What is Tramadol?
What is Tramadol used for?
Pain that isn't relieved by non-opioid pain medications alone
How Tramadol works
Tramadol is an opioid receptor agonist. It treats pain in two ways. It attaches to certain mu-opioid receptors in your brain. This changes the way you recognize pain. Tramadol might also help with pain by raising the levels of chemicals in your brain called serotonin and norepinephrine.
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Are you looking for information on trazodone or Ultracet (tramadol / acetaminophen) instead?
When does Tramadol start working?
Time passed since treatment started:
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HOURS
DAYS
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Initial effect
Full effect
Drug Facts
Common BrandsUltram (brand no longer available), ConZip, Qdolo
Drug ClassOpioid
Controlled Substance ClassificationSchedule IV
Generic StatusLower-cost generic available
AvailabilityPrescription only
More on Tramadol essentials
What are the risks and warnings for Tramadol?
Tramadol can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Potential for addiction and misuse
Risk factors: Personal or family history of alcohol or substance use disorder | History of depression or other mental health conditions
Tramadol is a controlled medication that has a risk for addiction and misuse. Take the medication exactly as prescribed. Don't change the dose or how often you take it without talking to your provider first. Misusing tramadol (i.e., taking it differently than prescribed, breaking the extended-release forms) might cause it to work less well. It can also raise the risk for serious and sometimes life-threatening side effects, such as dangerously slow breathing, inability to stay awake, and overdose. Your healthcare provider will prescribe the lowest amount of tramadol that's necessary for the shortest period of time possible.
Because of the risk of misuse, addiction, and overdose, the FDA requires tramadol to be under a restricted program called the Risk Evaluation and Mitigation Strategy (REMS) program. Under this program, your healthcare provider is required to provide you with a Medication Guide and go over the proper use, serious risks, and safe storage and disposal of this medication. This helps keep you and your loved ones safe.
Dangerously slow breathing (respiratory depression)
Risk factors: Taking medications that can cause slow breathing | Drinking alcohol | Older age | Being frail | Medical conditions that cause breathing problems | Having genes that break down tramadol too quickly | Children | Breastfed babies of mothers taking tramadol
Tramadol can cause dangerously slow breathing, which can be life-threatening. This can happen to anyone. But having certain genes or medical conditions (e.g., COPD, asthma, head injury, high pressure in the brain) might raise your risk. You also might be at higher risk if you take certain medications like benzodiazepines, other opioids, and sleep medications. If you experience breathing problems, call 911.
Additionally, children younger than 12 years old as well as children younger than 18 years who received surgery to remove tonsils or adenoids must avoid taking tramadol. There are reports of children experiencing serious breathing problems after taking tramadol. If your child is prescribed tramadol, make sure they take the lowest effective dose for the shortest amount of time possible.
Overdose
Risk factors: History of opioid use disorder | Previous opioid overdose | Alcohol use | Taking high doses of tramadol | Taking more opioids than prescribed
Take tramadol exactly as prescribed. Taking too much tramadol or taking it more often than prescribed can lead to an overdose. Symptoms of an overdose include not responding to sound or touch, extremely slowed breathing, extreme sleepiness, slow heartbeat, and cold or clammy skin. Be sure you and your loved ones know how to recognize an overdose. Your provider will likely prescribe naloxone (Narcan, Zimhi), an opioid antagonist that can treat an opioid overdose. Make sure you carry naloxone with you at all times in case you experience an overdose. Call 911 right away if this happens. Store your medication out of reach from children, pets, or visitors to prevent accidental exposure or overdose.
Harm to newborn babies
Long-term use of tramadol during pregnancy can cause your unborn baby to become dependent on the medication. This is because the medication can pass through the placenta to your unborn baby. Once your baby is born, they can experience withdrawal symptoms, such as high-pitched crying, poor feeding and sucking behavior, trembling, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare provider know if you've used tramadol during pregnancy or if you notice these symptoms in your baby.
Drug interactions
Tramadol can interact with a lot of common medications. Some medications (e.g., erythromycin, ketoconazole, ritonavir (Norvir)) can raise tramadol levels in your body. This can raise your risk for tramadol side effects and even potentially life-threatening slowed breathing.
Other medications, such as rifampin (Rifadin) and carbamazepine (Tegretol), can lower the levels of tramadol in your body. This can cause tramadol to not work as well to manage your pain and might cause withdrawal symptoms.
If you're already taking stable doses of tramadol together with one of these other medications, don't stop taking them suddenly. Doing so can also lead to unsafe tramadol levels. Let your provider or pharmacist know what other medications you're taking before starting tramadol to make sure your medications are safe for you to take.
Difficulty concentrating and extreme sleepiness
Risk factors: Taking high doses of tramadol | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Tramadol can cause extreme sleepiness and lower your ability to think, react, and focus. Drinking alcohol or taking other medications that cause sleepiness can make these side effects worse. Make sure you know how this medication affects you before driving or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from taking tramadol.
