If ULTRAM® is used as rescue medication in conjunction with extended-release tramadol tablets, the total daily dose of tramadol should not exceed 400 mg. Fentanyl products should not be used as rescue medication in patients taking ULTRAM®. I am simply adding here for someone starting on ultram to be aware that if the dose gets too high the extra problem with potential for seizures does exist and they should be aware of it. Good luck with the medication for you personally. God bless. A dose of 100 mg Ultram tended to provide analgesia superior to codeine sulfate 60 mg, but it was not as effective as the combination of aspirin 650 mg with codeine phosphate 60 mg. Ultram has been studied in three long-term controlled trials involving a total of 820 patients, with 530 patients receiving Ultram. Tramadol is a synthetic opioid analgesic medication used to treat moderate to moderately severe pain, such as that caused by osteoarthritis. Brand names include ConZip, FusePaq Synapryn, Rybix, Ryzolt, and Ultram. Tramadol, sold under the brand name Ultram among others, is an opioid pain medication used to treat moderate to moderately severe pain. When taken by mouth in an immediate-release formulation, the onset of pain relief usually begins within an hour. [1] How to use Ultram. Read the Medication Guide provided by your pharmacist before you start taking tramadol and each time you get a refill. If you have any questions, ask your doctor or pharmacist. The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25-50 mg every 3 days to reach 50-100 mg/day every 4 to 6 hours. However, the dose is usually not more than 400 mg per day. Children 12 years of age and older—Use and dose must be determined by your doctor. Children younger than 12 years of age—Should not be used in these patients. -During periods of changing analgesic requirements, including initial dose titration, frequent communication among members of the healthcare team, patients, and caregivers, is important; patients who experience breakthrough pain may require dose adjustments or if receiving the extended-release (ER) product, may need rescue medication with an immediate-release analgesic. - The maximally allowed daily dose of Tramadol (Ultram) is 400 mg. - In exceptional cases the oncological patients are allowed using higher daily doses but only under the supervision of the doctor. - The use of the tablets after meals will help to reduce the stomach upset and unpleasant side reactions of digestion organs.