Drug and Supplements


Written by
Dr. K Sneha
and medically reviewed by Vedprakash Verma

04 Jul 2019  -  5 min read



Tramadol is a widely used painkiller. Read the article to learn about the indications, side effects, dosage, and withdrawal symptoms of Tramadol.


We are analyzing drug Tramadol, as it is most widely used and misused all over the world, so some insight is reviewed in this article. Tramadol was first patented in 1963 by a West German pharmaceutical company. It is sold under many brand names worldwide. It is a prescription oral or injectable opioid agonist painkiller, which is used to relieve moderate to severe pain. It works by altering how you feel and respond to pain.

It is available in immediate-release, extended-release, and in combination with Paracetamol. It is a controlled substance, that is, it is available and to be used only under strict medical supervision.

Points to Remember:

  • Tramadol increases the risk of seizures by altering the threshold level of neuron discharge.

  • Avoid using Tramadol if you have a suicidal tendency or depressed.

  • Avoid using Tramadol if you have breathing problems, or if you are taking serotonergic drugs.

  • Do not use it if you are prone to addiction.

  • It can cause severe side effects if you take Tramadol with alcohol.

  • Never take it during pregnancy, as it can cause life-threatening withdrawal symptoms in the newborn.

  • Tramadol is contraindicated for children under 12 years of age.

What Is Tramadol Used For?

It is a narcotic-like analgesic and is used to treat chronic and acute moderate to severe pain. It can also be used in combination with other medicine like Paracetamol.

The extended-release formulation is used in cases of chronic pain, as the drug has to work round the clock.

How Does Tramadol Work?

Tramadol works by acting on serotonin and norepinephrine, which are associated with pain sensation. This medicine relieves pain by lowering the levels of both serotonin and norepinephrine.

Tramadol is broken down to O-desmethyltramadol by the liver enzymes. This O-desmethyltramadol binds to opioid receptors, which is where Morphine also binds, but it is a much stronger painkiller. Tramadol is only about 1/10th as effective as Morphine.

Tramadol is commercially available in the following doses:

  • Immediate-release - 50 mg.

  • Extended-release - 100, 200, and 300 mg.

Take this medicine only if your doctor prescribes it. The recommended dosage for moderate to severe pain in adults (age 18 to 64 years):

  • Immediate-release - 50 to 100 mg oral every 4 to 6 hours as needed. Not more than 400 mg/day.

  • Extended-release - Initially, 100 mg orally once a day. Can be increased by 100 mg/day every 5 days, but not more than 300 mg/day.

The recommended dosage for moderate to severe pain in older adults (above 65 years):

If your doctor has prescribed this medicine, then do not stop taking it abruptly as soon as the pain stops, as it might cause withdrawal symptoms. So, taper the dose and then stop in 1 to 2 weeks. Consult your doctor to find out safe ways to stop the medicine.

How to Use Tramadol?

Take this medicine orally as prescribed by your doctor. It can be taken with or without food, but if you have nausea, then it will help if you take it with food. It is usually started in a low dose and then adjusted depending on how effective it is. Do not crush, chew, or dissolve the sustained-release pill.

What Are the Side Effects of Using Tramadol?

Side effects are commonly seen when people start taking the drug for the first time. Over time, these side effects wear off.

Commonly seen side effects:

  • Nausea.

  • Vertigo.

  • Headache.

  • Drowsiness.

  • Sweating.

  • Weakness.

  • Dry mouth.

  • Diarrhea.

  • Itching.

  • Vomiting.

Other side effects:

  • Allergy.

  • Weight loss.

  • Suicidal thoughts.

  • Rapid heartbeat.

  • Postural hypotension.

  • Coordination problem.

  • Rash.

  • Losing consciousness.

  • Hives.

  • Problems in eyesight.

  • Menopausal symptoms.

  • Urine retention.

  • Breathing difficulty.

  • Frequent urination.

  • The pupil might get constricted.

Severe side effects:

  • Respiratory depression:

    • Shallow breathing.

    • Confusion.

    • Dizziness.

    • Fainting.

    • Slow breathing rate.

  • QT prolongation.

  • Serotonin syndrome:

    • Increased heart rate.

    • High blood pressure.

    • Fever.

    • Coordination problem.

    • Hallucinations.

    • Agitation.

    • Coma.

  • Seizures.

  • Adrenal insufficiency:

    • Muscle weakness.

    • Tiredness.

    • Abdominal pain.

  • Addiction.

  • Androgen deficiency:

    • Low energy.

    • Trouble sleeping.

What Are the Symptoms Seen with Tramadol Withdrawal?

The symptoms of Tramadol withdrawal starts in a day or two after the last dose. Some of the withdrawal symptoms include:

  • Irritability.