Serotonin syndrome
Risk factors: Taking a monoamine oxidase inhibitor (MAOI) 14 days before starting tramadol | Taking other medications that raise serotonin levels in your brain
Serotonin syndrome is a rare, but potentially life-threatening condition where there's too much serotonin in the brain. Serotonin is one of the chemicals in your brain responsible for your mood. Your risk for this condition goes up if you use tramadol with other medications that affect serotonin levels, such as certain antidepressants, MAOIs (e.g., phenelzine (Nardil)), linezolid (Zyvox), and certain migraine medications. Make sure your provider knows about all the medications you take or plan to take (including over-the-counter medications and supplements). They can check that your medications are safe for you. Symptoms of serotonin syndrome include fast heart rate, muscle stiffness or spasms, high fever, and confusion. Get medical help right away if you have any of these symptoms.
Seizures
Risk factors: History of seizures | Medical conditions that raise the risk for seizures | Taking high doses of tramadol | Taking other medications that raise seizure risk
Tramadol can raise your risk of seizures. Your risk might be higher if you take other medications that raise seizure risk or if you take higher doses of tramadol than recommended. If you've had a seizure before, discuss with your provider to see if tramadol is right for you.
Low blood pressure
Tramadol can cause extremely low blood pressure. A drop in blood pressure can happen when you stand from a sitting or lying down position. This can lead to dizziness and fainting. To avoid falling, get up slowly if you've been sitting or lying down. If dizziness or lightheadedness doesn't go away, talk to your healthcare provider.
Low adrenal hormone levels
Risk factors: Taking tramadol for longer than 1 month
Some people taking opioids like tramadol have had low adrenal hormone levels. This might be more likely to happen after taking opioids for longer than 1 month. Symptoms include tiredness, weakness, not feeling hungry, nausea, vomiting, and dizziness. Let your provider know if you experience these symptoms. If your adrenal hormone levels drop too low, you might need to stop tramadol and be treated with corticosteroids.
Physical dependence and withdrawal
Risk factors: Long-term use of tramadol
If taken regularly for a long time, tramadol can cause your body to rely on the medication to function (dependence). You might experience withdrawal if you stop taking the medication suddenly. Withdrawal symptoms include runny nose, yawning, sweating, chills, return of pain, restlessness, anxiety, and irritability. Don't lower your dose or stop taking the medication suddenly without talking to your healthcare provider first. Your provider will slowly lower your dose to prevent withdrawal symptoms. If you have concerns about taking tramadol because of this risk, talk to your healthcare provider about alternative pain medications.
Low blood sodium levels
There have been some reports of low sodium levels in the blood in people taking tramadol. This was mostly reported in females older than 65 years of age and within the first week of starting the medication. Get medical help right away if you experience weakness, confusion, difficulty concentrating, headache, or memory problems. These could be signs of low blood sodium levels, which is a medical emergency.
More on Tramadol warnings
Pros and cons of Tramadol
Pros
Extended-release tablets and ConZip capsules are taken once per day and last throughout the day.
Immediate-release tablets are available as a lower-cost generic.
Possible lower risk of misuse and dependency compared to other opioids
Cons
A controlled medication, so there are special requirements to get a prescription filled
Must slowly lower the dose to stop the medication after long-term use to avoid withdrawal symptoms
Can't use in some children due to higher risk of potentially severe and life-threatening side effects
Not recommended while breastfeeding
Pharmacist tips for Tramadol
You can take tramadol with or without food. If it's hurting your stomach, taking it with food can help.
For tramadol extended-release tablets or ConZip capsules: Swallow the pills whole. Don't split, crush, or chew the pill. This can cause too much medication to be released into your body at once, which can be deadly. If you're having trouble swallowing the pills, contact your provider to see if there's another medication that's easier for you to take.
For tramadol liquid form: Make sure to only use a medication dose cup or oral syringe from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
Constipation is a common side effect of tramadol. Make sure to drink plenty of water and add more fiber-rich foods into your diet. If that doesn't work, ask your provider about possible over-the-counter constipation medications like senna (Senokot). If constipation continues to be a problem, let your provider know so they can discuss with you about what the next steps are.
It's possible for tramadol to make you sleepy or cause difficulty sleeping. You might need to adjust the time of day you take tramadol based on how it affects your sleep. Don't drive or perform activities that require you to be alert until you know how it affects you.
Take tramadol exactly as your provider instructed you to. Don't change your dose or stop taking tramadol without talking to your provider first. They might need to lower your dose slowly before you can stop the medication completely to lower your risk of having withdrawal symptoms.
Tramadol can cause your blood sugar to drop. If you have diabetes, ask your provider how often you need to check your blood sugar while taking tramadol. Also ask when you should call 911 if you get low blood sugar levels.
