Author: Hannah Sumpter

Tramadol is a drug in the opioid family but with less potency than others.¹ It affects your system differently than most opioids, so it is considered an atypical opioid.² Tramadol is an ideal drug for those with deficiencies with their breathing, lungs, liver, or kidneys, such as older patients, obese individuals, and smokers, since it doesn’t negatively affect the respiratory or cardiovascular systems.³

What is Tramadol Prescribed For?

These special characteristics of tramadol have made it the most commonly prescribed pain management method for moderate to severe pain.² Acting similarly to codeine and morphine to stop pain messages from the spinal cord,¹ tramadol is used effectively to treat moderate-to-severe pain³ such as:^4,5

• Low back pain
• Neuropathic pain
• Labor pain
• Postoperative pain
• Osteoarthritis
• Fibromyalgia
• Neuropathic pain
• Cancer pain

Tramadol also appears to have a calming effect and can be used to treat anxiety. It has also been shown to possess some antidepressant qualities and can, therefore, treat depression.⁴ Often, tramadol is found in addiction recovery centers as it is commonly used for the detoxification process of patients recovering from opiate dependence.⁶

Tramadol can be taken in multiple forms, including pill form, drops, capsules, suppositories, and injections. Each method has different benefits, and your medical professional will decide which method is best suited for your pain management needs.

All methods of tramadol use prove effective for treating pain but have varying time frames for when pain relief is experienced. Oral prescription of tramadol seems to have the quickest rate of pain relief but may wear off quickly, whereas other forms of tramadol have an extended-release option that will offer a more sustained pain relief.¹

Tramadol Side Effects

In addition to not affecting your breathing and organs in the same negative way as other opioids, there also seem to be fewer negative side effects of tramadol. Tramadol, compared to other opioids, seems to cause less:

• Dizziness
• Nausea
• Sedation

However, it still causes the same level of dry mouth and sweating during use, although mild.⁷

Another benefit of tramadol use is that when it is used in epidural form during childbirth, tramadol does not appear to affect the infant. There are also little to no side effects reported in the mother after childbirth.⁷

Tramadol is unlike other opioids in regards to serious side effects. The times that you will see serious adverse side effects of tramadol is when a physical and chemical dependency has occurred and has continued for a sustained period.⁸

Although Tramadol does seem to have a low rate of side effects, patients have reported some mild side effects while taking the medication. You may not experience any side effects while taking tramadol, but if some of these are experienced, please speak with your medical provider for a possible tramadol dosage adjustment.

Some tramadol side effects may include:

• Constipation⁶
• Nausea⁹
• Loss of appetite⁶
• Delerium¹⁰
• Psychosis
• Seizures¹¹
• Serotonin syndrome¹²
• Addiction⁷
• Withdrawal symptoms⁹

Constipation

Constipation is by far the most frequently reported side effects of tramadol. Constipation is a natural side effect of any opiate use, and it is most often dose-dependent. Meaning, the higher the dosage of the opiate, the more likely constipation is to occur.⁶

Nausea

Another common side effect of tramadol is nausea. Although not a life-threatening issue, it can definitely impact your quality of life. If you are experiencing nausea while taking tramadol, you are always welcome to speak with your medical provider as they may be able to offer some relief for your discomfort.⁹

Delirium

Tramadol has been associated with delirium, but whether this risk differs from other opioids is still controversial. However, those taking tramadol should be aware that you may experience delirium, so please speak with your medical professional before tramadol use.¹⁰

Psychosis

Psychosis is specific to tramadol, as it is not a typical side effect for other opioids. Psychosis is most often seen when the patient has discontinued the tramadol medication. The resulting psychosis can easily be treated with medical assistance. The psychosis usually resolves within a few days of its onset.¹³

Seizures

Seizures are some of the more serious but rare side effects of tramadol. Tramadol seizures appear to be most common among males taking the medication,¹¹ those with other underlying health conditions,¹⁴ or those whose main job is occupational driving. It should also be noted that the seizures were strongly correlated with improper tramadol dosage, where tramadol was taken at a toxic level.¹¹

As such, tramadol seizures are rare in the general population,¹⁴ but if left untreated, can be fatal.¹⁴ Thankfully, tramadol seizures have yet to show any permanent damage in the patient’s brain. Meaning, if medical support is received and tramadol medication is discontinued, the patient appears to recover completely without any long-term health effects.¹¹

Serotonin Syndrome

Serotonin syndrome is the most severe of the possible side effects when taking tramadol. It can range from mild to potentially life-threatening, and it can progress quickly. Serotonin syndrome occurs when there is too much serotonin in your system, which may at first present itself as mild tremors, but it potentially leads to seizures, coma, and death.¹⁵

Serotonin syndrome is traditionally observed when taking a selective serotonin inhibitor (SSRI) for depression. Still, newer studies are showing that serotonin syndrome is occurring in those patients taking tramadol by itself. A heightened risk of serotonin syndrome can then be assumed if the patient is taking an SSRI and tramadol simultaneously.¹²

Those most at risk of developing serotonin syndrome appear to be those with underlying health conditions, those of the older population, those taking a high dosage of tramadol, and those also taking other medications at the same time as tramadol.¹⁶

Understanding the severity of these side effects, prescribing physicians will your medications closely to best ensure that there are no contraindications, such as using an SSRI at the same time as tramadol. This will best ensure the patient’s safety before beginning tramadol therapy and almost assuredly avoid the risk of serotonin syndrome.¹²

Taking Tramadol with Other Drugs

Tramadol may have some benefits in regards to pain management, but tramadol is one of the most concerning medications when prescribed at the same time as other medications.

