Does anybody take Ultram ER?

** Originally posted by silbar **

I saw my Rheumy the other day for intense joint pain. I have been taking percocet when needed but can not take this when I am at work. He suggested trying Ultram ER (extended release). He gave me samples of the 100mg and 200mg ER but wrote the script for "300mg because I think you'll need 300mg ". I felt alittle too restless on the 200mg and am going to ask him to change the script to 100mg as I think 300mg will be way too much (and you can't split the pills).
My understanding of extended release meds is that they slowly release the drug a little at a time over a 24 hour period but the insert info shows a graph of the Ultram ER peaking at the 12 hour mark. I am trying to figure out the best time of day to take this medication where I won't feel too restless but I can still take 5mg Ambien at bedtime for sleep.
If you take Ultram ER, how does it make you feel? What time of day is best for you? Do you feel a higher concentration/effect after 12 hours? Can you take 2 of the 100mg ER and get the same effect as a 200mg ER or will they release too much at the same time?
Any info will be greatly appreciated.

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** Originally posted by ericw10 **

I have taken the Ultram ER in the past and didnt like it at all as it was very inconsistent in strength and longevity. IMO if you are going to take Tramadol, just take 50-100mG immediate release. Tramadol itself is pretty long acting anyway without the ER mechanism.

Ask for brand Ultram though because I have taken various generics and they ARE different. Some wind me up so bad I grind my teeth. The brand works better and is much more mellow. Even still, try to take it before Noon because it is stimulating. After all, its a very close cousin of the anti-depressant Effexor. And dont take more than 200mg/day. The pamphlet will say 400, but dont go there. The stuff can trigger seizures at the upper dosages and contraindicated if you're on any type of SSRI.

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** Originally posted by kptruck **

I have taken the Ultram ER in the past and didnt like it at all as it was very inconsistent in strength and longevity. IMO if you are going to take Tramadol, just take 50-100mG immediate release. Tramadol itself is pretty long acting anyway without the ER mechanism.

Ask for brand Ultram though because I have taken various generics and they ARE different. Some wind me up so bad I grind my teeth. The brand works better and is much more mellow. Even still, try to take it before Noon because it is stimulating. After all, its a very close cousin of the anti-depressant Effexor. And dont take more than 200mg/day. The pamphlet will say 400, but dont go there. The stuff can trigger seizures at the upper dosages and contraindicated if you're on any type of SSRI.

I had no idea it was related to effexor... I took that for 3 yrs after I found out I had cancer, it kicked the depression in the butt and got me out of bed. I had to quit because I was having withdrawl symtoms if I didnt take the next pill within 30 minutes of the 24 hour mark.

Anyhoot, my husband used to take ultram, tramadol (same thing ones generic) but it didnt give him any relief, hes been put on morphine now and is doing better with that.

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** Originally posted by ericw10 **

I had no idea it was related to effexor... I took that for 3 yrs after I found out I had cancer, it kicked the depression in the butt and got me out of bed. I had to quit because I was having withdrawl symtoms if I didnt take the next pill within 30 minutes of the 24 hour mark.

Yep, tramadol is basically an anti-depressant marketed as a pain med. Or Effexor is a pain med marketed as an anti-depressant. Either way, they both can make you happy and dull pain, or make you care less about the pain. But ohhhhh yeah, withdrawal of Effexor or tramadol can be incredibly bad. Some people that took too much for too long say they are never the same again. Be careful with your brain, only got one. No spares, no transplants.

http://www.opioids.com/tramadol/antidepressant.htm

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** Originally posted by SuzanneT **

My GP just gave me an Rx for Ultram. After reading this, I'm not sure I'm going to try it! I'm also taking Ambien and low dose Nortriptyline (50 mg) for pain. :confused:

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** Originally posted by ericw10 **

My GP just gave me an Rx for Ultram. After reading this, I'm not sure I'm going to try it! I'm also taking Ambien and low dose Nortriptyline (50 mg) for pain. :confused:

If you're on a tricyclic that inhibits serotonin, then yes, Ultram would not be the best idea. Did your GP prescribe both? If so, not good IMO. Docs like to push the Ultram because it doesnt get scrutinized as much as the pure opiates (Oxycodone, Fentanyl etc) but getting off of those is a picnic compared to tramadol. Never experienced it myself, but do a little Google search on tramadol withdrawal to read about what fun it is.

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** Originally posted by DEBAK **

the only difference between Ultram and Tramadol is the Ultram ALSO HAS tylenol in it so if your liver enzymes are a challenge due to other meds and their effects then plain tramadol is the better of those two to use. I take 50 to 100 mg of Tramadol as needed and I also am on Elavil (low dose 20mg) and an SSRI called Celexa and have had no problems. When I asked the Dr about it she said the risk of seizures are dose related and not to worry.

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** Originally posted by ericw10 **

the only difference between Ultram and Tramadol is the Ultram ALSO HAS tylenol in it so if your liver enzymes are a challenge due to other meds and their effects then plain tramadol is the better of those two to use. I take 50 to 100 mg of Tramadol as needed and I also am on Elavil (low dose 20mg) and an SSRI called Celexa and have had no problems. When I asked the Dr about it she said the risk of seizures are dose related and not to worry.

