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    Tramadol acts on the opioid receptors through its major active metabolite desmetramadol, which has as much as 700-fold higher affinity for the MOR relative to tramadol.[11] Moreover, tramadol itself has been found to possess no efficacy in activating the MOR in functional activity assays, whereas desmetramadol activates the receptor with high intrinsic activity (Emax equal to that of morphine).[48][11][66] As such, desmetramadol is exclusively responsible for the opioid effects of tramadol.[67] Both tramadol and desmetramadol have pronounced selectivity for the MOR over the DOR and KOR in terms of binding affinity.[49][44][46]
    Q: What is the recommended Ultram dose? A: Ultram (tramadol) is a non-narcotic pain reliever, similar in action to the narcotic pain relievers. Ultram is indicated for the management of moderate to moderately severe pain in adults. The recommended Ultram dose should be individualized according to patient need and should be initiated and maintained using the lowest beneficial dose. Experience with Ultram has demonstrated that starting with the lowest dose and titrating upward to an effective dose results in fewer discontinuations and increased patient tolerability.
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