Tramadol has a lengthy list of contraindications, other medications with which tramadol cannot be taken, so please speak with your medical provider before beginning tramadol use to ensure that you can safely take all of your medications at one time and that there won’t be any tramadol interactions.³

Medications that shouldn’t be taken with tramadol include:

• Antidepressants
• SSRI
• Opioids
• Neuroleptics (risk of seizures)
• Hypnotic substances
• Centrally acting analgesics
• Psychotropics
• Sedatives (risk of breathing problems)

Tramadol Addiction

Tramadol appears to have a low dependence rate, meaning those taking tramadol do not seem to show the same level of physical and psychological dependence on the medication as when taking other opiates. As such, tramadol is considered to have a lower addiction rate than other opioids, but the risk cannot be fully dismissed.⁷

When tramadol addiction does occur, those most at risk for addiction are the patients who have been taking tramadol:

• For a longer period of time
• At higher doses
• Multiple times a day

Of course, if you have a history of a substance use disorder or recreational drug use, you may also be at an increased risk of addiction to tramadol. Please consider speaking with a medical professional before beginning tramadol.⁷

Damage to the Body

When dependence and addiction occur with tramadol, and the medication is misused for too long, potentially irreversible damage can be caused. Tramadol-induced oxidative stress and hepatotoxicity are two risks associated with tramadol addiction, especially in those addicted for 10-11 months.¹⁷

Hepatotoxicity is a highly concerning consequence of tramadol addiction, as it causes injury to the liver. The liver can regenerate, meaning it can repair itself after damage. However, if too much of the liver is damaged, it is unable to repair itself.

The amount of damage to the liver depends on how long tramadol is misused and the amount of tramadol taken at one time. If you feel that you may be experiencing hepatotoxicity for a tramadol addiction, please call 800-934-1582(Who Answers?) to find a rehab program, or speak with your medical professional.

Treatment for Tramadol Addiction

If an addiction has developed to tramadol, necessary detoxification will need to be done. During this time, withdrawal symptoms may be experienced, but most patients recover completely without any long-term health effects. In addition to withdrawal management, a full suite of rehab services is available for tramadol addiction treatment.

Always feel free to call 800-934-1582(Who Answers?) if you have any more questions or concerns about tramadol use, or if you are seeking guidance and support for tramadol addiction.

Resources

1. Grond S, Sablotzki A. (2004). Clinical pharmacology of tramadol. Clin Pharmacokinet, 4;43(13), 879-923.
2. Bravo, L., Mico, J.A., Berrocoso, E. (2017). Discovery and development of tramadol for the treatment of pain. Expert Opin Drug Discov, 12(12):1281-1291.
3. Scott, L.J., Perry, C.M. (2000). Tramadol. Drugs, 60, 139–176.
4. Barakat, A. (2019). Revisiting tramadol: A multi-modal agent for pain management. CNS Drugs, 33(5):481-501.
5. Duhmke, R.M., Cornblath, D.D., Hollingshead, J.R. (2004). Tramadol for neuropathic pain. Cochrane Database Syst Rev, (2):CD003726.
6. Dhagudu, N. K., Erravalli, A., Sarkar, S., & Chadda, R. K. (2019). Tramadol-related adverse drug reactions at an addiction psychiatry setting: A cross-sectional analysis. Indian journal of psychological medicine, 41(6), 593–595.
7. Lee, C.R., McTavish, D. & Sorkin, E.M. (1993). Tramadol. Drugs, 46, 313–340.
8. Subedi, M., Bajaj, S., Kumar, M.S., Yc, M. (2019). An overview of tramadol and its usage in pain management and future perspective. Biomed Pharmacother, 3(111)443-451.
9. Kabel, J.S., van Puijenbroek, E.P. (2005). Bijwerkingen van tramadol. 12 jaar ervaring in Nederland [Side effects of tramadol: 12 years of experience in the Netherlands]. Ned Tijdschr Geneeskd, 2;149(14):754-7.
10. Swart, L.M., van der Zanden, V., Spies, P.E., de Rooij, S.E., van Munster, B.C. (2017). The comparative risk of delirium with different opioids: A systematic review. Drugs Aging, 34(6):437-443.
11. Shamloul, R.M., Elfayomy, N.M., Ali, E.I., Elmansy, A.M.M., Farrag, M.A. (2020). Tramadol-associated seizures in Egypt: Epidemiological, clinical, and radiological study. Neurotoxicology, 7(79), 122-126.
12. Beakley, B.D., Kaye, A.M., Kaye, A.D. (2015). Tramadol, pharmacology, side effects, and serotonin syndrome: A Review. Pain Physician, 18(4), 395-400.
13. Rajabizadeh, G., Kheradmand, A., & Nasirian, M. (2009). Psychosis following Tramadol withdrawal. Addiction & health, 1(1), 58–61.
14. Hassamal. S., Miotto. K., Dale. W., Danovitch. I. (2018). Tramadol: Understanding the risk of serotonin syndrome and seizures. Am J Med, 131(11), 1382.e1-1382.e6.
15. Sansone, R. A., & Sansone, L. A. (2009). Tramadol: seizures, serotonin syndrome, and coadministered antidepressants. Psychiatry (Edgmont (Pa. : Township)), 6(4), 17–21.
16. Park, S.H., Wackernah, R.C., Stimmel, G.L. (2014). Serotonin syndrome: is it a reason to avoid the use of tramadol with antidepressants? J Pharm Pract, 27(1), 71-8.
17. Arafa, M.H., Atteia, H.H. (2018). Genetic polymorphisms of cytochrome P450 2D6 (CYP2D6) are associated with long term tramadol treatment-induced oxidative damage and hepatotoxicity. Toxicol Appl Pharmacol, 4(1), 346, 37-44.