Ultram is pure brand name tramadol. The one with Tylenol in it is Ultracet. Some people may get by with mixing an SSRI and trams, but serotonin syndrome is no joke. Use caution.

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** Originally posted by jeannep36 **

I live in washington state and both my rheumy and my Gp refuse to prescribe this, they claim it to be very unsafe as far as the manufacturer claims its not a narcotic yet it has a higher addiction ability than hydrocodone and its extremely hard to widthdrawl from it, I do know some states are still prescribing it. I have been on the same pain med for almost 11 years, I take Hydrocodone 7.5, two in morning 2 in afternoon 2 in evening and 2 before bed. I will be on them the rest of my life and Im okay with that, to me its no different than a diabetic needing insulin for the rest of their life. I dont get that ephoric feeling from them, I can function normally so all in all its what works best for me.

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** Originally posted by DEBAK **

Ultram is pure brand name tramadol. The one with Tylenol in it is Ultracet. Some people may get by with mixing an SSRI and trams, but serotonin syndrome is no joke. Use caution.

Your right...my BAD Ultracet is the one with tylenol

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** Originally posted by Flycaster **

...both my rheumy and my Gp refuse to prescribe this...its not a narcotic yet it has a higher addiction ability than hydrocodone and its extremely hard to widthdrawl from it...

My PM doc says the same thing. The ER form of Tramadol apparently works pretty well as a mild pain reliever when used in short term application. OTOH, for long term use she sticks with other drugs used in conjunction with true narcotics to handle pain. Also, just fwiw, narcotics withdrawal (for those of us who use typical 1-2mg/10lbs dosage of oxycodone equivilents) is highly over-rated. Last year I had to suddenly stop for 5 days from an 80mg/day dose (we think a local neighborhood teenager stole all my prescriptions): other than being in pain, it was no big deal. The first day I was a little anxious, but by day 2 it was all over and I felt fine...that is to say the back pain was crappy, but the withdrawal was over.

Yeah, we now keep our house locked and all my meds are well hidden. Oh well, c'est la vie.

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** Originally posted by Ocean71 **

hello, I took ultram for a few months for my PsA. It made me have daily stomach trouble no matter what I ate, it was very bad. I would ask the dr., and they all said, 'no its not the ultram'. I also have/had at one time a stomach ulcer, which youre not supposed to take ultram if you have. So I stopped the ultram, stomach trouble and grief went away very quickly! and to make a point, It didnt help on the PsA pain at all. I would say, no in my case it wasnt worth taking for any reason.

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** Originally posted by silbar **

I live in washington state and both my rheumy and my Gp refuse to prescribe this, they claim it to be very unsafe as far as the manufacturer claims its not a narcotic yet it has a higher addiction ability than hydrocodone and its extremely hard to widthdrawl from it, I do know some states are still prescribing it. I have been on the same pain med for almost 11 years, I take Hydrocodone 7.5, two in morning 2 in afternoon 2 in evening and 2 before bed. I will be on them the rest of my life and Im okay with that, to me its no different than a diabetic needing insulin for the rest of their life. I dont get that ephoric feeling from them, I can function normally so all in all its what works best for me.

I had been taking an occassional vicodin 5-10mg but my pain has become more constant in the past few weeks (feet and hands). My problem is that I am an RN who works 12-14hr shifts. On my work days the pain was at it's worst but I am reluctant to take any narcotics while working. Even though I am not mentally affected on vicodin, I don't want to be placed in a situation that could lead to losing my job or license. That is why the Rheumy gave me the script for Ultram ER. I will not be taking it on a daily basis. He also injected my hand and big toe with steroid and this has helped greatly.
Thank you for all who offered info.

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** Originally posted by Flycaster **

...My problem is that I am an RN who works 12-14hr shifts...

Yeah, that is a bit of tight rope you have to walk there. Narcs while on duty would be an open invitation to a real professional disaster, even with proper script. I think your best bet(s) would be the steroid injections and oral prednisone, at least until you can find a DMARD that works most of the time. Oral steroids saved my life for the first 3 years of this disease (I was initially misdiagnosed with PMR).

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** Originally posted by silbar **

Yeah, that is a bit of tight rope you have to walk there. Narcs while on duty would be an open invitation to a real professional disaster, even with proper script. I think your best bet(s) would be the steroid injections and oral prednisone, at least until you can find a DMARD that works most of the time. Oral steroids saved my life for the first 3 years of this disease (I was initially misdiagnosed with PMR).

Flycaster~~ Do you have Psoriasis also? If you do, did it flare up when you went OFF of the prednisone? I have heard that sometimes happens and I am very afraid of that, since my skin is finally 100% clear now.

