What is Tramadol and What Does it Do?

Medically Reviewed By

Dr. Po-Chang Hsu

Dr. Po-Chang Hsu

On April 14, 2024

Written By

Amanda Stevens

Amanda Stevens, B.S.

On February 21, 2024

Reading Time: 8 minutes

Tramadol, a synthetic opioid, offers a solution for managing moderate to severe pain, especially when standard pain relievers are ineffective. Although Tramadol is less prone to abuse as a Schedule IV drug, it has potential side effects and carries a risk of addiction. It can be combined with medications like acetaminophen under medical supervision, but mixing it with other drugs unadvisedly can lead to adverse reactions. Understanding all aspects of Tramadol’s benefits and risks is crucial for anyone dealing with potential dependency or anyone who is considering its use for pain management.

What is Tramadol?

Tramadol[1] is a type of prescription drug known as a synthetic opioid that effectively removes moderate to severe pain that other pain-relievers may not effectively treat.

Usually prescribed after surgery, Tramadol can help manage neuropathic pain, such as burning or tingling sensations. It can be taken in tablet or liquid form, or a doctor can administer it via injection.

What is Tramadol Used For?

Tramadol is prescribed for a variety of reasons. Below are common reasons and use cases for the medication:

Pain Management

Tramadol effectively relieves pain triggered by chronic ailments such as osteoarthritis or fibromyalgia, along with short-term pain that follows major surgeries. The medication takes an hour to show results, and its effects can last up to six hours.


Tramadol is sometimes used off-label to manage symptoms associated with psychiatric disorders such as anxiety and post-traumatic stress disorder. It can alleviate symptoms associated with mental health conditions and can even reduce some of the associated physical pain resulting from anxiety and post-traumatic stress disorder.

While the exact way it achieves its therapeutic effects is still uncertain, it is believed to regulate the brain’s dopamine and serotonin systems.

Extended Release Formulations

Tramadol comes in an extended-release form, slowly releasing the medication into the bloodstream over 24 hours. This is especially helpful for individuals who need continuous pain relief.

Additionally, it can benefit those with difficulty swallowing pills as it reduces the need for multiple doses throughout the day.

Off-Label Uses

Tramadol is sometimes used off-label to manage symptoms associated with psychiatric disorders such as anxiety and post-traumatic stress disorder, but this use is not widely recommended due to limited evidence and the risk of side effects.

How Does Tramadol Work?

To understand the mechanism of Tramadol, it’s important to note that it functions differently from traditional opioids. Tramadol is both an opioid receptor agonist and a serotonin-norepinephrine reuptake inhibitor (SNRI)[2].

It can effectively attach to pain receptors in the brain and spinal cord. This obstructs the reabsorption of serotonin and norepinephrine neurotransmitters, which helps to provide effective pain management.

Tramadol also activates the descending inhibitory system, a natural pain control system in the body. This system’s activation further helps to reduce pain.

After consumption, the liver’s cytochrome P450 system metabolizes tramadol into several metabolites, including O-desmethyltramadol (O-DSMT), which is more potent at μ-opioid receptors.

Once it attaches to these receptors, it closes specific ion channels and stops the pain signals from transmitting throughout the central nervous system.

Can Tramadol Be Used With Other Medications?

As with any medication, it is crucial to discuss its potential interactions with other prescriptions with a physician or pharmacist. Some medications can interact with Tramadol, causing serious side effects, while drug interactions may reduce its effectiveness.

It is imperative to avoid using Tramadol together with any medication that impacts serotonin levels in the brain, including SSRIs and other drugs utilized for the treatment of depression, anxiety, and migraines. This combination may trigger a critical condition known as serotonin syndrome, leading to a life-threatening outcome.

Similarly, Tramadol may interact with other pain medications, like muscle relaxers and benzodiazepines, leading to breathing problems, potential for overdose, and addiction. It is important to keep track of all medications being taken concurrently.

