Tramadol: 9 Things You Should Know
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 16, 2022.
Tramadol: A Controlled Substance In All 50 U.S. States
Tramadol is a narcotic-like painkiller, a centrally acting synthetic opioid analgesic. So it's no surprise that tramadol (common brand names include: ConZip, Qdolo, Ultram), was also found to be linked with drug abuse, addiction, and overdose in a 2015 report.
To address these concerns, the DEA placed all forms of tramadol into schedule IV of the Controlled Substances Act (CSA), meaning it does have potential for abuse. Previously, tramadol was thought to be of lower risk for abuse and was a controlled substance in only a few states.
What does this mean for patients? Now, tramadol prescriptions may only be refilled up to 5 times in a 6 month period after the date the prescription was first written. After five refills or six months, whichever occurs first, a new tramadol prescription is required from your healthcare provider.
Tramadol And Side Effects Go Hand-In-Hand
For many people, tramadol is well-tolerated when used for pain, but tramadol can also cause some common and bothersome side effects, especially with higher doses, such as:
- diarrhea or constipation
- nausea or vomiting
- impaired mental abilities and confusion
Take Note: Tramadol Serious Side Effects
Common side effects may be bothersome, but serious side effects (which may be less common or even rare) can be deadly. Tramadol products all have a Boxed Warning, which is the most prominent safety warning. You should be aware of the warnings and serious side effects that can occur in children, too.
Contact your doctor if you have any serious side effect, such as:
- serotonin syndrome
- slowed breathing
- life-threatening allergic or skin reactions
- angioedema (fluid swelling under the skin, often around the face)
- orthostatic hypotension (low blood pressure when you stand up)
- suicidal thoughts or actions
- opiate withdrawal symptoms
Warnings: Tramadol Use in Children
- Life-threatening respiratory depression (difficult, slowed breathing) and death have occurred in children who received tramadol. Life-threatening respiratory depression and death have occurred in children who received tramadol. In at least one case report, a child was noted to be an ultra-rapid metabolizer of tramadol.
- Tramadol should NOT be used (is contraindicated) in children younger than 12 years of age.
- It's especially important that tramadol NOT be used in children younger than 18 years of age after tonsillectomy and/or adenoidectomy surgical procedures (removal of tonsils or adenoids)
- Avoid the use of tramadol in adolescents 12 to 18 years of age who have other risk factors that may increase their sensitivity to the respiratory depressant effects of tramadol. Risk factors may include respiratory depression after surgery, obstructive sleep apnea, obesity, severe lung disease, neuromuscular disease, and use of other medications at the same time as tramadol that also cause respiratory depression.
Don't Stop Your Tramadol Cold Turkey
Don't abruptly stop taking tramadol if you have been using it regularly for pain control, as withdrawal symptoms may occur, such as:
Even more concerning, seizures can occur with recommended doses of tramadol, but are more likely at higher doses associated with abuse. Your doctor should suggest a slow and safe tapering dose schedule of tramadol when you stop treatment after using it regularly.
Beware: Drug Interactions With Tramadol
Tramadol drug interactions are complex and potentially deadly.
Patients receiving medicines like some antidepressants (SSRIs, SNRIs), triptan migraine medicines, or other serotonergic drugs may be at a higher risk for a dangerous drug interaction known as "serotonin syndrome" or the occurence of seizures. Serotonin syndrome is rare but potentially life-threatening condition.
Use of tramadol with a class of antidepressants known as monoamine oxidase inhibitors (MAOIs) may cause serious side effects and serotonin syndrome. Do not use tramadol at the same time or within 14 days of using a MAOI.
Do not take tramadol if you have used any alcohol, sedatives or tranquilizers (like benzodiazepines), or narcotic medication because of the risk of slowed breathing or other nervous system depression, which can be fatal in the most severe cases. Activities that require you to be alert, like driving or using dangerous machinery, should be avoided while taking tramadol.
Use with agents such as antidepressants, other narcotic pain relievers, or any other drug that lowers seizure threshold can result in a greater risk for seizures. Use with some opioids may also cause a withdrawal.
There are also complicated tramadol interactions with other drugs affected by certain liver enzymes. Blood levels of tramadol and its metabolite (M1) could change up or down and may lead to withdrawal, serious side effects, loss of pain relief, seizures, or even slowed or stopped breathing. Ask your doctor or pharmacist about the risk of these enzymes interactions with your medications.
This is not a full list of possible drug interactions with tramadol. Because there are so MANY tramadol drug interactions, you should always have a drug interaction review completed by your pharmacist or doctor each time you start, or even stop, any prescription, over-the-counter, vitamin or herbal supplement medication.
One Size Does Not Fit All
As with many medications, specific dose adjustments are often required if you are a child, older adult, or have kidney or liver disease.
This is also the case with tramadol dosing. The dosing interval (how often you take the drug) may need to be adjusted, the dose reduced, or there may be a maximum dose you should not exceed. Always follow your doctor's dosing instruction exactly.
For example, the extended-release oral formulations of tramadol (brand example: Conzip) should not be used in patients with severe liver (hepatic) impairment or severe kidney (renal) impairment. Talk to your doctor about the need for adjusted doses with any medication.
