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Tramadol Patient Tips

Medically reviewed on Jul 27, 2017 by C. Fookes, BPharm

How it works

  • Tramadol is a man-made (synthetic) pain-relief (analgesic) medicine that has narcotic-like (may also be called opioid-like) properties.
  • Although experts aren't exactly sure how tramadol works, studies have suggested that tramadol and its active metabolite bind to mu opioid receptors in the central nervous system (the brain and spinal cord). It also appears to weakly inhibit the reuptake of serotonin and norepinephrine, increasing levels of these two neurotransmitters in the nerve synapse.
  • Tramadol belongs to the group of medicines known as narcotic analgesics.

Upsides

  • Tramadol may be used for the treatment of moderate-to-severe pain such as that caused by cancer, osteoarthritis, and other musculoskeletal diseases. Tramadol is often prescribed postoperatively.
  • Tramadol may also be effective against nerve-type pain.
  • Tramadol may be less likely than other narcotic analgesics to cause respiratory depression.
  • Generic tramadol is available.

Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, nausea, dizziness, constipation, vomiting, joint pains, dry mouth, sweating, and an itchy skin are commonly reported side effects.
  • Sedation, which may affect a person's ability to drive or operate machinery, or perform hazardous tasks is also commonly reported. Alcohol may enhance this effect.
  • May cause dependence, addiction, and slowed breathing. Tramadol may be misused and sought after by drug abusers. Tolerance may develop to its effect.
  • Seizures have been reported with tramadol use. The risk is increased in people taking certain types of antidepressants (such as SSRIs, SNRIs, TCAs, MAO inhibitors), other opioids, antipsychotics, other drugs that reduce the seizure threshold, with a pre-existing seizure disorder, head trauma, excessive alcohol use or a metabolic disorder predisposing to an increased risk of seizures.
  • Do not take tramadol if you are also using alcohol, drugs with sedative properties, or other narcotic medications; dangerous or fatal side effects, such as slowed breathing, can occur.
  • Seniors over the age of 65 years may be more sensitive to the side effects of tramadol. Tramadol should be initiated cautiously, and extended-release tramadol is best avoided.
  • May not be suitable for some people including those with a history of depression or prone to addiction. Tramadol may increase the risk of suicidal thoughts or behaviors.
  • Tramadol may also not be appropriate for people at risk for respiratory depression, with head trauma or increased intracranial pressure, or with an acute abdominal disease.
  • The dosage of tramadol may require adjusting in liver or kidney disease.
  • Withdrawal symptoms (such as anxiety, sweating, insomnia, nausea, diarrhea, pain, piloerection [bristling of hairs]) have been reported when tramadol has been abruptly stopped following dosing for extended periods of time. The dosage of tramadol should always be tapered off slowly on discontinuation.
  • Tramadol may interact with a number of other drugs including antidepressants, antipsychotics, St John's Wort, bupropion, triptans, or other drugs that are metabolized by CYP 2D6 or CYP3A4 hepatic enzymes.
  • The metabolism of tramadol may be slowed by people who are poor metabolizers at CYP 2D6. While concentrations of tramadol may be higher in these people, concentrations of the active metabolite of tramadol may be lower, resulting in insufficient pain relief.
  • Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor or rigidity and stomach symptoms (including nausea, vomiting, and diarrhea).
  • Rarely, anaphylaxis (a potentially fatal allergic reaction) has occurred with tramadol use, usually following the initial dose. Itchy skin, a rash, difficulty breathing, and other allergy-type symptoms may be more common. Do not use in people with a history of an allergic reaction to codeine or another opioid.
  • Tramadol is not FDA-approved for use in children under the age of 12 (immediate-release capsules) or 18 (extended-release capsules).

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

Bottom Line

  • Tramadol is a strong pain relief medicine effective for both general and nerve-related pain. Tramadol can cause dependence and use may be limited by side effects such as nausea and sedation. Pain-relieving effects or side effects may be altered in some people due to genetic variation or drug interactions. 

Tips

  • Tramadol may be taken with or without food.
  • The long-acting formulation must be swallowed whole; do not crush or chew as you may receive a dangerous or fatal dose. Extended-release tramadol capsules are intended to be taken only once a day. Do not increase the dosage of tramadol unless your doctor has advised you to do so.
  • May make you sleepy and affect your ability to drive or operate machinery. Refrain from driving or potentially hazardous tasks until you are sure tramadol is not having this effect.
  • Avoid alcohol. Alcohol may enhance the side effects of tramadol and increase the risk of seizures.
  • Can cause nausea. Taking an antiemetic (anti-sickness medicine) with tramadol can counteract this effect. Starting treatment with low doses or taking with food may also help to lessen nausea.
  • If you have been taking tramadol for long periods of time, do not stop it suddenly. Your doctor will advise you the best way to taper down the dosage over several weeks.
  • Tell a doctor immediately if you experience an allergic reaction to tramadol, excessive sweating, feel agitated or confused, develop a fever or diarrhea, find it difficult to control your limbs, or notice spasmodic jerky contractions of your muscles.
  • Keep out of reach of children and pets. Keep your medicine in a safe, private storage area, out of view of any person that may illegally misuse it.
  • Do not use if pregnant or breastfeeding unless specifically recommended by your doctor.

Response and Effectiveness

  • Peak levels of immediate-release tramadol are reached approximately two hours after oral administration. Peak levels of extended-release tramadol capsules occur within 10 to 12 hours. There is a lot of variability in the way people respond to tramadol - some people may require higher or lower dosages than others for the same level of pain relief.
  • Starting at the lowest possible dose and increasing the dose slowly may lessen side effects like nausea, dizziness, and headache.
  • When stopping treatment with tramadol, it's best to slowly discontinue the medicine to avoid withdrawal symptoms. Your doctor will give you a schedule.

References

Tramadol hydrochloride extended release capsules [Package Insert]. Revised 04/2017. SA3, LLC https://www.drugs.com/pro/tramadol-capsules.html

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Tramadol only for the indication prescribed.

  • Disclaimer: Every effort has been made to ensure that this information is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This drug information does not endorse drugs, diagnose patients or recommend therapy. It is an informational resource designed as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of this information. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2017 Drugs.com. Revision Date: 2017-07-27 03:40:21

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