While there are certainly potential negative interactions between Tramadol and other medications, there are situations where it may be safe to take and even necessary. In some cases, physicians prescribe Tramadol alongside other pain medications, like acetaminophen or ibuprofen, for more effective pain relief.

A physician must monitor these combinations, as they may increase the risk for liver and kidney damage when taken together for a long time.

What is Tramacet?

Although Tramadol and Tramacet are potent analgesics that serve the same purpose, they differ in composition. Tramadol is a synthetic compound, while Tramacet is a blend of Tramadol and Acetaminophen. Uniquely, Tramadol employs a single active ingredient in pain management, while Tramacet takes a dual approach to tackle pain.

Tramacet combines Tramadol with Acetaminophen, which may offer enhanced pain relief for some patients compared to Tramadol alone.

Although Tramacet is more effective, it has an increased risk of potential side effects. Acetaminophen is known to have negative implications on the liver, and when combined with Tramadol, the risks could be amplified.

Additionally, Tramadol usage may cause mild side effects such as nausea, dizziness, and constipation. However, in rare cases, Tramadol can trigger seizures, making it unsuitable for individuals with convulsive episodes.

Are There Dangers When Combining Tramadol and Paracetamol?

Tramadol and Paracetamol[3] are two painkillers with unique mechanisms of action in the body. Tramadol is an opioid analgesic, and Paracetamol (also known as acetaminophen) is an analgesic and antipyretic. Each has a different mechanism of action, which allows them to be used together in some pain management strategies. Tramadol is a synthetic opioid drug, while Paracetamol is an analgesic capable of easing pain and fever.

Although the two may be used simultaneously, this has an elevated risk of side effects and complications. In addition, prolonged intake or consumption of high doses of these drugs can lead to undesirable outcomes such as liver damage. Therefore, patients prone to liver problems or taking medication that damages liver function must avoid combining the two drugs.

While Tramadol can increase the risk of respiratory depression, especially when combined with other opioids, Paracetamol does not contribute to respiratory depression. However, caution is advised when these medications are used together.

The combination of Tramadol and Paracetamol carries the potential risk of developing serotonin syndrome. This condition arises from an excessive buildup of serotonin in the body. Tramadol has been known to elevate serotonin levels, while it has been noted that Paracetamol can cause serotonin syndrome in certain patients.

Signs to watch for include increased agitation, confusion, heart palpitations, hypertension, and fever. If these symptoms occur when combining Tramadol and Paracetamol, it is crucial to seek prompt medical attention.

In addition, taking too large a dose of Tramadol or Paracetamol can result in addiction and dependency. As an opioid, Tramadol can be habit-forming, and Paracetamol can induce dependence when consumed in excessive quantities or for an extended period.

What are the Possible Side Effects of Using Tramadol?

As with all medications, Tramadol has potential side effects, including addiction and abuse, so learning about its possible consequences is essential. Below are some potential side effects of Tramadol and how to mitigate them.

Dizziness and Drowsiness

Tramadol can cause dizziness and drowsiness as side effects resulting from its action on the central nervous system. To ensure safety, it is advisable not to drive or manage heavy machinery while on Tramadol since the sedative effect may hinder your ability to do so effectively.

Nausea and Vomiting

Due to its impact on the digestive system, tramadol can often cause nausea and vomiting. To alleviate these symptoms, it is advisable to take Tramadol with food or split the dosage throughout the day.


Slowing down the movement of the intestines, Tramadol may lead to constipation. Consuming fluids and foods rich in fiber can help relieve this symptom. However, if you are facing severe constipation, it is essential to consult your doctor, who may suggest taking a laxative.

Serotonin Syndrome

In other side effects, Tramadol may cause serotonin syndrome, a rare but severe condition resulting from excessive serotonin in the body. Confusion, rapid heartbeat, muscle rigidity, and high fever are symptoms of serotonin syndrome. If these symptoms occur, prompt medical attention is essential.

Is Tramadol Addictive?

