Durela (Tramadol) belongs to a group of medications called opioid analgesics. It is used to manage moderate to moderately severe pain for people who need several days or more of pain control. It decreases pain by acting on the central nervous system.

Durela (Tramadol) may be available under multiple brand names and/or in several different forms. Any specific brand name of Durela (Tramadol) may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of Durela (Tramadol) may not be used for all of the conditions discussed here.

Your doctor may have suggested Durela (Tramadol) for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking Durela (Tramadol), speak to your doctor. Do not stop taking Durela (Tramadol) without consulting your doctor.

Do not give Durela (Tramadol) to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take Durela (Tramadol) if their doctor has not prescribed it.

The usual starting dose of Durela (Tramadol) extended release is 100 mg once every 24 hours. Your doctor may gradually increase the dose by 100 mg every 2 to 5 days, up to a maximum of 300 mg every 24 hours.

The medication may be taken with or without food, but it should be taken consistently (i.e., either always with food or always without food) and with a glass of water. The capsules and tablets must be swallowed whole and must not be broken, chewed, or crushed. Breaking the tablets may cause too much medication to be absorbed into the body at one time and may be fatal.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Do not stop taking Durela (Tramadol) without talking with your doctor. If Durela (Tramadol) is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shakiness, nausea, tremors, Diarrhea, or hallucinations.

It is important to that Durela (Tramadol) be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.  If you miss several doses in a row, talk to your doctor before starting Durela (Tramadol).

Store Durela (Tramadol) at room temperature and keep it out of the reach of children. Accidental ingestion of Durela (Tramadol) by a child can result in severe harm or even death.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Durela (Tramadol). If you are concerned about side effects, discuss the risks and benefits of Durela (Tramadol) with your doctor.

The following side effects have been reported by at least 1% of people taking Durela (Tramadol). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• blurred vision
• Constipation
• decreased interest in sexual activity
• decreased sexual ability
• dizziness
• drowsiness
• Dry Mouth
• fainting
• headache
• itchy skin
• loss of appetite
• muscle weakness
• nausea
• sweating
• trouble sleeping
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• decreased coordination
• fast, slow, or irregular heartbeat
• Low Blood Pressure (e.g., dizziness, fainting, light-headedness)
• symptoms of a bowel blockage (e.g., abdominal pain, severe constipation, nausea)
• symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heartbeat, weakness)
• withdrawal symptoms (e.g., nausea, vomiting, diarrhea, anxiety, sweating)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a Anaphylaxis (severe allergic reaction) (e.g., Hives; difficulty breathing; or swelling of the lips, mouth, throat, or tongue)
• signs of serotonin syndrome (e.g., agitation, confusion, diarrhea, Fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching)
• signs of too much medication (e.g., decreased breathing rate, severe dizziness, unconsciousness, vomiting, seizures, hallucinations, cold and clammy skin)
• symptoms of overdose (e.g., trouble breathing; extreme drowsiness with slowed breathing; slow, shallow breathing; feeling faint, dizzy, confused; difficulty thinking, talking, or walking; seizures; hearing, seeing, or feeling things that are not there [also known as hallucinations])
• symptoms of a severe skin reaction (e.g., high fever; rash; sores; painful blisters on the skin, mouth, or eyes; or skin peeling off)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Durela (Tramadol).

100 mg
Each opaque, white capsule, imprinted in blue ink with "G 252" on the cap and "100" between lines on the body, contains 100 mg of Durela (Tramadol) as Durela (Tramadol) hydrochloride. Nonmedicinal ingredients: corn starch, D&C Red No. 7 Calcium Lake (E180), D&C Yellow No. 10 Aluminum Lake, Eudragit NE 30D, FD&C Blue No. 2 Aluminum Lake (E132), gelatin, hypromellose, lactose monohydrate 200 mesh, magnesium stearate, microcrystalline cellulose, polysorbate 80, povidone K30, propylene glycol, shellac, simethicone emulsion, sodium starch glycolate, sucrose stearate, talc, and titanium dioxide.

200 mg
Each opaque, white capsule, imprinted in violet ink with "G 253" on the cap and "200" between lines on the body, contains 200 mg of Durela (Tramadol) as Durela (Tramadol) hydrochloride. Nonmedicinal ingredients: corn starch, D&C Red No. 7 Calcium Lake (E180), D&C Yellow No. 10 Aluminum Lake, Eudragit NE 30D, FD&C Blue No. 2 Aluminum Lake (E132), gelatin, hypromellose, lactose monohydrate 200 mesh, magnesium stearate, microcrystalline cellulose, polysorbate 80, povidone K30, propylene glycol, shellac, simethicone emulsion, sodium starch glycolate, sucrose stearate, talc, and titanium dioxide.

