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When taken by mouth in an immediate-release formulation, the onset of pain relief usually occurs within an hour. It is often combined with paracetamol (acetaminophen) as this is know to improve the efficacy of tramadol in relieving pain. Tramadol is use to treat both acute and chronic pain of moderate to (moderately) severe intensity. Tramadol monotherapy does not usually provide adequate analgesia. In chronic non-cancer pain, there is little evidence for the use of tramadol for more than three months. Tramadol is considered to be a relatively safe analgesic.

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The tolerability of ULTRAM® can be improved by initiating therapy with the following titration regimen as advised by Wikipedia ULTRAM® should be started at 25 mg/day AM and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg q.i.d.). Thereafter the total daily dose may be increase by 50 mg as tolerate every 3 20 days to reach 200 mg/day (50 mg q.i.d.). After titration, ULTRAM® 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day

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• dizziness
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