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Tramadol: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Feb 24, 2022.

1. How it works

  • Tramadol is a man-made, pain-relieving medicine that may be used for the treatment of moderate-to-severe pain.
  • 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), activating inhibitory neurons and reducing pain signals. 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.

2. 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 after surgery.
  • Tramadol may also be effective for nerve-related pain.
  • Tramadol may be less likely than other narcotic analgesics to cause respiratory depression.
  • Available as immediate-release conventional tablets, an oral solution (Qdolo), and extended-release capsules or tablets. Available in fixed combination with acetaminophen.
  • May be taken with or without food, but should be taken consistently (this means either with food or without food).
  • Generic tramadol is available.

3. 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 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 with 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 not be appropriate for people at risk for respiratory depression, with head trauma, 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 after being taken for a long 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).

Note: 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. View complete list of side effects

4. 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. 

5. 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 on 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.

6. 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.

7. Interactions

Medicines that interact with tramadol may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with tramadol. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with tramadol include:

  • anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
  • anticonvulsants, such as carbamazepine, phenytoin, phenobarbital, or primidone
  • antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
  • antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
  • any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
  • diuretics, such as furosemide
  • heart medications, such as digoxin
  • medications that are metabolized by the same enzymes such as bupropion, erythromycin, fluoxetine, ketoconazole, paroxetine, quinidine, or ritonavir
  • migraine medications, such as almotriptan, eletriptan, or sumatriptan
  • muscle relaxants, such as cyclobenzaprine
  • other medications that affect serotonin, such as amphetamines, fentanyl, lithium, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
  • others, such as quinidine, or rifampin.

Avoid drinking alcohol or taking illegal or recreational drugs while taking tramadol.

Note that this list is not all-inclusive and includes only common medications that may interact with tramadol. You should refer to the prescribing information for tramadol for a complete list of interactions.

References

Further information

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.

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

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