The Drug Enforcement Administration (DEA) classifies Tramadol as a Schedule IV drug. This means that it has a relatively low potential for abuse and dependence[4] compared to other opioids, such as fentanyl and oxycodone.

However, this does not imply that Tramadol is not addictive. Some people may become addicted to Tramadol even when taking it as instructed by their doctor.

While Tramadol can cause euphoria, this is generally more likely at higher than prescribed doses. This poses a significant threat to those with a history of addiction or substance abuse. Additionally, a physical dependence can arise, meaning the body gets reliant on the drug and may suffer withdrawal symptoms if usage is stopped abruptly.

To spot addiction, be alert for increasing tolerance. Tolerance happens because the body gets used to a drug, and more of it is needed to produce the same results. Taking Tramadol in higher amounts than recommended or more often than instructed may indicate addiction.

What are the Withdrawal Symptoms of Tramadol Addiction?

When someone is addicted to Tramadol, it can be challenging to stop taking the drug. This is because of the physical dependence that develops with prolonged use. When this happens, stopping Tramadol suddenly can cause withdrawal symptoms. Below are some of the most common withdrawal symptoms associated with tramadol addiction:

Physical Symptoms

Withdrawal from Tramadol can cause physical symptoms that affect the central nervous system, including nausea, dizziness, vomiting, sweating, fever, muscle pain, and tremors. These symptoms can be severe, leading to dehydration, high blood pressure, and an elevated heart rate. The severity of opioid withdrawal symptoms depends on how often and how much the drug is used.

Emotional Symptoms

Prolonged use of Tramadol can significantly impact mental health, particularly for those who develop an addiction to opioids. Emotional symptoms such as anxiety, depression, irritability, mood swings, and even suicidal thoughts may occur. The severity of these symptoms can vary based on an individual’s mental health and susceptibility to mental health issues.

Psychic Symptoms

During Tramadol withdrawal, a person may experience psychic symptoms such as hallucinations, difficulty concentrating, and intense yearning for the drug. The severity of the hallucinations can vary and may be accompanied by other symptoms like paranoia and confusion.

Cravings for opioids can be intense, sometimes leading to relapse as the individual may engage in drug-seeking behavior.

Sleep Disorders

Sleep disorders can result from addiction to Tramadol, which affects the quality and quantity of sleep. Insomnia is a frequent withdrawal symptom that can last weeks and make it difficult for individuals to sleep well. In addition, sleep disorders resulting from opioid addiction, such as those caused by tramadol, may contribute to or exacerbate health problems like anxiety and depression.

Gastrointestinal Symptoms

Gastrointestinal symptoms are often experienced during Tramadol withdrawal, including diarrhea, abdominal cramps, and loss of appetite. These symptoms can lead to dehydration and malnutrition, resulting in various other health challenges like weight gain or loss, anemia, and chronic fatigue.

Treatment Options for Tramadol Addiction

For anyone struggling with Tramadol addiction, it is crucial to seek help. Several treatment options are available for individuals suffering from opioid abuse, including detox, medication-assisted treatments, psychotherapy and counseling, and support groups.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a treatment option to help patients overcome Tramadol addiction. This involves using medications such as buprenorphine or methadone to help reduce withdrawal symptoms and cravings.

MAT also involves counseling and behavioral therapy to address underlying issues contributing to the individual’s addiction. This approach effectively reduces opioid overdoses and has been proven to be an effective way to manage drug addiction.

Inpatient Treatment

Inpatient treatment involves the admission of an individual to a rehabilitation center for intensive treatment. This treatment option requires the individual to live in the center for some time and is recommended for individuals with more severe addictions.

Inpatient treatment provides a drug-free environment and medical support around the clock. In addition, it offers various therapies to address the physical, emotional, and psychological effects of addiction.

Outpatient Treatment

Outpatient treatment is a treatment option that allows individuals to continue their everyday lives while receiving treatment. This treatment is less intensive than inpatient treatment and is recommended for individuals with less severe addiction.

