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Tramal Side Effects

Generic Name: tramadol

Note: This page contains side effects data for the generic drug tramadol. It is possible that some of the dosage forms included below may not apply to the brand name Tramal.

It is possible that some side effects of Tramal may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to tramadol: oral capsule extended release, oral suspension, oral tablet, oral tablet disintegrating, oral tablet extended release

As well as its needed effects, tramadol (the active ingredient contained in Tramal) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking tramadol, check with your doctor immediately:

Less common or rare
  • Abdominal or stomach fullness
  • abnormal or decreased touch sensation
  • blisters under the skin
  • bloating
  • blood in the urine
  • blood pressure increased
  • blurred vision
  • change in walking and balance
  • chest pain or discomfort
  • chills
  • convulsions (seizures)
  • darkened urine
  • difficult urination
  • dizziness or lightheadedness when getting up from a lying or sitting position
  • fainting
  • fast heartbeat
  • frequent urge to urinate
  • gaseous abdominal or stomach pain
  • heart rate increased
  • indigestion
  • irregular heartbeat
  • loss of memory
  • numbness and tingling of the face, fingers, or toes
  • numbness, tingling, pain, or weakness in the hands or feet
  • pain in the arms, legs, or lower back, especially pain in the calves or heels upon exertion
  • pain or discomfort in the arms, jaw, back, or neck
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • pale bluish-colored or cold hands or feet
  • recurrent fever
  • seeing, hearing, or feeling things that are not there
  • severe cramping
  • severe nausea
  • severe redness, swelling, and itching of the skin
  • shortness of breath
  • sweats
  • trembling and shaking of the hands or feet
  • trouble performing routine tasks
  • weak or absent pulses in the legs
  • yellow eyes or skin

If any of the following symptoms of overdose occur while taking tramadol, get emergency help immediately:

Symptoms of overdose
  • Change in consciousness
  • decreased awareness or responsiveness
  • difficulty with breathing
  • lack of muscle tone
  • lightheadedness
  • loss of consciousness
  • pinpointed pupils of the eyes
  • severe sleepiness
  • shortness of breath
  • slow or irregular heartbeat
  • unusual tiredness

Some tramadol side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Abdominal or stomach pain
  • agitation
  • anxiety
  • constipation
  • cough
  • diarrhea
  • discouragement
  • drowsiness
  • dry mouth
  • feeling of warmth
  • feeling sad or empty
  • feeling unusually cold
  • fever
  • general feeling of discomfort or illness
  • headache
  • heartburn
  • irritability
  • itching of the skin
  • joint pain
  • loss of appetite
  • loss of interest or pleasure
  • loss of strength or weakness
  • muscle aches and pains
  • nausea
  • nervousness
  • redness of the face, neck, arms, and occasionally, upper chest
  • restlessness
  • runny nose
  • shivering
  • skin rash
  • sleepiness or unusual drowsiness
  • sore throat
  • stuffy nose
  • sweating
  • tiredness
  • trouble concentrating
  • unusual feeling of excitement
  • weakness
Less common or rare
  • Abnormal dreams
  • appetite decreased
  • back pain
  • bladder pain
  • blistering, crusting, irritation, itching, or reddening of the skin
  • bloody or cloudy urine
  • body aches or pain
  • change in hearing
  • clamminess
  • cold flu-like symptoms
  • confusion
  • cough producing mucus
  • cracked, dry, or scaly skin
  • decreased interest in sexual intercourse
  • difficult, burning, or painful urination
  • difficulty with moving
  • disturbance in attention
  • ear congestion
  • ear drainage
  • earache or pain in ear
  • excessive gas
  • fall
  • false or unusual sense of well-being
  • feeling hot
  • feeling jittery
  • flushing or redness of the skin
  • general feeling of bodily discomfort
  • goosebumps
  • headache, severe and throbbing
  • hoarseness
  • hot flashes
  • inability to have or keep an erection
  • itching, pain, redness, swelling, tenderness, or warmth on the skin
  • joint sprain
  • joint stiffness
  • joint swelling
  • loss in sexual ability, desire, drive, or performance
  • loss of voice
  • lower back or side pain
  • muscle aching or cramping
  • muscle injury
  • muscle pain or stiffness
  • muscle spasms or twitching
  • nasal congestion
  • neck pain
  • night sweats
  • pain
  • pain in the limbs
  • pain or tenderness around the eyes and cheekbones
  • pain, swelling, or redness in the joints
  • skin discoloration
  • swelling
  • swelling of the hands, ankles, feet, or lower legs
  • tightness of the chest
  • trouble in holding or releasing urine
  • trouble with sleeping
  • troubled breathing
  • weight increased or decreased

