Ultram in combination with other narcotics?

Specialties Hospice


Can anyone relate personal experiences about effectiveness of Ultram used in combination with other narcotics? Previously I have only seen in used in combination with NSAIDS.

A couple of weeks ago I had a patient with dementia unable to provide a consistent response to questions about pain. Cancer, history of arthritis pain, history of CVA, history of recent GI bleed and probable seizure (was on dilantin) Patient had a duragesic patch, and ultram BID, with Q6 prn, and also Roxanol q2 prn.

Ortho-McNeil says there have been no clinical studies done regarding the effectiveness of ultram in combination with other opioids. The literature states that it has no antagonistic properties, but users may experience withdrawal symptoms if they have been using narcotics and switch to ultram. There is also increased risk of seizure.

Sooooo, anybody have any anecdotal info about this? Have you seen ultram work well with narcotics? I'm just not comfortable with it.


1,961 Posts

Hi Aimeee!

Ultram enjoyed a brief surge of popularity on my unit for post op c-sections. Only 1 group of docs used it for about 6 months, then it was gone. Looking back, it was probably when we started using Toradol.

It seems so long ago, but I'm pretty sure we gave it in combination with Percocet. (The same as with our Toradol now) Both meds, along with Percocet, provided better pain relief than Percocet alone.

Our hospital's policy is that NO other NSAIDS are to be given with the Ultram. Upon arrival to our unit the patients receive a "self med pack". (Tylenol, Motrin, and stool softener). We had to go as far as to remove the Motrin until they were off the Ultram.

Both the Ultram and Toradol can't be used by our breast feeding moms.



6 Posts

We have been using Ultram along with narcotics, since Ultram has proven itself more effective in arthritic pain with many of our clients. A patient on a Duragesic patch continued to c/o bilat knee pain; we started the Ultram and had no further complaints.

My concern with Ultram is the potential for GI problems. Approx 20 precent of my clients on Ultram developed nausea and vomiting while on the med, which was resolved when it was discontinued.

aimeee, BSN, RN

932 Posts

Thank you, Pammy and Heather, for your responses. Interesting info.


1 Article; 2,334 Posts

I was trying to avoid taking to many Tylox 5 days post-op back surgery so tried up alternating leftover Ultram with the Tylox...

Ended up back in the hospital on a PCA pump for pain crisis, was told by 2 Orthos and a Nueo to not mix then it can have an antagonistic effect.

Also (and I do tend to preach this one) avoid using it if the patient is on any SSRI...can cause a 'seratonin syndrome'...my Mom developed EPS while on Paxil and Ultram. When she later mentioned it to the house Doc at the SNF she worked at he did some research (don't know what) but came back and DC'd the Ultram on all his patients on SSRIs.


2 Posts


Ive heard there are some Hospices that have an automatic Comfort Care Packet given to the patient when they are admitted to Hospice. Does anyone know what is in them. Ive heard Roxanol, Haldol, Tylenol suppositories and bowel meds are in them. Anyone know what exactly is in them?

aimeee, BSN, RN

932 Posts

Yep. We use those. The kit contains (6) ABHR suppositories (Ativan, Benadryl, Haldol, Reglan), (6) Tylenol suppositories, 15 ml. Haldol, (10) 0.125 mg Hyoscyamine tablets, (10) 1 mg. Lorazepam tables, 15 ml Roxanol, (6) 10 mg Compazine capsules and (6) 25 mg. Compazine suppositories.

The patient/family is told to put the box in the refridgerator and NOT to open it unless instructed to by the hospice nurse. If the patient already has Roxanol in the home we have the kit made up without Roxanol. These are really wonderful for handling those middle of the night turns for the worse.


1,173 Posts

Ultram is a weak opioid, maybe OK for a bad headache or milder pain...but it you have someone using Roxanol, stick with that, or whatever narcotic analgesic works best.

If someone is on OxyContin, there's no need to also have T#3, Percocet, MSIR, etc....keep it simple. If they're on OxyContin, use OxyIR for breakthrough.

Sometimes in hospice, you wind up with a smorgasboard of meds, which makes is confusing for the pt, the family, the caregivers. Docs have a habit of just "throwing meds" at situations...esp end of life.

The right drug, with adequate titration, can do a world of wonders.


365 Posts

I tried Ultram for my arthritis pain in my knees. Candy would have worked better. I threw a full bottle down the toilet, got NO relief at all. To me, this med is useless!

By using the site, you agree with our Policies. X