Ultram Review: Is This Pain Reliever Safe?

Ultram Review: Is This Pain Reliever Safe?

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​​Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to pain relief.

Ultram is a prescription analgesic drug, which means it can relieve pain. The medication is used to treat moderate to severe chronic pain, and for acute post-surgery pain.

Tramadol is the generic version of the drug, but it’s also sold under the name Conzip. These terms all refer to the same active chemical compound, so we'll use them interchangeably throughout this article.

But is Ultram proven effective for pain relief in research studies? Does it cause side effects? Is it addictive? And does it make more sense to take the generic version of the drug?

In this article we’ll answer all of these questions and more, as we review medical studies on Ultram to determine if the medication is safe and effective for pain relief.

We’ll explain how Ultram works, highlight side effects of the drug, and review research-based dosage information.

We'll also share a popular animated YouTube explainer video on Ultram and explain a Food and Drug Administration (FDA) warning related to the drug. 

Does Ultram Relieve Pain?

A 2009 meta-study examined whether or not Ultram was effective for pain relief in cancer patients.

The patients were all experiencing mild to moderate chronic pain at the inception of the study.

The study authors documented that Ultram was effective at reducing pain on average:

Patients using Ultram reported a decrease in pain categorized as “very good” or “good” 89% of the time, and in just four hours after the first dose of the medication, pain scores decreased by more than 50%. 

medical review published in the Drugs journal analyzed whether Ultram could successfully treat perioperative pain (experienced during or post-surgery).

The drug was effective in both pediatric and adult patient populations. Ultram was similarly effective to morphine, and the researchers stated that it could successfully treat “moderate to severe postoperative pain.”

Ultram has also been studied for its ability to treat musculoskeletal pain, which is often experienced by patients with conditions like fibromyalgia and chronic fatigue syndrome (CFS).

Ultram was found in the above-linked medical review to be superior to non-steroidal anti-inflammatory drugs (NSAIDs), which are often prescribed for musculoskeletal pain.

Based on the available research, it seems clear that Ultram is quite effective for reducing pain, which is unsurprising given that the medication is approved by the FDA for pain relief.

The medication has been shown in clinical trials to successfully treat mild, moderate and severe pain.

Is Ultram Addictive?

As an opioid, Ultram does have the potential for addiction.

A 2013 population study examined whether patients with no history of substance abuse could become addicted to the drug.

The study authors found that addiction to Ultram alone was possible, and discredited the notion that only patients with a history of substance abuse could get addicted to Ultram. 

Of the patients in the above-linked study addicted to Ultram, 90% were not using any other drugs, and 87% had no previous history of drug abuse.

Patients with a personal or family history of substance abuse may wish to speak with their doctor about pain relieving medication other than opioids, to reduce the risk of addiction and abuse.

One of the most popular YouTube videos on opioids is published by the TED-Ed channel, has beautiful animated graphics, and explains why opioid addiction is so difficult to treat:

Does Ultram Cause Side Effects?

Ultram does cause side effects in some patients, as do most pharmaceutical drugs.

meta-review on the side effects of Ultram found the following to be the most commonly experienced: dizziness, sleepiness, nausea, headache, constipation and vomiting. 

10-20% of patients were described as experiencing one or more of these side effects.

Another potential side effect of Ultram is serotonin syndrome, which can be fatal. Any medication that artificially increases circulating levels of serotonin can increase the risk for this condition, and Ultram tends to increase serotonin levels.

medical review on the pharmacology of Ultram noted the following:

“physicians should be aware of [Ultram] as a potential single-agent cause of serotonin syndrome.” In layman’s terms, this means that Ultram alone can potentially cause serotonin syndrome; it doesn’t need to be combined with other drugs to cause this condition."

We would recommend that patients already taking antidepressants speak with their doctor about the risk of serotonin syndrome prior to taking Ultram.

Taking a selective serotonin reuptake inhibitor (SSRI) along with Ultram may increase the risk of this potentially-fatal condition.

Is Generic Ultram a Better Choice?

The generic version of Ultram is called tramadol.

Some patients consider branded versions of drugs to be superior, but medical research suggests that there is no difference in average effectiveness.

medical study published in the well-respected JAMA journal analyzed millions of data points comparing branded and generic drugs, and found them to be “clinically equivalent.”

Since branded and generic drugs contain the same active chemical compound, this makes logical sense.

We would recommend that patients speak to their doctor about generic tramadol rather than Ultram. Generic versions of drugs are often cheaper, and if Ultram isn’t proven to be more effective than the generic version, it seems illogical to take it.

According to GoodRx, generic tramadol is available in the US at the time of updating this article, and retails for under $20.

Patients Review Ultram

Drugs.com is a website that allows prescription medication patients to rate and review the drugs they're taking.

We cannot verify the accuracy or authenticity of any reviews on this site.

At the time of updating this article, tramadol has been reviewed over 140 times on Drugs.com, and has an average review rating of 6.3 out of 10.

A top positive review of Ultram is written by an anonymous user who gave the medication a 10/10 rating and claims it improved their pain and mood:

“I was prescribed [Ultram] after a herniated disc in my lower back and 50mg gives me great pain relief for about 6 hours. If the pain is really bad then 100mg works wonders as well. I have not experienced any negative side effects. This medicine also puts me in a GREAT mood…”

A top negative review of Ultram comes from a user named “AgentClear” who claims the medication is not as effective an analgesic as Vicodin:

“Honestly I believe that I am now receiving 1/10 the relief from pain that the Vicodin were providing.”

How Does Ultram Work?

Ultram is part of a class of drugs called opioids; one of the most common classes of analgesics.

According to a 2023 medical reviewUltram attaches to opioid receptors in the central nervous system (CNS) and reduces nerve signaling to the brain indicating that the body is in pain.

