Patient was educated on precautions to be exercised while taking Ultram as follows:

1. Ultram must be avoided or used cautiously in individuals allergic to opioid analgesics, such as, Hydrocodone and Oxycodone.
2. Ultram slows down the bowel movements heavily and leads to constipation. Increase intake of daily fiber can help the situation and promote regular bowel movements. Any signs and symptoms of intestinal obstruction and ileus, such as, intense bloating, constipation, abdominal pain, nausea, and vomiting must be immediately reported. Any lack of bowel movement in 3 days must be reported to the physician.
3. Drink plenty of water with Ultram and keep up with your daily fluid requirements without fail. This can help prevent episodes of constipation. Also, maintain compliance with laxative intake, as recommended by your doctor.
4. Ultram produces and intense feeling of drowsiness and dizziness, as a side effect to modifying the pain perception of brain. Patients can also experience hallucinations, seizures, and mood changes due to Ultram use. Ultram must be avoided or used with extreme caution in individuals taking antidepressants and other psychotropic medications that have the potential to induce hallucinations and mood changes. Avoid driving or operating machinery until you know how Ultram affects you.
5. Avoid using Ultram along with other medications that have a potential to cause respiratory depression, such as, muscle relaxants, sedatives, and antianxiety medications. Though they cause mild respiratory depression individually, they can have an additive effect when combined with Ultram and thus, precipitate severe respiratory depression.
6. Ultram should be avoided or used with extreme caution in individuals with history of head injury, coma, and brain surgery. These individuals are at increased risk for depression of the respiratory center and coma with Ultram.
7. Do not change the dose on Ultram without consulting your doctor.
8. Do not share your Ultram with any family and friends. Keep a regular track of the number of pills left in your pillbox, to prevent a chance for abuse, as this is one of the most commonly abused drug.
9. Do not take Ultram with alcohol. Both alcohol and Ultram depress the respirations. When taken together, their effects on respirations can get added up and lead to severe respiratory depression and can even be fatal. Also, this can increase your risk of liver damage, as Ultram contains acetaminophen and acetaminophen with alcohol is a dangerous combination for the liver.
10. Ultram is metabolized by the liver and Ultram intake can lead to hepatic injury. Individuals with history of compromised liver function cannot metabolize Ultram and this can lead to increased blood levels of Ultram for longer duration, leading to toxicity. Ultram should be avoided or used with extreme caution in such individuals. Observe compliance with any labs ordered for evaluation of hepatic function.
11. Ultram is mainly excreted in the urine. Individuals with compromised renal functions tend to retain the drug in the circulation longer, thus resulting in toxicity. Ultram should be avoided or used with extreme caution in such individuals. Observe compliance with any labs ordered for evaluation of renal function.
12. Do not abuse Ultram by continuing to take the medication, even after the pain resolved.
13. Watch out for any continuing or worsening pain, to report to your doctor immediately, so that, a change in plan could be considered.
14. If you miss a dose, try taking it at the earliest notice of noncompliance. If it is time for the next dose, skip the missed dose and take the dose scheduled. Do not take an extra dose to try making up for the missed dose. Notify your doctor and other health care personnel regarding your dose noncompliance.