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Use: For the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. Use: For the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Tramadol is not recommended for use in pediatric patients 17 years or older: See Adult Dose. Immediate-release Patients with cirrhosis: 50 mg orally every 12 hours Extended-release Severe hepatic impairment Child-Pugh Class C: Use is not recommended. Assess each patient's risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers.

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