I don't know how many people out there are aware of a clearly defined fact in the Physicians Desk Reference (PDR) and also in the package insert, is that Ultram and opiates are not supposed to be taken concomitantly(at the same time). This is especially true for opiate dependent patients. Tramadol(Ultram) can actually precipitate opiate withdrawl symptoms. So if you're taking 30+ mg of hydrocodone or other opiate a day, and are taking tramadol simultaneosly or using it for "breakthrough pain", I would recommend that you read the PDR or speak with a well informed physician. A good percentage of physicians out there do not not read thoroughly the contraindications of the medications they prescribe. They may read the handout brochure that the manufacturer representative provides, but that's it. If you run out of your normal pain medication such as codeine, hydrocodone, dihydrocodeine, etc, then 24 hours after your last dose is the recommended safe time to start taking tramadol. It should not initiate any antagonistic effects with the minimal amount of opiate left in your system. For those of you that experience occassional withdrawl symptoms on those "hydro holidays" and you are extremely unconfortable as well as in pain, having a Darvon, Darvocet, actually any propoxyphene hydrochloride or napsylate can minimize the withdrawl symptoms. Darvon is typically the least effective narcotic analgesic on the market, but it can help with the withdrawl symptoms. I am not promoting the concomitant use of Darvon and Hydro though. Now if you've been taking both opiates and tramadol at the same time and have not experienced any side effects, then consider yourself lucky and do what you gotta do.

There's another thread out there on this board re: "if you or someone you know has experienced a seizure after taking tramadol", provide a response to the poll. I guarantee that a large percentage of those persons who suffered a seizure following the administration of tramadol were opiate dependant patients. I'm sure most of you are aware that opiate dependancy and tolerance is not addiction and that's one of the main obstacles in the medical profession in reference to proper pain management (sorry to go off on another tangent, but that irritates the heck out of me). I cannot understand a doctors reluctance to prescribe Ultram. If you take Ultram for a long period of time and at dosages higher than recommended, then there is chance of physical and psychological withdrawl symptom upon immediate cessation of use. It is not a controlled substance at this point and the potential for phychological dependence is present and it can be habit forming, but the chances are minimal. Physicians should speak to their patients regarding all medicines, including over-the-counter types, that have dependancy potential.

To get back to the subject at hand, doctors shouldn't hand it out like candy, but if there is evidence of legitimate pain, Ultram is the safest, most effective analgesic for moderate to severe pain.

That's my two cents worth, I hope I din't bore you too much.

Good day and good health,
Painster