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** Originally posted by Flycaster **

Yes, I have P also, but a fairly mild case of it. So far, I've been able to back off the pred (over many, many months) from 20mg/day to 2mg/day without having severe P flares; however, during the period from 5mg/day to the current 2, I've been on DMARDS. They didn't help my PsA worth beans, but it is possible they may have suppressed the P once I dipped below the "biologic" dose of 5mg. I guess that's a long winded way of saying I don't know the answer to your question.

FWIW, my dermatologist was very concerned about my tapering off pred without having a biologic in place first. His words to me were something to the effect, "Your psoriasis is going to flare like a SOB if you drop the pred now..." It was that concern plus the fact that I really ran into a brick wall (headaches, intense muscle/joint pain) just slightly below 2mg that I have elected to stay at that daily dose until we know if the Enbrel is really working or not.

I know this may confuse you even more, but I hope you find some relief that doesn't put you at professional risk. For *me*, the PsA pain was far more severe than the P. The P was/is primarily on my legs so it is visually unobtrusive; it itches like hell, but relative to the PsA "broken glass" joint pain, it was/is a walk in the park - thus, again for *me*, I'd run the risk of a P flare any day of the week to get the relief that pred gave me. A little itch and irritation vs. having to eat 25-40mg/day of oxycodone just to be able to walk around? It was a complete no-brainer.

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** Originally posted by michiganag **

Silbar - Has Ultram given you much relief? I found it made me feel rather "thick" in the head and did nothing for my pain.

Are you in the US? Have you spoken with your employer & your BON? In many states you can work on narcs as long as you are not impaired (and people who are using them long term are often not impaired). For me it's not an option - they don't touch my pain and I'm very impaired :rolleyes:

I'm sure it could get a bit sticky and you probably don't want to go there if you can help it, but if you find that narcs are the only thing that controls your pain it may be worth seeing what your state and employer regulations are on this.

Hope you find something that works soon!

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** Originally posted by silbar **

Yes, I have P also, but a fairly mild case of it. So far, I've been able to back off the pred (over many, many months) from 20mg/day to 2mg/day without having severe P flares; however, during the period from 5mg/day to the current 2, I've been on DMARDS. They didn't help my PsA worth beans, but it is possible they may have suppressed the P once I dipped below the "biologic" dose of 5mg. I guess that's a long winded way of saying I don't know the answer to your question.

FWIW, my dermatologist was very concerned about my tapering off pred without having a biologic in place first. His words to me were something to the effect, "Your psoriasis is going to flare like a SOB if you drop the pred now..." It was that concern plus the fact that I really ran into a brick wall (headaches, intense muscle/joint pain) just slightly below 2mg that I have elected to stay at that daily dose until we know if the Enbrel is really working or not.

I know this may confuse you even more, but I hope you find some relief that doesn't put you at professional risk. For *me*, the PsA pain was far more severe than the P. The P was/is primarily on my legs so it is visually unobtrusive; it itches like hell, but relative to the PsA "broken glass" joint pain, it was/is a walk in the park - thus, again for *me*, I'd run the risk of a P flare any day of the week to get the relief that pred gave me. A little itch and irritation vs. having to eat 25-40mg/day of oxycodone just to be able to walk around? It was a complete no-brainer.

Flycaster~ I know exactly what you're saying.I am on Humira, Celebrex and methotrexate.

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** Originally posted by silbar **

Silbar - Has Ultram given you much relief? I found it made me feel rather "thick" in the head and did nothing for my pain.

Are you in the US? Have you spoken with your employer & your BON? In many states you can work on narcs as long as you are not impaired (and people who are using them long term are often not impaired). For me it's not an option - they don't touch my pain and I'm very impaired :rolleyes:

I'm sure it could get a bit sticky and you probably don't want to go there if you can help it, but if you find that narcs are the only thing that controls your pain it may be worth seeing what your state and employer regulations are on this.

Hope you find something that works soon!

Between the last cortisone injections and the Ultram ER the pain is much less. I still get a shart pain in the ball of my foot if I forget to turn my foot sideways when I go down the stairs. I haven't had to use any Vicodin in the past week so I feel better now. We'll see how I feel after a few weekends at work.
Yes, I am in USA. I would rather not open up any can of worm work-wise as people are being laid off in the surrounding hospitals due to the economy. The less my employers/BON know the better _for now anyways.

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** Originally posted by michiganag **

Between the last cortisone injections and the Ultram ER the pain is much less. I still get a shart pain in the ball of my foot if I forget to turn my foot sideways when I go down the stairs. I haven't had to use any Vicodin in the past week so I feel better now. We'll see how I feel after a few weekends at work.
Yes, I am in USA. I would rather not open up any can of worm work-wise as people are being laid off in the surrounding hospitals due to the economy. The less my employers/BON know the better _for now anyways.

Sure... I hear that. Glad you've found a combo that is holding you ok for now :)

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** Originally posted by Flycaster **

My hunch is the cortisone shots (Kenalog 40?) are probably having the much larger effect. Personally speaking, tramadol doesn't do much at all (for me it has about the same analgesic benefit as tylenol), but the shots are manna from heaven; they give me about 3 months of terrific relief, at least in the specific area of injection.

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