Tramadol should be taken slowly, starting at a low dose. Then it can be increased gradually until the pain is under control. The dosage should be adjusted based on the severity of pain, treatment response, previous experience, and other risk factors such as abuse, addiction, and misuse.

Adult Dose For Pain:

Adults over 17 years old: 50 to 100mg orally every 4-6 hours, if needed. For patients who do not require immediate analgesic effects: Start with 25 mg once daily; gradually increase the dose by 50 mg every three days.
Maximum dose: 400 mg per day.

Adult Dose For Chronic Pain:

Extended-Release (ER):
Tramadol-naive for 18+: 100mg orally once daily
To minimize adverse reactions, titrate individual doses in increments of 100 mg every five days.
-Maximum Dose: 300 mg/day

Patients currently receiving Tramadol Immediate-Release
Initial Dose: Determine 24-hour IR requirements and start with a daily ER dose of 100 mg orally, once a day.

Conversion from Other Opioids: Stop using all around-the-clock opioid drugs before you start therapy
Initial dose: 100mg ER orally, once daily
To minimize adverse reactions, titrate individual doses in increments of 100 mg every five days.
-Maximum Dose: 300 mg/day.

What should I do?
Tramadol should be taken exactly as directed by your doctor. Follow all instructions on your prescription label. Read all medication guides. Tramadol should not be taken in higher doses or for a longer time than is prescribed. If you feel the need to take more tramadol, talk to your doctor. Do not share tramadol, especially with someone who has a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. You must keep the medicine safe from others. This medicine cannot be sold or given away. Tramadol is an opioid medication. You should stop taking them all. Tramadol is safe to be taken with or without food. However, it should always be taken the same way every time. To avoid a potentially fatal overdose, swallow the whole capsule or tablet. Do not crush, chew or open the capsules. Use the provided syringe to measure liquid medicine. Do not crush tramadol tablets to inject it into your veins. This has led to death. If you suddenly stop tramadol, you may experience withdrawal symptoms. Before you stop taking tramadol, consult your doctor. Keep the medicine at room temperature, away from heat and moisture. Keep track of the medicine. It is important to be aware of anyone using your medicine without a prescription or in an improper manner. Keep any tramadol leftovers out of reach. One dose of tramadol can lead to death if it is taken in error or misused. Ask your pharmacist for information about drug disposal programs. Mix the remaining medicine with cat litter, coffee grounds and seal the bag. Throw the bag in trash if there isn't one.

Warnings
Tramadol-treated patients have reported seizures. Higher doses of tramadol can increase your risk of having seizures. People with seizure disorders or who are taking antidepressants and opioid medication have a higher risk of seizures. Tramadol should be avoided if you are suicidal, or susceptible to addiction. buy tramadol online should not be taken if you are experiencing severe breathing difficulties, blockage of the stomach or intestines, or have used alcohol, tranquilizers or narcotic medication or MAO inhibitors (isocarboxazid or linezolid), phenelzine or rasagiline or selegiline, or any other MAO inhibitors. Tramadol may cause you to have a slow or halt in breathing. It can also make you more habitual. MISSING OUT ON THIS MEDICINE COULD CAUSE ADDICTION, OVERDOSE OR DEATH. This is especially true if the medication is not prescribed for children or anyone else who uses it. This medicine should be kept out of reach of children and others. Tramadol should never be given to children younger than 12 years of age or to anyone who has recently had surgery to remove tonsils or adenoids. Anyone younger than 18 should not receive Ultram ER. Tramadol can cause withdrawal symptoms in newborns that could be life-threatening. If you take this medicine along with alcohol or other drugs that slow down your breathing or cause drowsiness, there may be fatal side effects.