, or a history of alcohol or drug abuse.

What special precautions should I follow?
This medicine may cause some people to become drowsy, dizzy, or lightheaded. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangero us if you are dizzy or are not alert.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help lesse n this problem.

Nausea or vomiting may occur, especially after the first couple of doses. This effect may go away if you lie down for awhile. However, if nausea or vomiting continues, check w ith your medical doctor or dentist. Lying down for a while may also help relieve some other side effects, such as dizziness or lightheadedness, that may occur.

What is this medicine
Tramadol is used to relieve moderate to moderately severe pain. It also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain.

Possible Side Effect
Get emergency help immediately if any of the following symptoms of overdose occur:

- Convulsions (seizures); difficulty in breathing; pinpointed pupils of the eyes

Also, check wi th your doctor as soon as possible if any of the following side effects occur:

- Blisters under the skin; blurred vision ; change in walking and balance; convulsions (seizures); difficult urination; dizziness or lightheadedness when getting up from a lying or sitting position; fainting; fast heartbeat; frequent urge to urinate; loss of memory; numbness, tingling, pain, or weakne ss in hands or feet; seeing, hearing, or feeling things that are not there; severe redness, swelling, and itching of the skin; shortness of breath ;

Tell your doctor if you have any other medical problems, especially:
- Kidney disease or
- Liver disease—The chance of side effects may be increased. Your doctor will consider this when deciding on your doses.
- Seizures—T
When you are taking tramadol, it is especially important that your health care provider know if you are taking any of the following:

- Carbamazepine (e.g., Tegretol)—May decrease the effect s of tramadol by decreasing the amount of medicine in the body
- Central nervous system (CNS) depressants (medicines that cause drowsiness)—Using these medicines with tramadol may increase the ch ance of serious side effects or increase the risk of convulsions (seizures)
- Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e .g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—The chance of convulsions (seizures) may be increased