Outpatient treatment involves counseling and therapy sessions that can be scheduled around the individual’s daily routine. It is also a cost-effective option for individuals unable to afford inpatient treatment.

Support Groups

Support groups provide a safe space for individuals to share their struggles and receive encouragement and support from others who have gone through similar experiences. These groups can benefit individuals who are recovering from Tramadol addiction.

Group therapy sessions provide a sense of community and offer opportunities for individuals to build lasting relationships with others in recovery. Support groups such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) are available in most communities and can be helpful for individuals seeking support and guidance.

Holistic Treatments

Holistic treatments approach addiction differently and focus on treating the whole person. Holistic treatments may include alternative therapies such as yoga, meditation, and acupuncture.

These treatments aim to promote physical, psychological, and spiritual wellness. While not all of them are evidence-based, these alternative therapies can still benefit individuals in addiction recovery.

Learn More About Opioid Medications and Their Side Effects

If you’re looking for more information about other opioid medications, their potential side effects, or addiction treatment options, see these additional resources:

Tramadol FAQs

What are the long-term effects of taking Tramadol?

Long-term use of Tramadol may lead to several side effects, including dependence, tolerance, and withdrawal symptoms. Other potential long-term effects include dizziness, constipation, nausea, headache, drowsiness, sleep disturbances, and mood changes. It is essential to follow your doctor’s prescription and guidance when taking Tramadol to minimize these risks.

Are there any natural alternatives to Tramadol?

There are several natural alternatives to Tramadol that may help with pain management. Some options include:

  • Acupuncture
  • Massage therapy
  • Physical therapy
  • Herbal remedies
  • Meditation
  • Yoga
  • Tai Chi

It’s important to consult with your healthcare provider before trying any new treatments, as they may not be suitable for everyone.

Is Tramadol safe for pregnant or breastfeeding women?

Tramadol is classified as a Category C drug by the FDA, which means that risk to the fetus cannot be ruled out. Use during pregnancy is only recommended if the potential benefits justify the potential risks to the fetus. Tramadol can pass into breast milk and may have undesirable effects on a nursing infant, so it is important to discuss the risks and benefits with your doctor if you are breastfeeding. If you are pregnant or breastfeeding, it’s important to consult with your doctor before using Tramadol.

How quickly can someone become dependent on Tramadol?

The chances of developing dependence on Tramadol depend on various factors such as the dose, duration of use, and individual susceptibility. The risk of developing dependence on Tramadol can increase with regular use, particularly at higher doses or over extended periods. Dependence could develop within a few weeks under such conditions.

To reduce the risk of dependence, following your doctor’s instructions and taking the smallest effective dose for the shortest period possible is recommended.

Is there an age limit for taking tramadol, or is it only recommended for adults?

Tramadol is typically prescribed for adults, as its safety and effectiveness have not been thoroughly studied in children. In some cases, it may be prescribed for adolescents aged 12 years and older for specific conditions or under close medical supervision.

It is not recommended for children under 12 years of age. Always consult your healthcare provider before giving Tramadol to anyone under 18 years old.

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[1] Tramadol. National Center for Biotechnology Information. (n.d.-a). https://www.ncbi.nlm.nih.gov/books/NBK537060/ on May 25, 2023

[2] Sansone, R. A., & Sansone, L. A. (2014, March). Serotonin norepinephrine reuptake inhibitors: A pharmacological comparison. Innovations in clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008300/ on May 25, 2023

[3] Husic, S., Izic, S., Matic, S., & Sukalo, A. (2015, February). Efficacy and safety of a fixed combination of Tramadol and Paracetamol (acetaminophen) as pain therapy within Palliative Medicine. Materia socio-medica. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4384875/ on May 25, 2023

[4] Shah, K., Stout, B., & Caskey, H. (2020, July 11). Tramadol for the management of opioid withdrawal: A systematic review of randomized clinical trials. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417126/ on May 25, 2023