10 Things You Need to Know About Tramadol

Tramadol is a synthetic opioid analgesic medication used to treat moderate to moderately severe pain, such as that caused by osteoarthritis. Brand names include ConZip, FusePaq Synapryn, Rybix, Ryzolt, and Ultram. Tramadol binds to opioid receptors, decreasing the body's ability to feel pain. It is similar to morphine in the way it works but is about one-tenth as potent.

The U.S. Drug Enforcement Administration listed tramadol as a schedule IV controlled substance in August 2014 due to the risk of addiction and overdose. Examples of other schedule IV drugs include Valium (diazepam), Xanax (alprazolam), and Ambien (zolpidem).

Tramadol may have a useful place in your treatment regimen. However, it's especially critical that you are informed about the drug before you use it. Here are 10 important things to know about tramadol to ensure you are using it appropriately and safely:

Tramadol Is Not an NSAID

Tramadol belongs to the class of drugs known as opiate agonists. What that means is tramadol binds to opioid receptors in the brain and provides pain relief. Some people mistakenly believe that tramadol is an NSAID (nonsteroidal anti-inflammatory drug), but it is not. Just as it works differently, tramadol also carries with it different potential side effects that must be weighed (see below).

Some People Cannot Take Tramadol

Tramadol is not FDA-approved for children under 18 years of age, as children are at greater risk of experiencing drug-induced breathing problems and death compared to adults. It is also not recommended for breastfeeding mothers, as the drug can be passed on through breast milk, possibly causing harm to infants.

Because the safety of tramadol use during pregnancy has not been established, the medication should not be used during pregnancy. 

The Drug Comes in Two Forms

Tramadol may be prescribed as an immediate-release 50 mg tablet or as an extended-release 100, 200, or 300 mg tablet. The extended-release tablets are usually reserved for patients with chronic pain who require continuous, long-term treatment.

As with all Schedule IV controlled substances in the U.S., after a prescription is first written, you can get a maximum of five refills in a six-month period. After you hit that limit or reach the six-month mark (regardless of the number refills), a new prescription is required from your healthcare provider. Always follow your doctor's instructions regarding dosage and how often to take the medication. 

It Must Be Swallowed As Is

It is important to swallow tramadol pills whole and especially important not to split, chew, or crush extended-release tablets. Breaking the pill may cause too much of the drug to be released into your system at one time. 

Take your medication exactly as directed and follow prescribing instructions to stay as safe as possible.

Side Effects Can Be Serious

Tramadol is usually well-tolerated when taken properly, and side effects are usually temporary.

That said, there are cases when they can be deadly.

Common side effects may include:

• Nausea or vomiting
• Constipation
• Dizziness
• Headache
• Drowsiness
• Vomiting

Less common side effects include:

• Itching
• Sweating
• Diarrhea
• Rash
• Dry Mouth
• Vertigo

Serious side effects include:

• Seizures
• Serotonin syndrome, characterized by symptoms such as muscle rigidity, confusion, and rapid heart rate
• Slowed breathing
• Life-threatening allergic or skin reactions
• Angioedema (fluid swelling under the skin)
• Orthostatic hypotension (low blood pressure when you stand up)
• Suicidal thoughts or actions

Always report side effects to your doctor. Get immediate help if a serious side effect occurs.

Dangerous Drug Interactions Are Possible

Tramadol interacts with many other medications, which can lead to life-threatening interactions including breathing problems, sedation, and coma. Of special concern are interactions with benzodiazepines, such as Ativan (lorazepam) and Klonopin (clonazepam), and monoamine oxidase inhibitors (MAOIs), such as Nardil (phenelzine) and Parnate (tranylcypromine).

If taken with recreational or controlled substances, like alcohol, narcotics, anesthetics, tranquilizers, and sedatives, tramadol can affect breathing—even causing breathing to stop. 

Discuss all medications and supplements you take, plan to take, or plan to stop taking with your doctor so these can be adjusted to prevent a dangerous interaction.

People Process it Differently

Tramadol is broken down in the liver and excreted mostly by the kidneys in the urine. The half-life of tramadol in the blood is between five and nine hours, and even longer for people who have been taking multiple doses. That is the time it takes half of a dose to be inactivated by the body. Complete elimination takes about five to six times as long as the half-life.

However, about 7 percent of people are "poor metabolizers" of tramadol, and it takes them longer to break it down. As a result, they have more active drug in their bloodstream for a longer time. These people are especially at risk if taking other medications that further reduce the actions of the enzymes that break down tramadol.

Tramadol Can Be Habit Forming 

A 2015 government report showed a steep rise in emergency room visits due to tramadol abuse between 2005 and 2011. Even at prescribed doses, the drug can be addictive. If you suspect you are becoming dependent on tramadol or taking more than you're supposed to to get the desired effect, talk to your doctor or a social worker about how you can wean yourself off the medication and seek alternatives for pain relief. Likewise, do not share your tramadol or store it in a place that is easily accessible to others.

Stopping the Drug Suddenly Can Cause Withdrawal Symptoms

Do not stop taking this medicine suddenly without talking to your doctor first. Gradually reducing the amount over time will prevent withdrawal symptoms such as anxiety, diarrhea, headache, nausea, shivering, sweating, tremors, or insomnia.

In Case of Overdose, Call 911 Immediately

Symptoms of a tramadol overdose include decreased pupil size, difficulty breathing, problems staying awake, unconsciousness, coma, heart attack, or seizure. Call for help, even if you are unsure whether you should. Tramadol overdoses can be treated with Narcan if detected early enough.