ULTRAM ER SIDE EFFECTS
- Generic Name: tramadol hcl extended-release
- Brand Name: Ultram ER
SIDE EFFECTS
ULTRAM ER was administered to a total of 3108 patients during studies conducted in the U.S. These included four double-blind studies in patients with osteoarthritis and/or chronic low back pain and one open-label study in patients with chronic nonmalignant pain. A total of 901 patients were 65 years or older. The frequency of adverse events generally increased with doses from 100 mg to 400 mg in the two pooled, twelve-week, randomized, double-blind, placebo-controlled studies in patients with chronic non-malignant pain (see Table 1).
Table q: Incidence (%) of patients with adverse event rates ≥ 5% from two 12-week placebo-controlled studies in patients with moderate to moderately severe chronic pain by dose (N=1811).
| MedDRA Preferred Term | ULTRAM ER | Placebo | |||
| 100 mg (N=403) n (%) |
200 mg (N=400) n (%) |
300 mg (N=400) n (%) |
400 mg (N=202) n (%) |
(N=406) n (%) |
|
| Dizziness (not vertigo) | 64 (15.9) | 81 (20.3) | 90 (22.5) | 57 (28.2) | 28 ( 6.9) |
| Nausea | 61 (15.1) | 90 (22.5) | 102 (25.5) | 53 (26.2) | 32 ( 7.9) |
| Constipation | 49 (12.2) | 68 (17.0) | 85 (21.3) | 60 (29.7) | 17 ( 4.2) |
| Headache | 49 (12.2) | 62 (15.5) | 46 (11.5) | 32 (15.8) | 43 (10.6) |
| Somnolence | 33 ( 8.2) | 45 (11.3) | 29 ( 7.3) | 41 (20.3) | 7 ( 1.7) |
| Flushing | 31 ( 7.7) | 40 (10.0) | 35 ( 8.8) | 32 (15.8) | 18 ( 4.4) |
| Pruritus | 25 ( 6.2) | 34 ( 8.5) | 30 ( 7.5) | 24 (11.9) | 4 ( 1.0) |
| Vomiting | 20 ( 5.0) | 29 ( 7.3) | 34 ( 8.5) | 19 ( 9.4) | 11 ( 2.7) |
| Insomnia | 26 ( 6.5) | 32 ( 8.0) | 36 ( 9.0) | 22 (10.9) | 13 ( 3.2) |
| Dry Mouth | 20 ( 5.0) | 29 ( 7.3) | 39 ( 9.8) | 18 ( 8.9) | 6 ( 1.5) |
| Diarrhea | 15 ( 3.7) | 27 ( 6.8) | 37 ( 8.5) | 10 ( 5.0) | 17 ( 4.2) |
| Asthenia | 14 ( 3.5) | 24 ( 6.0) | 26 ( 6.5) | 13 ( 6.4) | 7 ( 1.7) |
| Postural hypotension | 7 ( 1.7) | 17 ( 4.3) | 8 ( 2.0) | 11 ( 5.4) | 9 ( 2.2) |
| Sweating increased | 6 ( 1.5) | 8 ( 2.0) | 15 ( 3.8) | 13 ( 6.4) | 1 ( 0.2) |
| Anorexia | 3 ( 0.7) | 7 ( 1.8) | 21 ( 5.3) | 12 ( 5.9) | 1 ( 0.2) |
The following adverse events were reported from all the chronic pain studies (N=3108).
The lists below include adverse events not otherwise noted in Table 2.
Adverse events with incidence rates of 1.0% to < 5.0%
Eye disorders: vision blurred
Gastrointestinal disorders: abdominal pain upper, dyspepsia, abdominal pain, sore throat
General disorders: weakness, pain, feeling hot, influenza like illness, fall, rigors, lethargy, pyrexia, chest pain
Infections and infestations: nasopharyngitis, upper respiratory tract infection, sinusitis, influenza, gastroenteritis viral, urinary tract infection, bronchitis
Investigations: blood creatine phosphokinase increased, weight decreased
Metabolism and nutrition disorders: appetite decreased
Musculoskeletal, connective tissue and bone disorders: arthralgia, back pain, pain in limb, neck pain
Nervous system disorders: tremor, paresthesia, hypoesthesia
Psychiatric disorders: nervousness, anxiety, depression, restlessness
Respiratory, thoracic and mediastinal disorders: sneezing, cough, rhinorrhea, nasal congestion, dyspnea, sinus congestion
Skin and subcutaneous tissue disorders: sweating increased, dermatitis
Vascular disorders: hot flushes, vasodilatation
Adverse events with incidence rates of 0.5% to < 1.0% and serious adverse events reported in at least 2 patients.
Cardiac disorders: palpitations, myocardial infarction
Ear and labyrinth disorders: tinnitus, vertigo
Gastrointestinal disorders: flatulence, toothache, constipation aggravated, appendicitis, pancreatitis
General disorders: feeling jittery, edema lower limb, shivering, joint swelling, malaise, drug withdrawal syndrome, peripheral swelling
Hepato-biliary disorders: cholelithiasis, cholecystitis
Infections and infestations: cellulitis, ear infection, gastroenteritis, pneumonia, viral infection
Injury and poisoning: joint sprain, muscle injury
Investigations: alanine aminotransferase increased, blood pressure increased, aspartate aminotransferase increased, heart rate increased, blood glucose increased, liver function tests abnormal
Musculoskeletal, connective tissue and bone disorders: muscle cramps, muscle spasms, joint stiffness, muscle twitching, myalgia, osteoarthritis aggravated
Nervous system disorders: migraine, sedation, syncope, disturbance in attention, dizziness aggravated
Psychiatric disorders: euphoric mood, irritability, libido decreased, sleep disorder, agitation, disorientation, abnormal dreams
Renal and urinary disorders: difficulty in micturition, urinary frequency, hematuria, dysuria, urinary retention
Respiratory, thoracic and mediastinal disorders: yawning
Skin and subcutaneous tissue disorders: contusion, piloerection, clamminess, night sweats, urticaria
Vascular disorders: hypertension aggravated, hypertension, peripheral ischemia
Post-marketing Experience
The following adverse reactions, not noted above, have been identified during post approval use of tramadol-containing products. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency.
Eye disorders: miosis, mydriasis
Metabolism and nutrition disorders: Cases of hypoglycemia have been reported very rarely in patients taking tramadol. Most reports were in patients with predisposing risk factors, including diabetes or renal insufficiency, or in elderly patients.
Nervous system disorders: movement disorder, speech disorder
Psychiatric disorders: delirium