How to take Tramadol. Take tramadol exactly as prescribed. Follow all directions on your prescription label. Stop taking all other around-the-clock narcotic pain medications when you start taking tramadol. Tramadol can be taken with or without food, but take it the same way each time. Do not crush, break, or open an extended-release tablet or capsule (ConZip, Ultram ER). Swallow it whole to avoid exposure to a potentially fatal dose. Never crush or break a tramadol tablet to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death.