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Tramadol: 9 Things You Should Know

Medically reviewed on Jan 9, 2017 by L. Anderson, PharmD.

Tramadol: Now A Controlled Substance In All 50 U.S. States

There is an ongoing concern that tramadol (Ultram, Ultram ER, Ultracet, ConZip, Ryzolt, Rybix ODT), a narcotic-like pain reliever, is linked with drug abuse, addiction, and overdose. To address these concerns, in 2014 the DEA placed all forms of tramadol into schedule IV of the Controlled Substances Act (CSA). Previously, tramadol was thought to be 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 prescription is required.

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 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:

Don't Stop Your Tramadol Cold Turkey

Don't abruptly stop taking tramadol if you have been using it long-term for pain control, as withdrawal symptoms like nausea, diarrhea, anxiety, sweating or tremors may occur. 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 will suggest a slow and safe tapering dose schedule if you need to stop treatment.

Beware Of Drug Interactions With Tramadol

Patients receiving migraine agents called “triptans” - drugs like Imitrex, Zomig, and Relpax - 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. Activities that require you to be alert, like driving, 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 each time you start or stop any prescription or OTC medication.

Tramadol: Don't Make It A Habit

Even though tramadol is not a full opiate, 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 the best option.

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, but may be lessened by a slow, dose reduction combined with symptomatic support, as directed by your doctor.

Find Support

Support groups aren't the right way to get individual medical advice; that should only be provided by your doctor. However, the group discussions may be helpful for patients looking to find others with similar medical conditions who want to share experiences and express concerns. While group chats might be helpful to you, they are NOT a substitute for the expertise, knowledge and judgement of your healthcare professional.

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 prescription dollars.

For example, 60 tablets of the immediate-release generic tramadol cost about $8.00, on average, using a common online prescription discount coupon (prices will vary around the country). However, the brand name Ultram runs close to $175 for the same amount and strength. Think what you could do with that extra savings!

Your Dose: One Size Does Not Fit All

As with many medications, tailored drug doses are often required if you are a child, senior, or have kidney or liver disease. This is 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.

Talk to your doctor about the need for adjusted doses with any medication. In fact, the extended-release tablets (tramadol ER, Ultram ER) and the brand name form of tramadol called Ryzolt should NOT be used at all in patients with severe liver disease.

Finished: Tramadol: 9 Things You Should Know

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  • 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 January 9, 2017 at
  • ERs See Spike in Narcotic Painkiller Abuse Cases. Accessed January 9, 2017 at
  • Drug Enforcement Administration. Office of Diversion Control. Drug & Chemical Evaluation Section. Tramadol. (Trade Names: Ultram®, Ultracet®); July 2014. Accessed January 9, 2017.
  • Sansone RA, Sansone LA. Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants. Psychiatry (Edgmont). 2009;6:17-21. Accessed January 9, 2017 at
  • Young JWS, Juurlink DN. Tramadol. CMAJ : Canadian Medical Association Journal. 2013;185:E352. Accessed January 9, 2017 at doi:10.1503/cmaj.121592.
  • Tramadol Package Insert. FDA. Accessed January 9, 2017 at