Tramadol

Tramadol is a mild opiate, prescribed to relieve and reduce pain by changing the way in which the body processes pain signals.

Overview

Tramadol is a mild opiate which works as an analgesic to reduce pain. It works by changing the way in which the brain responds to pain signals and by releasing chemicals within the body to suppress the pain. It is prescribed in varying doses to patients who are suffering acute or long-term pain from ongoing injury or illness.

Once a dose of tramadol is taken, it begins its journey by binding to opioid receptors which are found in the brain and the spinal cord. These receptors are able to both relieve pain and also to induce the euphoric highs which are associated with opiate addiction and abuse. It is possible for patients to receive a high from taking tramadol, and this feeling can lead to a dependence and an addiction for some users.

After binding to opioid receptors, tramadol then increases the levels of serotonin in the brain. This is the same effect which is created by the use of antidepressants. The increased levels of serotonin suppress pain but also induce a lighter, happier mood. This dual approach to pain relief is what makes the drug effective as an analgesic, but it is also what makes it easy to become dependent on tramadol.

There are two commonly-prescribed forms of tramadol tablets; fast-acting and slow release. Both tablets work in the ways listed above, the only difference is in the time in which it takes for the drug to have an effect on the pain receptors, and how long this effect lasts for before another dose is needed. Fast-acting tablets are used to provide quick and intense burst of pain relief where pain is only expected for a short period of time. This might be as a result of trauma or injury. Doctors will either prescribe fast acting tablets to be taken only as and when the patient feels they need them or to be taken on a regular basis if the pain is more persistent. Slow-release tablets are used to gradually release the tramadol into the body over the course of a longer period of time. This type of tramadol tablet is used to treat conditions in which the pain is expected to be ongoing.

Tramadol is associated with a range of diverse but minor side effects. Many patients experience nausea, loss of appetite and dizziness when they first begin taking the drug, but these symptoms usually begin to fade in the first few days or weeks after taking the first dose. It is also possible to become addicted to the drug, but this very rarely happens to patients who have been following the prescription of their doctor. Caution is advised to patients who have been taking the drug for a long time as the body may become more tolerant of the medication and it may lose some of its effectiveness.

Conditions treated

  • Moderate Pain
  • Moderately Severe Pain

Type of medicine

  • Painkiller

Side Effects

Tramadol is known to cause side effects for many patients who take it. The most common side effects are not usually very serious and include:

  • Nausea
  • Vomiting
  • Constipation
  • Tiredness
  • Dizziness
  • Sweating
  • Low energy levels
  • Headaches
  • Dry Mouth

Many of these minor side effects of Tramadol can be treated or managed effectively to allow the patient to continue taking the pain medication.

Nausea and Vomiting

Nausea can often be reduced or eliminated entirely by taking an anti-nausea pill at the same time as the Tramadol. Doctors may be able to prescribe this alongside the painkiller. Patients experiencing nausea and/or vomiting after taking tramadol are advised to take the pill after they have eaten. Sticking to plain food rather than ones which are rich in flavor, fat and spice can also help to reduce this side effect. For the majority of patients, this side effects wears off a few days after they start taking tramadol.

Constipation

Constipation can be prevented by introducing more fiber into the diet and drinking large amounts of water. Exercise can also help, but this can be difficult depending on the cause of the pain for the patient. It is also very important to stay hydrated, drinking plenty of water will help to prevent constipation. In more extreme cases, laxatives can be used to soften the stool. These can either be purchased from a pharmacy or prescribed by a doctor.

Dry Mouth

In extreme cases, it is possible to prescribe an artificial saliva which can help to increase the moisture within the mouth. This can come in the form of capsules to suck, a spray or a gel to be rubbed inside the mouth. In most cases, the dry mouth can be combatted by sucking sugar-free candy or chewing sugar-free gum.

Headaches

Headaches are a common side effect of taking Tramadol, but they usually wear off after a week of taking the medication. There are other painkillers which can be taken in order to reduce the severity of the headaches, it is worth speaking to a healthcare professional about which would be best suited. In order to prevent headaches from occurring, patients should avoid drinking more than a small amount of alcohol, should make sure that they are getting plenty of rest and also ensure that they are drinking enough fluids.

