ULTRAM will add to the effects of alcohol and other CNS depressants (medicine that causes drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Do not drink alcoholic beverages, and check with your medical doctor or dentist before taking any of the medicines listed above while you are using ULTRAM.

ULTRAM may cause some people to become drowsy, dizzy, or lightheaded. Make sure you know how you react to ULTRAM before you drive, use machines, or do anything else that could be dangerous 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 lessen 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 with 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.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking ULTRAM. Taking tramadol together with medicines that are used during surgery or dental or emergency treatments may cause increased side effects.

If you think you or someone else may have taken an overdose of tramadol, get emergency help at once. Signs of an overdose include convulsions (seizures) and pinpoint pupils of the eyes.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

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 with your doctor as soon as possible if any of the following side effects occur:

• Less common or rare
  • 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 weakness in hands or feet;  seeing, hearing, or feeling things that are not there;  severe redness, swelling, and itching of the skin;  shortness of breath ;  trembling and shaking of hands or feet;  trouble performing routine tasks 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Abdominal or stomach pain;  agitation ;  anxiety;  constipation ;  diarrhea;  dizziness;  drowsiness;  dry mouth;  headache;  heartburn;  itching of the skin;  loss of appetite;  loss of strength or weakness;  nausea ;  nervousness;  skin rash ;  sweating;  unusual feeling of excitement;  vomiting 
  
  

• Less common
  • Confusion;  depression;  excessive gas;  flushing or redness of the skin;  general feeling of bodily discomfort;  hot flashes;  trouble in sleeping 
  
  

After you stop using ULTRAM, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. During this period of time check with your doctor if you notice any of the following side effects:

• Anxiety;  body aches;  diarrhea;  fast heartbeat;  fever, runny nose, or sneezing;  gooseflesh;  high blood pressure;  increased sweating ;  increased yawning;  loss of appetite;  nausea or vomiting;  nervousness, restlessness or irritability;  shivering or trembling;  stomach cramps;  trouble in sleeping;  unusually large pupils;  weakness 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.