After you stop taking this drug, it is possible that you may still experience side effects that need medical attention. If you notice any of the following side effects check with your doctor immediately:

  • Gooseflesh
  • high blood pressure
  • increased sweating
  • increased yawning
  • shivering or trembling
  • unusually large pupils

For Healthcare Professionals

Applies to tramadol: oral capsule extended release, oral tablet, oral tablet disintegrating, oral tablet extended release


Gastrointestinal side effects are common. Nausea and constipation occur within the first 90 days of therapy in 40% and 46% of treated patients, respectively. Vomiting, diarrhea, dyspepsia, anorexia, flatulence, abdominal pain, and dry mouth have also been reported.[Ref]

Nervous system

Seizures have been reported in patients receiving the normal recommended dose. The risk for seizures is increased with doses above the recommended range.[Ref]

Nervous system side effects occur frequently. Dizziness, headache, and somnolence have been reported in more than 25% of treated patients during the first three months of therapy. CNS stimulation, including nervousness, anxiety, tremor, agitation, euphoria, emotional lability and hallucinations, has also been reported. Confusion, sleep disorders, and coordination disturbances have been reported in less than 5% of patients. Seizures have been reported in over 200 cases. Cases of long-lasting delirium have been reported in two elderly patients. A case of serotonin syndrome triggered by tramadol has also been reported.[Ref]


Dermatologic side effects including pruritus (11%) have been reported. Rash and urticaria have occurred rarely.[Ref]


Genitourinary side effects including urinary retention and urinary frequency have been reported in less than 5% of treated patients.[Ref]


Cardiovascular side effects including tachycardia and orthostatic hypotension have been reported rarely.[Ref]


Hypersensitivity side effects including anaphylactoid reactions have been reported after first doses of tramadol (the active ingredient contained in Tramal) as well as in patients with a documented history of codeine allergy. Angioedema has been reported rarely.[Ref]

The use of tramadol is contraindicated for patients with a history of allergy to any opioid.[Ref]


Other side effects including withdrawal symptoms and, rarely, auditory hallucinations have been reported. A case of vocal cord closure has also been reported.[Ref]


Metabolic side effects including hyponatremia have been reported.[Ref]


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2. Jensen EM, Ginsberg F "Tramadol versus dextropropoxyphene in the treatment of osteoarthritis: a short term double-blind study." Drug Invest 8 (1994): 211-8

3. Rauck R, Ruoff GE, Mc Millern JI "Comparison of tramadol and acetaminophen with codeine for long-term pain managemnet in elderly patients." Curr Ther Res Clin Exp 55 (1994): 1417-31

4. Cossmann M, Wilsmann KM "Effect and side-effects of tramadol: an open phase IV study with 7198 patients." Therapiewoche 37 (1987): 3475-85

5. Sunshine A, Olson NZ, Zighelboim I, DeCastro A, Minn FL "Analgesic oral efficacy of tramadol hydrochloride in postoperative pain." Clin Pharmacol Ther 51 (1992): 740-6

6. Vizcaychipi MP, Walker S, Palazzo M "Serotonin syndrome triggered by tramadol." Br J Anaesth 99 (2007): 919

7. Kahn LH, Alderfer RJ, Graham DJ "Seizures reported with tramadol." JAMA 278 (1997): 1661

8. Kunig G, Datwyler S, Eschen A, Schreiter Gasser U "Unrecognised long-lasting tramadol-induced delirium in two elderly patients. A case report." Pharmacopsychiatry 39 (2006): 194-9

9. Labate A, Newton MR, Vernon GM, Berkovic SF "Tramadol and new-onset seizures." Med J Aust 182 (2005): 42-43

10. Nightingale SL "Important new safety information for tramadol hydrochloride." JAMA 275 (1996): 1224

11. Hallberg P, Brenning G "Angioedema induced by tramadol-a potentially life-threatening condition." Eur J Clin Pharmacol 60 (2005): 901-3

12. Keeley PW, Foster G, Whitelaw L "Hear my song: auditory hallucinations with tramadol hydrochloride." Br Med J 321 (2000): 1608

13. Ripamonti C, Fagnoni E, De Conno F "Withdrawal syndrome after delayed tramadol intake." Am J Psychiatry 161 (2004): 2326-7

14. Brinker A, Bonnel RA, Beitz J "Abuse, dependence, or withdrawal associated with tramadol." Am J Psychiatry 159 (2002): 881; discussion 881-2

15. Fodale V, Mondello B, Mirenda F, Spinelli F, Santamaria LB "Tramadol and Vocal Cord Closure." Anesthesiology 102 (2005): 227-229

16. Sarret D, Le Berre JP, Zemraoui N "Tramadol-induced hyponatremia." Am J Kidney Dis 52 (2008): 1026; author reply 1027

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