Tiredness and Dizziness

Feeling dizzy and/or tired is a common side effect in the first two weeks of taking Tramadol. The body needs to get used to having the drug in its system and this can cause the patient to feel tired and dizzy. It is important to get plenty of rest, and to speak to a health care professional if the tiredness and/or dizziness persists after two weeks.

In the vast majority of cases, these side effects will actually begin to subside as the body becomes used to the drug, but patients should always speak to their doctor if the side effects continue to get worse or do not show signs of subsiding. It is extremely important to tell someone if side effects are persistent, as continuing to take the drug will only exacerbate these and potentially lead to more serious health problems.
In some cases, Tramadol can cause more serious side effects, these are much less common but patients should notify their doctor immediately if they experience any of the following:

  • Mood changes
  • Anxiety
  • Hallucinations
  • Severe abdominal cramps/pain
  • Difficulty and/or pain when passing urine
  • Loss of appetite
  • Severe and sudden weight loss
  • Fatigue
  • Fainting
  • Seizures
  • Reduced libido
  • Inflammation of the eyes, tongue, lips, face, throat, fingers, hands, toes, feet, legs and ankles
  • Hives
  • Allergic reactions such as; hives, rashes, blisters
  • Difficulty breathing
  • Irregular heartbeat

These side effects could all become dangerous if left untreated, and could be the first signs of a more serious underlying condition. Patients are advised to get in touch with their doctor immediately if they begin to experience any of the side effects listed above.

In very rare cases, tramadol can cause seizures. This risk is heightened in cases where patients have previously suffered from seizures.

If tramadol is taken consistently over a long period of time, there are more serious side effects which may start to take hold slowly. These include:

  • Physical dependence on the drug
  • Psychological dependence
  • Addiction
  • Tolerance (the tramadol becomes less effective as a painkiller)
  • Cognitive decline

Dosage

Tramadol is prescribed in doses which reflect the medical condition of the patient at the time. Side effects from Tramadol are common, so doctors often prescribe a smaller dose to begin with, gradually increasing the amount taken if necessary.

Doses and the form of the tablets are often adjusted according to how long the patient’s pain is likely to last. Some tables release the drug more slowly into the patient’s system, which allows a higher dose to be slowly released over a longer amount of time. This will treat long-term pain much more effectively.
Shorter term pain can be treated by using fast-acting tramadol tablets which will begin to work in half an hour. These tablets are often prescribed to patients who are able to wait until the pain sets in before taking a short burst of pain relief.

For adults under 75 years of age, the maximum dose recommended by doctors and pharmacologists is 400 milligrams per day. For patients over 75 years old, this maximum recommendation falls to 300mg each day.
Tramadol is usually prescribed to be taken several times a day. Fast-acting tablets are taken up to four times a day whereas as patients who are prescribed slow release tablets may only have to take the medication once each day.

Interactions

There is always the possibility that two or more drugs may cause an adverse reaction when taken together. It is always a good idea for patients to keep a comprehensive list of all of the medications they are currently taken in order to be able to present a full record to their pharmacist or healthcare professional if required. Patients should always be completely honest with healthcare professionals about the drugs they are currently taking, both prescribed and non-prescribed as it is not just prescription medications which can interact with one another.

The following medications are known to have potentially severe interactions when taken alongside tramadol:

  • Dapoxetine/Serotoninergic Agents
  • Propoxyphene; Tramadol/Rasagiline; Selegiline
  • MAOIS

As both tramadol and the substances listed above increase the levels of serotonin in the body, these medicines should not be taken together. Excess serotonin levels can have a multitude of effects, causing symptoms such as changes in mood, temperature and blood pressure as well as muscle tremors and/or severe diarrhea. If the high levels of serotonin persist, the patient can develop Serotonin Syndrome which is potentially life-threatening.