300 mg
Each opaque, white capsule, imprinted in red ink with "G 254" on the cap and "300" between lines on the body, contains 300 mg of Durela (Tramadol) as Durela (Tramadol) hydrochloride. Nonmedicinal ingredients: corn starch, D&C Red No. 7 Calcium Lake (E180), D&C Yellow No. 10 Aluminum Lake, Eudragit NE 30D, FD&C Blue No. 2 Aluminum Lake (E132), gelatin, hypromellose, lactose monohydrate 200 mesh, magnesium stearate, microcrystalline cellulose, polysorbate 80, povidone K30, propylene glycol, shellac, simethicone emulsion, sodium starch glycolate, sucrose stearate, talc, and titanium dioxide.

Do not take Durela (Tramadol) if you:

• are allergic to Durela (Tramadol) or any ingredients of the medication
• are allergic to other opioid medications (e.g., Codeine, Morphine)
• are intoxicated with alcohol or other medications that can depress breathing and consciousness, such as hypnotics, other opioids (e.g., codeine or morphine), or psychotropic medications (certain medications for mental health conditions)
• are breast-feeding or pregnant
• are treating pain caused by surgery
• are experiencing acute Alcoholism or delirium tremens
• are experiencing acute Asthma or other obstructive airway disease
• are experiencing acute respiratory Depression
• are experiencing sudden, severe abdominal pain that may require surgery (e.g., Appendicitis, pancreatitis)
• are less than 18 years old and have had a tonsillectomy and/or surgery to treat Sleep Apnea syndrome
• have a blockage or narrowing of the gastrointestinal tract
• have a head injury, brain tumour, or increased pressure inside the head or spinal cord
• have any condition that reduces the movement of masses through the digestive tract, such as ileus
• have mild pain, pain that comes and goes, or pain which can be treated with other pain medications
• have severe kidney function impairment
• have severe liver function impairment
• have taken monoamine oxidase (MAO) inhibitor medications (e.g., Phenelzine, Tranylcypromine) within the last 14 days

Do not give Durela (Tramadol) to children less than 12 years old.

There may be an interaction between Durela (Tramadol) extended release and any of the following:

• Abiraterone
• aclidinium
• alcohol
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• antihistamines (e.g., cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• anti-Parkinson's medications (e.g., amantadine, Apomorphine, Bromocriptine, levodopa, Pramipexole, Ropinirole)
• antipsychotics (e.g., Chlorpromazine, Clozapine, haloperidol, quetiapine, olanzapine, risperidone)
• atropine
• azelastine
• "azole" antifungal medications (e.g., fluconazole, itraconazole, ketoconazole)
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• belladonna
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• Benztropine
• Bosentan
• brimonidine
• Buprenorphine
• Bupropion
• Buspirone
• Butorphanol
• Cabergoline
• cannabis
• Celecoxib
• chloral hydrate
• chloroquine
• Cinacalcet
• Clonidine
• conivaptan
• Deferasirox
• Desmopressin
• Dextromethorphan
• Disopyramide
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• Domperidone
• Dronedarone
• Enzalutamide
• ergot derivatives (e.g., Dihydroergotamine, ergoloid mesylates, ergonovine, ergotamine, methylergonovine)
• Flavoxate
• general anesthetics (medications used to put people to sleep before surgery)
• glycopyrrolate
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., darunavir, indinavir, lopinavir, ritonavir, saquinavir)
• ipratropium
• isoniazid
• Linezolid
• lithium
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• magnesium sulfate
• Methadone
• Methylphenidate
• Metoclopramide
• mifepristone
• Mirabegron
• Mirtazapine
• Mitotane
• Modafinil
• monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine, Moclobemide, Selegiline, Rasagiline)
• muscle relaxants (e.g., Baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• Nabilone
• Naltrexone
• narcotic pain relievers (e.g., codeine, Fentanyl, morphine, oxycodone)
• nefazodone
• Octreotide
• Oxybutynin
• Pegvisomant
• Pentazocine
• Perampanel
• protein kinase inhibitors (e.g., Dabrafenib, imatinib, Nilotinib)
• quinidine
• quinine
• rifabutin
• rifampin
• Rotigotine
• Rufinamide
• St. John's wort
• scopolamine
• seizure medications (e.g., Carbamazepine, Gabapentin, Levetiracetam, Phenytoin, Topiramate)
• selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine, fluoxetine, citalopram)
• serotonin antagonists (anti-emetic medications; e.g., Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, duloxetine, venlafaxine)
• siltuximab
• Stiripentol
• Tapentadol
• tetrahydrocannabinol
• terbinafine
• thalidomide
• Ticlopidine
• tiotropium
• Tocilizumab
• Tolterodine
• Trazodone
• tricyclic antidepressants (TCAs; e.g., amitriptyline, imipramine)
• "triptan" migraine medications (e.g., Sumatriptan, Naratriptan)
• Tryptophan
• umeclidinium
• Warfarin
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Durela (Tramadol). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.