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Patients over 75 years old : No more then 300 mg/day in divided doses Patients with kidney impairment : The dosing interval of Tramadol should be increased to 12 hours with a maximum daily dose of 200 mg. Provides cheap generic ultram product or service and discount ultram. Patients with cirrhosis : Recommended dosage is 50 mg every 12 hours. Patients receiving chronic carbamazepine : Doses up to 800 mg daily may be required, this is up to twice the recommended dose of Tramadol. ADVERSE REACTIONS : Tramadol was administered to 550 patients during the double-blind or open-label extension periods in U. Provides cheap generic ultram product or service and discount ultram.