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Tramadol: the use, how it works, and side effectsTramadol is an opioid pain reliever used to alleviate moderate to moderately severe chronic pain in patients with specific circumstances. Read our article for a full review of tramadol.

Tramadol: a comprehensive drug review

Tramadol is a pain reliever that belongs to opioids. It was initially FDA-approved in the USA in 1995. Since 2014, the drug has been classified as a Schedule IV compound, which means it is available only with a doctor’s prescription, and the latter cannot be refilled more than 5 times in half a year. The most common forms of the drug are two kinds of capsules or tablets for oral administration:

  • 50 mg immediate-release (IR) pills..
  • 100 mg, 200 mg, or 300 mg extended-release (ER) pills for chronic pain that requires full-time management.

There are also injections, suppositories, drops, etc. Tramadol can be obtained as a generic and under various trade names, such as:

  • Bestodol;
  • Conzip;
  • Ryzolt;
  • Tramacon;
  • Ultram.

How it works in the body?

As an opioid, tramadol selectively binds to the opiate receptors in the CNS. This action blocks pain signals transmitted through nerves. Additionally, the compound can slow down the reuptake of norepinephrine and serotonin, which promotes the alleviation of pain.

Indications and use

Tramadol is indicated for the alleviation of moderate to moderately severe pain (nerve, post-surgery, etc.) when non-opioid analgesics are not effective. If the pain lasts more than a week and the patient needs unceasing control for it, doctors prescribe ER forms of the drug. The medication can be used off-label. This means that the FDA did not approve the drug for this specific purpose, but clinical research shows that it may be beneficial for patients. For instance, tramadol has potential for the management of restless leg syndrome or premature ejaculation when other treatment methods fail. The dosage depends on many factors, including the patient’s age, their response to treatment, etc. If the patient needs to switch from IR form to ER, their dose will depend on how much tramadol they received in 24 hours. The maximum daily dose of the drug is 300 mg. Tramadol can be administered with a meal or without it. If the patient takes extended-release tablets or capsules, they should not split, chew, dissolve, crush, or sprinkle them on food.


  • known hypersensitivity or intolerance to tramadol, other components of tramadol-containing medications, or other opioids;
  • age less than 12 years;
  • age less than 18 years with a history of tonsillectomy or adenoidectomy;
  • breathing difficulties (including bronchial asthma and other conditions);
  • GI obstruction;
  • severe liver or kidney failure;
  • other contraindications applicable to opioids.

Warnings and precautions

Risk of seizures

Seizures may occur when taking tramadol, particularly in patients who also take antidepressants (SSRIs, MAOIs, tricyclics); have a history of epilepsy, seizures, or head trauma; or are more susceptible to seizures as a result of other illnesses.

Drug abuse, addiction, misuse, and suicidal thoughts

Patients who are predisposed to these problems or who have a history of them should be prescribed tramadol with extreme caution.

Ambulatory use

Patients who are not hospitalized should avoid activities that require a certain level of mental and physical performance as it may be impaired by the drug.

Simultaneous use with other chemically active compounds

When taken with particular substances (alcohol, antidepressants, CNS depressants, etc.), tramadol increases the risk of side effects. Additionally, it has potentially harmful interactions with some drugs, such as digoxin, warfarin, carbamazepine, etc. If you receive ongoing medical treatment, you should always notify your healthcare provider before beginning a new prescription.

Allergic reactions

The drug can cause severe to fatal reactions, such as anaphylaxis, bronchospasm, toxic epidermal necrolysis, hives, etc.


Rapid discontinuation of therapy may lead to withdrawal symptoms, such as insomnia, anxiety, pain, tremor, etc.

Pregnancy, delivery, and nursing

Tramadol may cause neonatal seizures or withdrawal syndrome. Cases of stillbirth or death of the unborn child have been reported. The drug crosses the placenta and should not be used before or during labor and delivery. The effect of tramadol was not studied on nursing mothers, thus, the drug cannot be used safely.


Drug overdose may lead to respiratory depression and death.

Adverse reactions

The most commonly reported side effects:

  • dry mouth;
  • nausea;
  • constipation;
  • vomiting;
  • dizziness;
  • somnolence.

Other adverse effects, including serious ones, are conceivable. Notify your physician right away if you experience any ailment after starting tramadol.