Tramadol Side Effects, Risks, and More - GoodRx (2024)

Tramadol is part of a group of medications called opioids. It’s used to treat pain that isn’t relieved by non-opioid medications. This includes over-the-counter pain relievers like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol).

But like all opioid medications, tramadol comes with risks, especially when it’s used for long periods of time or at high doses.

What is tramadol?

Tramadol is an opioid medication. It’s approved to treat severe pain in adults when other pain medications haven’t worked.

Tramadol is available in a few different forms, including:

• Generic tramadol immediate-release (IR) tablets

• Generic tramadol extended-release (ER) tablets

• Brand-name oral liquid (Qdolo)

• Brand-name ER capsules (Conzip)

• Brand-name tramadol/celecoxib tablets (Seglentis)

• Generic and brand-name tramadol/acetaminophen tablets (Ultracet)

How does tramadol work?

Opioids like tramadol activate opioid receptors. These receptors are present throughout the body, including in your brain, spinal cord, and stomach.

By attaching to opioid receptors, tramadol helps block pain signals. So even if your body is hurting — after an injury, for example — you won’t feel the sensation of pain as strongly if you’re taking tramadol or another opioid.

But tramadol also works in another way that’s different from other opioids: It increases the activity of two chemicals in the body: serotonin and norepinephrine. It’s thought that higher levels of these chemicals can lower the intensity of your pain.

Common tramadol side effects

Tramadol can have side effects. Some of these side effects are related to how opioids affect your brain and spinal cord. It may cause:

• Dizziness

• Headache

• Tiredness

• Nervousness or anxiety

• Low energy levels

• Nausea and vomiting

• Itching (opioid receptors on the skin also likely play a role)

Other tramadol side effects, including constipation, indigestion, and diarrhea, may be due to the fact that tramadol affects how well your gut works.

Sweating and skin flushing (redness) can also occur with opioids. This is because they cause your body to release a chemical called histamine. And opioids can cause dry mouth due to their anticholinergic effect.

These side effects are usually mild and may pass as your body gets used to the medication. But constipation from tramadol may last for as long as you take it, and in some cases might require treatment.

Serious tramadol risks

Tramadol (and all opioids) can cause more severe side effects. If you experience anything discussed below, reach out to your healthcare provider immediately. In serious cases, such as an overdose, seek emergency care.

Dependence and misuse

Tramadol is a controlled substance. This means that it’s more likely to cause dependence than non-controlled medications. Dependence can sometimes lead to opioid use disorder (OUD), a medical diagnosis where someone continues to use opioids despite negative consequences.

OUD with tramadol is more likely if you take more than prescribed, or take it for a longer amount of time. It’s also more likely if you or someone in your family has a history of a substance use disorder.

But it’s important to note that tramadol is weaker than other opioids. It’s considered a Schedule 4 controlled substance. So it’s less likely to cause dependence and misuse than Schedule 1, 2, or 3 controlled substances. In fact, research shows that tramadol is less likely to be misused than other commonly prescribed opioids. This includes hydrocodone/acetaminophen and oxycodone (Roxicodone, Oxycontin).

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

Overdose risk

Overdose is possible with tramadol. Symptoms include difficulty breathing, coma, and even death.

Overdoses are more likely if you take too much tramadol or take it with other substances that also affect breathing, such as benzodiazepines, alcohol, and other opioids. So it’s best to avoid combining these substances and tramadol. Overdoses are also more likely in people who are older or who have medical conditions that affect how well they can breathe.

If you take tramadol, it’s a good idea to have naloxone (Narcan, Zimhi) with you at all times. Naloxone is a fast-acting medication that can reverse an opioid overdose. You can find it for free in some states and without a prescription throughout the entire U.S.

After administering or receiving Narcan, someone should still call 911 or seek emergency help.

Suicide risk

Tramadol can increase your risk of having suicidal thoughts or behaviors. These side effects may be more common in people who have depression, current suicidal thoughts, or a history of substance misuse.

If you or someone you know is having thoughts of suicide, contact the National Suicide Prevention Lifeline by dialing 988 or local emergency services.

Withdrawal symptoms

Tramadol withdrawal can happen if you abruptly stop taking tramadol. Symptoms might include sweating, anxiety, and sleep disturbances. If you’ve been taking tramadol for a while, work with your healthcare provider to slowly lower your dose instead of stopping it abruptly.

Risks in children under 12 years old

Children are more likely to experience trouble breathing from tramadol. So children under 12 years old shouldn’t take tramadol. Children who are between 12 and 18 years old should also avoid it when possible.

Other tramadol risks

Besides the risks discussed above, tramadol can sometimes cause:

• Serotonin syndrome: This condition can occur when you take tramadol with other medications that raise serotonin levels. These include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

• Seizures: These are more likely if you have an existing seizure disorder or if you take other medications that raise seizure risk. These include medications like other opioids, SSRIs, and bupropion (Wellbutrin XL, Wellbutrin SR).

• Low sodium levels: These are more likely in the beginning of treatment and you may not always experience symptoms. Low sodium levels may cause a headache or confusion.

• Adrenal insufficiency: This can happen if your adrenal glands don’t make enough of certain hormones. You may experience nausea and vomiting, tiredness, or loss of appetite.

• Low blood pressure: Hypotension can happen when taking tramadol, especially while changing positions (orthostatic hypotension). Fainting may also occur. This risk is higher if you already have low blood pressure, take too much tramadol, or if you’re taking other medications that have this effect.

• Low blood sugar:Hypoglycemiamay be more likely if you have diabetes. If you have diabetes and take tramadol, make sure to check your blood sugar regularly at home.

How is tramadol different from hydrocodone products?

Tramadol is different from hydrocodone products for a few reasons. The major difference is that hydrocodone products are Schedule 2 controlled substances. Since tramadol is a Schedule 4 substance, it’s considered less likely to cause dependence or misuse.

Tramadol also works differently than hydrocodone. It affects serotonin and norepinephrine levels in the brain, while hydrocodone isn’t known for having a major effect on these chemicals. Additionally, tramadol immediate release lasts longer in the body than hydrocodone immediate release products like hydrocodone/acetaminophen.

Can you take tramadol and hydrocodone together for pain?

It’s best to avoid taking more than one opioid at a time. While some people may need a long-acting and short-acting opioid (like those who have pain from cancer), it's generally best to avoid this when possible. Taking multiple opioids can increase your risk of dependence, misuse, and overdose. It can also increase your risk of everyday side effects like nausea and constipation.