Store tramadol out of reach from children, pets, or visitors. If you don't need to take tramadol anymore, throw away the medication through a take-back program. This lowers the risk of accidental overdose and helps prevent medication misuse.
Frequently asked questions about Tramadol
Can I take other non-opioid pain medications while I'm taking tramadol for pain?
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Yes, it's generally acceptable and safe to take non-opioid pain medications with tramadol. These medications include acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). In fact, it's usually recommended to take non-opioid pain medications with opioids for additional pain relief. This is a way to lower the amount of opioids you need to take to manage pain. But it's important to note that these non-opioid pain medications also have several risks (e.g., liver or kidney problems, heart risks) that shouldn't be ignored. Before using other pain medications with tramadol, speak with your healthcare provider to make sure it's safe for you to do so.
Is tramadol as strong as other opioids?
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Tramadol is considered a weaker opioid compared to other opioids. But tramadol can still work well because it has an additional way that it helps manage pain. While most opioids mainly act on the opioid receptor to change the response to pain, tramadol can also raise the levels of serotonin and norepinephrine in your brain. This is thought to help with pain. Tramadol might also have a lower risk of misuse compared to the other opioids.
What is a REMS program, and why is tramadol under this program?
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Since tramadol has a risk for misuse and dependency, it's only available through a Risk Evaluation and Mitigation Strategy (REMS) program called the Opioid Analgesic REMS program. The FDA announced the launch of this restrictive program in 2018 for all opioids that aren't used in a hospital setting. The purpose of this REMS program is to make sure tramadol is distributed and used in a safe manner. Your provider must register with the REMS program and receive training on proper tramadol use in order to prescribe the medication. They are required to inform you about how to take tramadol safely and responsibly.
What's the difference between extended-release (ER) and immediate-release (IR) forms of tramadol?
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The extended-release (ER) forms of tramadol slowly release the medication into the body throughout the day. This can help manage your pain as you continue your day. This means you only need to take it once per day. On the other hand, the immediate-release (IR) forms of tramadol release medication into your body quickly (about 1 to 2 hours). Typically, the effects don't last as long as the ER form, so the IR form is usually taken more often throughout the day as needed for pain relief. Discuss with your provider about which formulation of tramadol fits your needs.
Can I take tramadol if I'm pregnant?
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Opioids like tramadol are generally not recommended during pregnancy unless the benefits of the medication are clearly greater than the risks. Taking opioids during pregnancy can cause developmental and growth problems in your baby. Additionally, your baby can become dependent on opioids and develop neonatal abstinence syndrome after being born. This is when your baby has opioid withdrawal symptoms like high-pitched crying, poor feeding and sucking behavior, irritability, abnormal sleep patterns, or seizure. This condition requires urgent treatment. If you're pregnant or thinking of becoming pregnant while taking tramadol, contact your provider right away to discuss the risks and benefits of using the medication during pregnancy.
Can I take tramadol if I'm breastfeeding?
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No, it's not recommended to take tramadol if you're breastfeeding. This medication can pass into breast milk and potentially raise the risk of very serious and sometimes life-threatening side effects in your baby. This can include extreme sleepiness and slowed breathing. In fact, the FDA announced that nursing mothers should avoid tramadol. Tell your provider if you want to breastfeed while taking tramadol. To make sure your breastfed baby is safe, your provider can recommend other pain medications for you or suggest other ways to feed your baby (e.g., use formula or previously stored breast milk).
Tramadol dosage forms
Tablet
| Dosage | As low as |
|---|---|
| 25mg | $26.27 for 30 tablets |
| 50mg | $8.40 for 30 tablets |
| 100mg | $32.61 for 60 tablets |
Typical dosing for Tramadol
Your provider will work with you to prescribe the right dose of tramadol for your individual needs, such as the type of pain you have and how well the medication is working for you. It's recommended to use the lowest dose possible for the shortest duration of time to manage your pain. General dosing ranges are listed below.
Tramadol immediate release (IR) - tablets, oral solution: The typical dose ranges from 25 mg to 100 mg by mouth every 4 to 6 hours as needed for pain.
Tramadol extended release (ER) - tablets, capsules: The typical dose ranges from 100 mg to 300 mg by mouth once per day.
Your dose might differ if you have severe kidney or liver problems.
How much does Tramadol cost?
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Tramadol (generic)
Tramadol contraindications
Contraindications are specific health conditions or situations in which a person shouldnot take a medication due to safety concerns. If you have any of the following conditionsor if any of the following apply to you, let your healthcare provider know because Tramadol will not be safe for you to take.
Ages 12 years and younger
Ages 18 years and younger taking tramadol for pain management after tonsil or adenoid surgery
Severely slowed breathing (respiratory depression)
Severe asthma
Conditions that cause blockage of the stomach passageway
Severe allergy to tramadol
Currently take or have taken an MAOI in the last 14 days