An oral solution form of tramadol, called Qdolo, was FDA-approved for adults in Sept. 2020. It comes as a 5 mg/mL oral solution to allow flexible dosing and titration as directed in labeling. Do not administer Qdolo at a dose exceeding 400 mg (80 mL) per day.
- Like other tramadol products, Qdolo contains an FDA Boxed Warning detailing multiple opioid safety concerns, including addiction, abuse, ultra-rapid metabolism, overdose, respiratory depression and death.
- Do not use Qdolo in children younger than 12 years of age. Also, do not use in children under 18 years of age for pain management after a tonsillectomy and/or adenoidectomy surgical procedure. Avoid use in children 12 to 18 years of age who have other risk factors for respiratory depression.
- Common side effects are dizzines or vertigo, nausea, constipation, headache, extreme drowsiness (somnolence), vomiting and itching.
Fact: Generics Save You Money
Bottom line - if you need to save money and can get a medication in the generic form, do it. Also, ask your doctor to prescribe only generics when possible. Tramadol does come in generic forms for both the immediate-release and extended-release forms and can probably save you hundreds of dollars. Don't hesitate to talk to your pharmacist about cost-savings, too.
- For example, 60 tablets of the immediate-release generic tramadol 50 mg tablet runs about $24.00, on average, using a common online prescription discount coupon (prices will vary around the country and at different pharmacies).
- However, the brand name Ultram runs over $220 for the same amount and strength.
- Generic extended-release tramadol (Conzip) can also save you hundreds of dollars. A generic for the liquid form of tramadol (Qdolo) is not yet available and costs roughly $150 for a 4 ounce (120 mL) bottle.
- Ask your pharmacist about other ways to save money on your prescriptions; in some cases, paying cash may be cheaper than your insurance co-pay with certain generics. Manufacturers may also be able to offer coupons or financial patient assistance.
Learn more: Drugs.com Tramadol Price Guide
Tramadol: Don't Make It A Habit
Even though tramadol is not a full opiate -- it's thought it also exhibits weak inhibition of reuptake of norepinephrine and serotonin -- people with a history of drug abuse may be at a greater risk of addiction.
Tramadol is related to the opioids like codeine and morphine and can lead to psychological and physical dependence, drug-seeking behavior, and withdrawal. Short-term use of tramadol is your best option if you are prescribed this medication.
- If you are concerned you are becoming addicted, talk to your doctor about alternative pain medicines.
- As previously mentioned, tramadol should not be stopped abruptly. Withdrawal symptoms may occur if you are dependent upon tramadol and quickly stop taking it. Serious withdrawal symptoms can include uncontrolled pain, suicide, and drug-seeking behavior.
- However, these symptoms can be lessened by a slow dose reduction combined with symptomatic support, as directed by your doctor.
Call 911 or get emergency if there is a tramadol overdose. Ask your doctor if you should have access to nalaoxone to help help reverse a tramadol overdose. Discuss with your doctor if you should keep naloxone with you while you are taking tramadol.
Online support groups aren't the right way to get individual medical advice; that should only be provided by your doctor.
However, the Drugs.com group discussions may be helpful for patients looking to find others with similar medical conditions who want to share experiences, express concerns, and keep up with the latest news.
While group chats might be helpful to you, they are NOT a substitute for the expertise, knowledge and judgement of your healthcare professional.
Finished: Tramadol: 9 Things You Should Know
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- Conzip (tramadol extended-release) prescribing information. Sept. 2021. Vertical Pharmaceuticals, LLC Bridgewater, NJ. Accessed Feb. 16, 2022 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/022370s023lbl.pdf
- Qdolo (tramadol) [product information]. Sept. 2020. Athena Bioscience. Athens, GA. Accessed Feb. 16, 2022 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/214044s001lbl.pdf
- D.M. Bush. The DAWN Report: Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Medication Tramadol. (2015). Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Rockville, MD. Accessed Feb 26, 2021. https://www.samhsa.gov/data/sites/default/files/report_1966/ShortReport-1966.html
- ERs See Spike in Narcotic Painkiller Abuse Cases. Drugs.com. Accessed Feb. 12, 2019.
- Drug Enforcement Administration. Office of Diversion Control. Drug and Chemical Evaluation Section. Tramadol. (Trade Names: Ultram, Ultracet); Accessed Feb 28, 2020. https://www.deadiversion.usdoj.gov/drug_chem_info/tramadol.pdf
- Sansone RA, Sansone LA. Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants. Psychiatry (Edgmont). 2009;6:17-21. Accessed Feb 26, 2021 at PMID: 19724727
- Young JWS, Juurlink DN. Tramadol. CMAJ : Canadian Medical Association Journal. 2012;185:E352. Accessed Feb 26, 2021 at doi: 10.1503/cmaj.121592
- Tramadol Product Label. DailyMed. US National Library of Medicine (NIH). Aurobindo. Accessed Feb 16, 2021 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6c2894df-eeeb-4b22-ab32-8ce1601bfdfa&audience=consumer