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According to the prescribing information, Ultram should not be given to patients who are addiction-prone or suicidal. Furthermore, Ultram should be used with caution in patients concomitantly taking tranquilizers, antidepressants, use alcohol in excess or who have been diagnosed with emotional disturbance or depression. Ultram related deaths have occurred in these populations of patients. Serotonin syndrome is possible with treatment with Ultram alone.
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Long-term use of high doses of tramadol will cause physical dependence and withdrawal syndrome.[27] These include both symptoms typical of opioid withdrawal and those associated with SNRI withdrawal; symptoms include numbness, tingling, paresthesia, and tinnitus.[28] Psychiatric symptoms may include hallucinations, paranoia, extreme anxiety, panic attacks, and confusion.[29] In most cases, tramadol withdrawal will set in 12–20 hours after the last dose, but this can vary.[28] Tramadol withdrawal typically lasts longer than that of other opioids. Seven days or more of acute withdrawal symptoms can occur as opposed to typically three or four days for other codeine analogues.[28]
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