Zytram-XL is a single-entity opioid analgesic indicated for moderate pain of e.g. osteoarthritis of hip, joint, knee for several days or more (compare to Tramacet for 5 days or less). Advantage is once-daily dosing. Start with 150mg. Increase at weekly intervals to maximum 400mg. Zytram-XL must be swallowed whole. It is approved for age group 18 to 75. It must not be given if within 14 days of MAO inhibitors, or intoxication with alcohol, hypnotics, antipsychotics, opioids. Seizure can occur within normal dosage range but more so in presence of MAOI, SSRI, neuroleptics, tricyclics, opioids, head trauma, CNS infection, metabolic imbalance, alcohol/drug withdrawal, Tramadol has a potential to cause psychic and physical dependence of the morphine-type. Discontinuation should be gradual. Available in 150, 200, 300, and 400mg controlled release tablets.