Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Ultram is a prescription analgesic drug, which means it can relieve pain. It’s 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 a separate branded version called Conzip. These terms all refer to the same active chemical compound and we will use them interchangeably throughout this article.
In this article we’ll review published medical studies on Untram to determine if the medication is a safe and effective analgesic. We’ll explain how Ultram works, highlight side effects of the drug, and review research-based dosage information.
Does Ultram Work?
A meta-study of Ultram published in 2009 examined whether the drug was effective in a patient population with cancer. The patients all experienced mild to moderate chronic pain as a result of their condition. This study was extremely thorough, with 113 citations to other medical trials on the topic.
The study authors documented that Ultram was effective at reducing pain on average. Patients receiving 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 greater than 50%.
Another medical study 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 when compared with 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 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. The medication has been shown in clinical trials to treat mild, moderate and severe pain successfully.
How Does Ultram Work?
Ultram is part of a class of drugs called opioids; one of the most common classes of analgesics. According to StatPearls, which is a free medical database maintained by the National Library of Medicine in the U.S., Ultram 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 StatPearls resource page, is that the drug may improve serotonin levels, which can improve mood and reduce subjective pain. The medication blocks reuptake of serotonin, which artificially increases circulating levels. This is the same way that selective serotonin reuptake inhibitor (SSRI) drugs work. This category of drugs is one of the most popular for treating depression.
An in-depth medical study of 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.
Ultram Side Effects
Ultram does cause side effects in some patients, as do most pharmaceutical drugs.
A meta-review of Ultram side effects found the following to be the most commonly experienced: dizziness, sleepiness, nausea, headache, constipation and vomiting. Most of these side effects were experienced by around 10-20% of patients.
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 as we discussed in the previous section, one of the downstream effects of Ultram is increased serotonin levels.
A medical review of 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 serotonin syndrome prior to taking Ultram. Taking an SSRI along with Ultram may increase the risk of developing this condition.
FDA Drug Safety Warning
In 2017, the Food and Drug Administration (FDA) in the U.S. 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 for 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.
Ultram is prescribed at a wide range of dosages, and also in different forms (immediate release and extended release).
According to the StatPearls page linked to previously, 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 Ultram dosages as high as 800 mg can cause increased dependence, and more safety studies are needed before Ultram should be regularly prescribed at those doses in our opinion.
Ultram Vs. Generic Version
The generic version of Ultram is called tramadol, and there are several different branded versions.
Some patients consider branded versions of drugs to be superior, but medical research shows that there is no difference in average effectiveness. A medical study published in the well-respected JAMA journal analyzed an enormous amount of efficacy data 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 tramadol rather than Ultram. Generic versions of drugs are often cheaper, and if Ultram isn’t proven to be more effective it seems illogical to take it.
Is Ultram Addictive?
As an opioid, Ultram does have the potential for addiction. A medical review examined whether patients with no history of substance abuse could become addicted to the drug.
The study authors found that addiction to Ultram was possible in this patient population, and discredited the notion that only patients with a history of substance abuse could get addicted to Ultram. Of the patients in this study addicted to Ultram, 90% were not using any other drugs, and 87% had no previous history of drug abuse.
This study had a small number of total patients, so we wouldn’t suggest that it’s conclusive. But given what we know about opioids generally, it seems logical to assume that Ultram may be addictive.
Patients with a personal or family history of substance abuse may want to speak with their doctor about analgesics which aren’t opioids, to reduce the risk of Ultram addiction and abuse.
Is Ultram More Effective With Tylenol?
Medical research has documented the effects of Tylenol and Ultram taken concurrently. A clinical trial on this drug combination for treating pain found that it was more effective than either medication alone. 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 Vs. Oxycodone
Oxycodone is a commonly-prescribed analgesic, so patients often ask which treatment is more effective.
While individual results will vary, a medical study directly compared the two drugs on patients that 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% vs. 44%).
A more recent clinical study found similar results: both drugs were equally effective at reducing pain for 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.
Ultram User Reviews
Drugs.com has an Ultram reviews page where patients can write personal reviews of the medication. The drug has an average rating of 6/10 for pain, and 5/10 for chronic pain.
We cannot guarantee the accuracy or legitimacy of reviews on this website, but we still find it to be a useful resource as the largest medication review site with user-generated content.
The 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…”
The top negative review of Ultram is published by 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.”
Ultram can effectively treat mild, moderate and severe pain in adults. People considering the medication for their children 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, we would recommend that patients speak with their doctor about non-opioid analgesics for mild pain.
Using Tylenol concurrently with Ultram may improve pain relief, but also doesn’t seem to have been safety tested for long periods of time (>1 year).
We’d recommend that patients speak with their doctor about the generic tramadol over Ultram, because it should be similarly effective but is likely to be cheaper.