The following pharmaceuticals are known to have serious interactions when taken at the same time as tramadol:

  • Abstral
  • Acetaminophen
  • Amilon
  • Aminophylline
  • Ammonium Chloride
  • Amphetamine
  • Anexsia
  • Banflex
  • Baxdel
  • Brompheniramine
  • Cafatine
  • Codeine
  • Conjugated Estrogens
  • Darvocet
  • Dihydrocodeine
  • Equanil
  • Endal CD
  • Endocodone
  • Epidrin
  • Fentanyl
  • Granisol
  • Halcion
  • Hydrocodone
  • Ibuprofen
  • Lithium
  • Lorazepam
  • Morphine
  • Methadone
  • Opium
  • Oramorph
  • Temazepam
  • Valium
  • Vicodin
  • Xanax
  • Xylocaine
  • Zoloft

The majority of the drugs listed above are deemed to have serious interactions with tramadol because when taking either drug there is a very small chance of causing seizures. The risk of causing the patient to have a seizure is increased if more than one of these drugs is taken at once, however, the likelihood still remains incredibly low. The majority of patients who take two or more of these drugs would probably not experience seizures at all, but the increased risk means that the interactions must be noted.

It is not possible to offer a complete list of all of the interactions between tramadol and other drugs as there are many different possibilities, and there may even be interactions which have yet to be discovered. When prescribing a drug, doctors will weigh up the possibility of side effects against the need for the drug to control existing symptoms. Be honest when informing the doctor of any medications you may be taking, but do not be alarmed if they prescribe tramadol knowing that you are already taking medication with a known interaction. The doctor will be looking to alleviate your pain and the risk of side effects may be incredibly small. If you are concerned, monitor your own condition closely and be vigilant about reporting any changes in your physical or mental health. This will help to minimize the impact of any potential interactions between medications.

In addition to interacting with different pharmaceuticals, Tramadol can exacerbate or interact with different medical conditions. Patients who are prescribed Tramadol should be especially careful to let their doctor know if any of the following statements are true:

  • You have an allergy to tramadol
  • You are suffering from, or have ever suffered from, liver or kidney disease
  • You are taking any prescription or non-prescription medication
  • You are an alcoholic or have a history of alcohol or substance abuse
  • You have ever been diagnosed with acute abdominal conditions
  • You are prone to seizures or have been diagnosed with a seizure disorder
  • You have ever been dependent on drugs
  • You have ever struggled with suicidal tendencies
  • You have been diagnosed with intracranial pressure or experienced a severe head injury
  • You suffer from respiratory depression
  • You have ever had a reaction to different forms of strong painkillers

If any of the above statements are true, these conditions could interact with tramadol and either reduce its effectiveness as a painkiller or put the patient at risk of potentially life-threating side-effects.

It is extremely important to remain vigilant and to report any side effects to a doctor if these are not expected or are more persistent or severe than they should be. Patients should attend their regular consultations with doctors and monitor their own progress in order to spot any unexpected interactions early on.

Warnings

It is possible to overdose on tramadol, and the effects of an overdose can be incredibly serious. If you notice any of the following signs, make sure to seek emergency medical attention and stop taking the drug until you have further medical advice:

  • Extreme lightheadedness
  • Severe difficulty in breathing
  • Loss of muscle tone
  • Loss of awareness and/or responsiveness
  • Irregular heartbeat
  • Extreme drowsiness
  • Pinpoint pupils

Tramadol works by altering the way in which the brain responds to and deals with pain. In addition to relieving pain it can also bring on highs and can relieve anxiety. It is a mild opiate, and therefore can be addictive. Patients who continue to use tramadol over a longer period of time can develop a dependency on the drug. In order to avoid addiction, it is imperative not to exceed the dose prescribed by the doctor.

