How long does it take for tramadol to start working?
Medically reviewed by Sally Chao, MD. Last updated on Feb 2, 2021.
Tramadol — a synthetic opioid — generally starts to relieve pain within an hour in its fast-acting forms, which are used for short-term pain management.
Fast-acting forms include:
- Some tablets and capsules
With slow-release or extended-release (ER) forms, the drug may take longer to start because it’s gradually released over 12 or 24 hours, but pain relief lasts longer. Slow-release tramadol is used to help with long-term pain. Slow-release forms include some tablets and capsules.
However, a number of factors can affect how quickly it takes tramadol to kick in, including:
- Whether you have taken opioids in the past
- Whether tramadol is combined with another medication, such as a nonsteroidal anti-inflammatory drug
A diagram of tramadol’s action in your body would have a bell shape: The medication begins to work, peaks in your system and then tapers off.
- Fast-acting tramadol peaks in your system after 2 to 3 hours, and typically lasts around 6 hours. It’s taken every 4 to 6 hours as needed for pain.
- The extended-release version peaks at 10 to 12 hours, but generally provides lasting pain relief for up to 24 hours. It’s taken once daily.
Food doesn’t affect how tramadol is absorbed, so you can take it with or without food. But tramadol does have to be taken in its original form. It cannot be split, chewed or crushed. It also shouldn’t be dissolved.
- For fast-acting tramadol, the recommended limit is 400 mg per day. A starting dose is 25 mg or 50 mg. After titration, 50 mg to 100 mg may be taken as needed for pain relief every 4 to 6 hours.
- For extended-release tramadol, the recommended limit is 300 mg per day. It’s taken once daily and comes in three different strengths: 100 mg, 200 mg and 300 mg.
When you first start taking tramadol, a lower dose is prescribed and then slowly raised every few days until the optimal dose is found. People who have kidney disease or are over 75 years old may need to take lower doses of tramadol.
When you’re in pain, it can be hard to wait for a medication to take effect, but it’s very important not to take more tramadol than prescribed.
- Food and Drug Administration (FDA). Highlights of prescribing information: Ultram (tramadol hydrochloride) tablets. April 2019. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020281s041lbl.pdf . [Accessed September 9, 2020].
- National Health Service (NHS). Tramadol. November 26, 2018. Available at: https://www.nhs.uk/medicines/tramadol/. [Accessed September 21, 2020].
- Gay-Escoda C, Hanna M, Montero A, et al. Tramadol/dexketoprofen (TRAM/DKP) compared with tramadol/paracetamol in moderate to severe acute pain: Results of a randomised, double-blind, placebo and active-controlled, parallel group trial in the impacted third molar extraction pain model (DAVID study). BMJ Open. 2019;9(2). https://bmjopen.bmj.com/content/9/2/e023715.long.
- Food and Drug Administration (FDA). Highlights of prescribing information: Ultram ER (tramadol hydrochloride) extended-release tablets for oral use. May 2010. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022370s000lbl.pdf. [Accessed September 2, 2020].
- DailyMed. TRAMADOL HYDROCHLORIDE EXTENDED-RELEASE- tramadol hydrochloride capsule. October 23, 2019. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c0bc7218-3fd0-4646-96f4-25355fc84aa9#LINK_7232c31a-0d12-4704-998e-e52486298875. [Accessed October 19, 2020].
- Drugs.com. Tramadol tablets. September 1, 2019. Available at: https://www.drugs.com/pro/tramadol-tablets.html#s-34090-1. [Accessed September 14, 2020].
- Drugs.com. Tramadol - Top 8 Things You Need to Know. January 24, 2020. Available at: https://www.drugs.com/article/tramadol-need-to-know.html. [Accessed September 17, 2020].
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