  • Anxiousness.

  • Restlessness.

  • Sleeping problems.

  • Increased breathing rate.

  • Dilated pupil.

  • Yawning.

  • Runny nose.

  • Nausea.

  • Vomiting.

  • Chills.

  • Sweating.

  • Muscle pain.

  • Teary eye.

  • Loss of appetite.

To prevent withdrawal symptoms, your doctor might taper the dose gradually before stopping it completely.

What Are the Drug Interactions of Tramadol?

Always tell your doctor about all the medicines, supplements, and herbs that you are taking, as Tramadol can interact with them and cause serious side effects.

Drugs that can increase the side effects of the drug taken or Tramadol are:

  • Benzodiazepines - Can result in sedation, respiratory depression, coma, and death.

  • Serotonergic drugs - Can cause serotonin syndrome.

    • Selective serotonin reuptake inhibitors (SSRIs).

    • Serotonin and norepinephrine reuptake inhibitors (SNRIs).

    • Tricyclic antidepressants.

    • Triptans.

    • 5-HT3 receptor antagonists.

    • Monoamine oxidase inhibitors (MOI).

What Is Tramadol Dependence?

Patients might become dependent on Tramadol if it is taken for more than a few weeks or months, but the potential for dependence is low as compared to other opioid agonist drugs. People who are prone to addiction are more at risk.

Tramadol is a commonly prescribed synthetic analgesic. Two potential adverse reactions of this medicine are seizures and SS (serotonin syndrome). Either of these reactions may occur with Tramadol monotherapy, but both appear to be much more common with either abuse or overdose or in combination with other drugs, particularly antidepressants. These adverse reactions appear to be more common in the elderly.

The majority of commonly prescribed antidepressants have been implicated in both of these adverse reactions. When prescribing antidepressants to patients on Tramadol, particularly in the elderly and/or those who might be at a heightened risk (i.e., individuals with epilepsy, head injuries, neurological dysfunction). If coadministration is undertaken, we advise careful monitoring for these two particular hazards.

Tramadol is a remarkable drug, but like all drugs, effective use entails balancing the benefits versus the risks. So tramadol is popular due to its property of less respiratory depression and well gastric tolerance. So before starting this medicine, screening for risk factor should be done, avoid using it in known cases of seizure, liver failure, and renal failure.

Frequently Asked Questions


How long does Tramadol stay in your system?

The half-life of Tramadol, that is the time taken for 50 % of the drug to be eliminated from the body is 6.3 hours. But, it can take up to 40 hours for the drug to completely leave the body.


How long does Tramadol stay in your urine?

Tramadol can be detected in the within 2 hours of taking the medicine orally. And it can be detected for up to 40 hours.


How long does it take for Tramadol to start working?

Immediate-acting tablets start acting within 30 to 60 minutes of oral administration. If it is injected locally, pain relief is almost instant. The painkiller action lasts for about 4 to 6 hours.
The extended or slow-release tablet is released slowly for 12 to 24 hours, but it might take longer to start working.


Is Tramadol stronger than Codeine?

Tramadol and Codeine are both used to relieve moderate to severe pain, but Tramadol is considered to be more potent. Both of them are opioid analgesics, and the only difference is Codeine is made from the poppy plant and Tramadol is synthesized chemically in a lab.


Does Tramadol make you sleepy?

Yes, you might feel drowsy or sleepy after taking Tramadol.


Can you take two Tramadol tablets together?

The immediate-release is available as a 50 mg tablet, which can be taken 50 to 100 mg every 6 hours, so you can take two tablets together. But not more than 300 or 400 mg.
The extended-release is available as 100, 200, and 300 mg tablets. The higher doses should not be consumed more than prescribed, as it can cause severe side effects.


Can Tramadol mess up your liver?

For patients with liver and kidney damage, the body cannot process and eliminate the drug properly, which might cause the blood levels of Tramadol to reach harmful levels. If given in high doses, Tramadol can cause liver failure.


What are the long-term effects of Tramadol?

Long-term use of Tramadol can result in addiction. Some of the other side effects include seizure, adrenal insufficiency, respiratory problems, androgen insufficiency, hallucinations, liver and kidney damage, and serotonin syndrome.


Can Tramadol make you gain weight?

Tramadol usually does not cause weight gain. As loss of appetite is a side effect of Tramadol, it might cause weight loss.


Can Tramadol cause mental illness?

Addiction to Tramadol can result in mental illness like depression, anxiety, and loss of confidence.


Is Tramadol stronger than Naproxen or Ibuprofen?

Yes, Tramadol is more effective in relieving pain than Naproxen or Ibuprofen. And Tramadol is seen to be more effective if given along Paracetamol.

Last reviewed at:
04 Jul 2019  -  5 min read





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