Patients with an addiction to or dependence on tramadol will start to experience adverse physical effects as they enter withdrawal. Withdrawal from tramadol will induce some or all of the following symptoms:

  • Feelings of pronounced panic and anxiety
  • Sweating
  • Muscle spasms
  • Nausea
  • Vomiting
  • Tremors and shaking
  • Flu-like symptoms; runny nose, cough, chills
  • Extreme pain

As with any addiction, dependence on tramadol can also start to have negative consequences, including but not limited to:

  • Being unable to attend appointments
  • Increased health issues
  • Difficulty maintaining personal and professional relationships
  • Failure to maintain professional standards
  • Missing days at work
  • Failure to uphold personal or professional commitments
  • Financial consequences

The following scenarios are all indicators that a patient has become overly-dependent on tramadol:

  • The patient has started associating the drug with a high rather than pain relief
  • The patient has significantly increased the dose they take at any one time
  • The patient goes out of their way to procure higher quantities of the drug, eg. Shopping around different doctors, unnecessary visits to the emergency room, ‘losing’ prescriptions or lying about the quantity prescribed
  • The patient is reluctant to medical examination or refuses to take medical tests
  • The patient is seeking to obtain the drug illegally or without prescription
  • The patient is panicky or anxious if the drug is out of reach and begins to plan their day around their doses.

Addiction to tramadol can put undue pressure and strain on the body. As even using the drug as prescribed can cause noticeable side effects, increasing the dose taken can increase the prevalence and severity of the following side effects:

  • Muscle pain: aches and cramps
  • Lightheadedness and dizziness
  • Drowsiness
  • Lack of appetite
  • Inability to regulate temperature: chills and sweating
  • Changes in mood
  • Muscle weakness
  • Nausea and vomiting
  • Constipation
  • Headaches

If you suspect that you or someone you know has developed an addiction to tramadol, you should get in touch with a doctor straight away. Earlier intervention may prevent any lasting physical effects on the body.

Storage

Tramadol should be stored in the container it was prescribed in, and an air-tight seal should be maintained. It can be dangerous to those who have not been prescribed the drug and as with all medications it should be stored well out of reach of pets and children. Tramadol needs to be kept at room temperature, somewhere where it does not get excessively hot or excessively cold. It should be stored away from moisture and therefore should not be stored in the kitchen or the bathroom.

As Tramadol is sometimes taken up to 3 times a day, patients often find it necessary to carry the drug on them when out and about so as not to miss a dose. The same measures should be taken to store the medication whilst travelling. The drug should remain in a sealed container which is clearly labelled, at room temperature and away from moisture. Extra care should be taken to make sure that the drug remains within the possession of the patient.
Patients wishing to dispose of any excess tramadol tables should do so carefully. Tablets should not be placed in household garbage as there is the risk that they could cause harm to others. Tramadol should never be flushed down the toilet either. If patients find that they have more tablets than they require, the excess doses should be returned to a healthcare center, surgery or hospital so that they can be disposed of safely.

Summary

Tramadol is a drug which has provided a great deal of relief for many people suffering from moderate to moderately severe pain. It is versatile in its uses as the dose can be adapted and controlled depending on the individual needs of a specific patient. This means that it can be used to treat a wider variety of different types of pain. Fast-acting tablets can be used to treat patients who require short bursts of pain relief as and when the pain presents itself. Slower release tablets can be used to emit a consistent dose of pain relief to a patient who might be experiencing long term and ongoing pain.

Tramadol is a useful drug as it provides a middle-ground between mild over-the-counter painkillers such as ibuprofen and paracetamol and stronger, more invasive opiate-based painkillers. This allows patients with moderate levels of pain a relief from persistent conditions, illnesses or injuries, without resorting to more aggressive forms of analgesic.

Tramadol is known for causing common side effects. Many patients will suffer from side effects such as nausea, vomiting, dizziness and tiredness when they first start taking tramadol. There are measures which patients can take in order to minimize these side effects, and they normally disappear after a few days or weeks after the first dose. Most patients find that the pain-relieving benefits outweigh the side effects, and this is why tramadol is so commonly prescribed by doctors and healthcare professionals.

As a mild opiate, tramadol can be addictive. It is possible for patients who exceed their prescribed dose, or for patients who have been taking the drug consistently for a long time to develop a physical and/or psychological dependency on the drug. It is therefore extremely important for those who are prescribed tramadol that they do not exceed the dose prescribed to them by the doctor and to seek medical help as soon as possible if they believe they are developing a tolerance to or a dependence on tramadol.

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Last Reviewed:
December 25, 2017
Last Updated:
December 22, 2017
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