Another benefit of Ultram, documented in the above-linked review, is that the drug may improve serotonin levels, which can improve mood and reduce subjective pain.

Ultram blocks reuptake of serotonin, which artificially increases circulating levels. This is the same way that SSRI drugs work to relieve depression.

medical study on Ultram published in the CNS Drugs journal explains that the drug causes more biological changes to the body than most opioids. It can suppress nerve conduction and block voltage-gated sodium ion channels, both of which contribute to pain.

One of the most popular YouTube videos on Ultram comes from a channel called Medical Videos and has over 140,000 views at the time of updating this article.

It's a visually engaging, animated video that explains what Ultram is used for and how it works:

Ultram FDA Safety Warning

In 2017, the FDA issued a notice that the active ingredient in Ultram, tramadol, was restricted for use in children and adolescents.

Ultram’s label now must list a warning that the medication should not be used by children under 12 years old.

The FDA also warns that Ultram should not be used to treat pain in children under 18 years old who received tonsil or adenoid surgery.

Finally, the FDA recommends that women avoid breastfeeding while taking Ultram because the drug may be absorbed by the infant through breast milk, and could cause serious adverse effects. 

A baby’s body cannot process and clear prescription medication as efficiently as an adult can.

Given this information, we recommend that parents intent on using prescription medication for their child or adolescent speak with their pediatrician about different medication options than Ultram.

Ultram vs. Oxycodone 

Oxycodone is a commonly-prescribed analgesic, so patients are often curious about which drug is more effective for pain relief.

While individual results will vary, a medical study directly compared the two drugs in patients who had just completed facial surgery.

Oxycodone was considered more effective, because pain reduction scores were similar between both medications but oxycodone caused significantly less nausea than Ultram (28% of patients on oxycodone vs. 44% on Ultram).

A clinical trial published in the Pharmacology journal reported that both drugs were equally effective at reducing pain in patients with breast cancer. In this study, there was no reported difference in side effects.

Based on the available research it seems too early to recommend either Ultram or oxycodone over the other in regard to efficacy or safety. More medical research is needed.

Is Ultram More Effective With Tylenol?

Tylenol is an NSAID used for pain relief, so patients are often curious about whether or not it can be used at the same time as Ultram.

A 2003 medical review found that this drug combination was more effective than either medication taken in isolation. Surprisingly, there were no increased adverse effects compared with taking Ultram alone.

Tylenol is quickly absorbed by the body, and Ultram usually takes longer to take effect, so this may be why patients experienced greater pain relief when these medications were taken together. 

Even though Tylenol is available over-the-counter (OTC), we would recommend that patients speak with their doctor before they take Tylenol while prescribed Ultram, because the long-term safety of this combination doesn’t seem conclusively proven in medical studies.

Ultram Dosage

Ultram is prescribed at a wide range of dosages, and also in different forms (immediate release and extended release).

According to the 2023 medical review cited in the section explaining how Ultram works, the immediate release Ultram dose is 50 milligrams (mg), while the extended release version is prescribed at three different doses: 100 mg, 200 mg and 300 mg.

Ultram immediate release is absorbed and utilized more quickly by the body, and reaches peak concentration in less than two hours. Ultram extended release doesn’t reach peak concentration for 12 hours.

Some studies show that using daily Ultram doses as high as 800 mg can cause increased dependence, so we would strongly recommend that patients speak with their doctor about addiction and abuse risks associated with doses in this range.

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Cannabidiol (CBD) is clinically shown to be effectively absorbed through the skin, and CBD caused "significant improvements in pain" when applied topically in a 2020 clinical trial.

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Cinnamon was shown to reduce inflammatory markers in a 2020 clinical trialThe study authors concluded that “Cinnamon could be regarded as a safe supplement to relieve pain.”

All of the products recommended in this section are entirely free of ingredients that we consider to be unhealthy.

We do not recommend using dietary supplements to treat any specific medical condition related to pain, and we are not suggesting that any of the products referenced in this section are as effective as Ultram or any other FDA-approved medication for pain relief.

Ultram FAQs

Is Ultram a narcotic?

Ultram would be defined as a narcotic. A narcotic is a substance used to treat serious pain, which Ultram is FDA-approved to do.

Is Ultram a controlled substance?

According to the Drug Enforcement Administration (DEA), Ultram is a controlled substance as of August 18th, 2014.

This means there are federal limits on prescriptions and refills, and it may be illegal for patients to handle Ultram without a prescription depending on their jurisdiction.

Is Ultram an NSAID?

Ultram is not an NSAID. It’s an opioid, and is alternatively described as a narcotic. It is not available to purchase OTC.

Does Ultram make you sleepy?

Sleepiness is a common side effect of Ultram. It may occur in upwards of 20% of patients, and higher doses may be more likely to cause this effect.

Stay up-to-date on our research reviews


Ultram can effectively treat mild, moderate and severe pain in adults.

People considering the medication for a child or adolescent should speak with a pediatrician first, because the FDA has issued a warning about the active ingredient in Ultram and has issued safety guidelines and restrictions for its use in children and adolescents.

Due to the potential for addiction, patients may benefit from speaking with their doctor about non-opioid analgesics for mild (and even moderate) pain.

Using Tylenol concurrently with Ultram is clinically shown to cause greater pain relief than using either drug in isolation, but this combination doesn’t seem to have been safety tested for periods of time greater than one year.

If a patient is prescribed Ultram, we'd recommend that they inquire about the availability of the generic tramadol, since this medication should be equally effective but may be significantly cheaper depending on health insurance coverage.

Oxycodone is clinically shown to be equally effective to Ultram in regard to pain relief, and has a lower risk of causing nausea according to at least one medical review cited in this article.