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Tramadol: 9 Things You Should Know

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 26, 2021.

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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:

  • itching
  • headache
  • diarrhea or constipation
  • nausea or vomiting
  • dizziness
  • drowsiness
  • impaired mental abilities and confusion
The occurrence of side effects may be more frequent and serious in the elderly, too.

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. Contact your doctor if you have any serious side effect, such as:

Warnings: Tramadol Use in Children

  • Life-threatening respiratory depression (difficult, slowed breathing) and death have occurred in children who received tramadol. Common brands include: Ultram, ConZip, Qdolo
  • Tramadol should NOT be used (contraindicated) in children younger than 12 years of age.
  • It's especially important that tramadol NOT be used (contraindicated) 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:

  • nausea
  • diarrhea
  • anxiety
  • sweating
  • tremors

Even more concerning, seizures can occur with recommended doses of tramadol, but are more likely at higher doses associated with abuse.

Tramadol drug interactions 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. 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

Patients receiving migraine agents called “triptans” -- drugs like Imitrex (sumatriptan), Zomig (zolmitriptan), and Relpax (eletriptan) -- may be at a higher risk for a dangerous drug interaction known as "serotonin syndrome".

Do not take tramadol if you have used any alcohol, sedatives, tranquilizers, 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.

There are many other tramadol drug interactions, so you should always have a drug interaction review completed by your pharmacist or doctor each time you start or stop any prescription, over-the-counter, vitamin or herbal supplement medication.

One Size Does Not Fit All

As with many medications, specific drug doses are often required if you are a child, senior, 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, vomiting and itching.

Fact: Generics Save You Money

Bottom line - if you 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.

  • 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 differemnt pharmacies).
  • However, the brand name Ultram runs over $200 for the same amount and strength.
  • A generic for the solution form of tramadol (Qdolo) is not yet available.
  • 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.

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. While naloxone (for example, Narcan) will reverse some, but not all, symptoms caused by overdosage with tramadol, the risk of seizures is also increased with naloxone administration.

Discuss with your doctor if you should keep naloxone with you while you are taking tramadol.

The manufacturer recommends that for a clinically significant respiratory or circulatory depression secondary to tramadol overdose, an opioid antagonist should be administered. Prolonged observation, and additional naloxone, may be required, particualrly with long-acting formulations of tramadol.

Find Support

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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Sources

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  2. 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
  3. ERs See Spike in Narcotic Painkiller Abuse Cases. Drugs.com. Accessed Feb. 12, 2019.
  4. Drug Enforcement Administration. Office of Diversion Control. Drug and Chemical Evaluation Section. Tramadol. (Trade Names: Ultram, Ultracet); July 2014. Accessed Feb 28, 2020.
  5. Sansone RA, Sansone LA. Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants. Psychiatry (Edgmont). 2009;6:17-21. Accessed Feb 26, 2021 at PMID: 19724727
  6. Young JWS, Juurlink DN. Tramadol. CMAJ : Canadian Medical Association Journal. 2013;185:E352. Accessed Feb 26, 2021 at doi: 10.1503/cmaj.121592
  7. Tramadol Product Label. DailyMed. US National Library of Medicine (NIH). Aurobindo. Accessed Feb 26, 2021 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6c2894df-eeeb-4b22-ab32-8ce1601bfdfa&audience=consumer

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.