Immediate Release (IR):

• Initial dose: 25 mg orally once daily in the morning
• Titration: Gradually increase by 25 mg every 3 days as tolerated, up to a maximum of 100 mg/day (25 mg 4 times daily)

Extended Release (ER):

• Initial dose: 100 mg orally once daily
• Titration: Increase by 100 mg every 5 days as tolerated, up to a maximum of 300 mg/day 

Common:

• Nausea and vomiting
• Dizziness or lightheadedness
• Constipation
• Headache
• Drowsiness

Less Common:

• Serotonin syndrome (when used with other serotonergic drugs)
• Seizures (particularly at higher doses)
• Respiratory depression (especially when combined with other CNS depressants)
• Allergic reactions (rash, itching, swelling)

Risk of Dependence and Withdrawal: Tramadol can lead to physical and psychological dependence. Avoid abrupt discontinuation to prevent withdrawal symptoms.

Serotonin Syndrome: Tramadol interacts with serotoninergic medications, increasing the risk of serotonin syndrome. Use caution when combining tramadol with SSRIs, SNRIs, or MAO inhibitors.

Respiratory Depression: Tramadol can depress respiratory function, particularly when combined with other CNS depressants like alcohol, benzodiazepines, or opioids.