Tramadol Side Effects, Symptoms, and Warning Signs
Tramadol is a prescription opioid painkiller that is often used to treat moderate to moderately severe pain.1 Although it’s a legal substance, people may misuse it for certain effects, such as to get high. According to the U.S. Drug Enforcement Administration (DEA), it is most misused by people who are addicted to other narcotics (morphine and oxycodone), health professionals, and people with chronic pain.2
If you use tramadol or know someone who does, it’s important to understand what you’re taking and the potential risks. This article will help you understand:
- What tramadol is.
- Tramadol’s addictive potential.
- Signs of tramadol misuse.
- Tramadol side effects.
- Tramadol overdose.
- Treatment for opioid addiction.
What Is Tramadol?
Tramadol is a mild/moderate opioid painkiller, and when used as prescribed, it can help alleviate moderate acute pain. It exerts partial opioid agonist effects at the mu-opioid receptor, which means they ease cravings and withdrawal symptoms.3 Mu opioid agonists provide effects that are similar to morphine.
Tramadol is available in immediate-release and extended-release formulations.5 The immediate-release form is intended for pain that lasts less than a week, while the extended-release form is intended for pain that lasts longer than a week and requires 24-hour management.5
Brand names of tramadol include Ultram and Ultracet.2
Is Tramadol Addictive?
The U.S. Drug Enforcement Administration (DEA) indicates that tramadol is categorized as a Schedule IV substance under the Controlled Substances Act. This means that it has been found to have a low potential for misuse and low risk of dependence.2, 7 When taken as prescribed under a physician’s guidance, and when used over short periods of time, opioid painkillers are generally effective and do not typically lead to addiction, but may still produce tramadol side effects.8
When misused and especially when taken over longer periods of time, people can develop dependence, which means that their bodies and brains have adapted to the presence of the substance, and they need to take it to prevent withdrawal symptoms.8
Chronic use can also lead to tolerance, which means you need a higher or more frequent dose to experience previous effects.8
In some cases, people can also develop a tramadol addiction, which means compulsive substance use despite the negative consequences.8
Addiction and dependence are not the same thing. However, dependence is often a feature of addiction.8 Dependence can occur in people even when they use a medication as prescribed; if they suddenly stop taking it, they can experience unpleasant withdrawal symptoms.8
Anyone can develop an addiction, but tramadol may have a higher potential for addiction in people who have a prior history of substance use and misuse.9 However, there are also cases of people who develop an addiction to tramadol without a history of opioid use disorder.5
Signs of Tramadol Misuse
According to the Results from the 2020 National Survey on Drug Use and Health, 3.3% of adults aged 12 and older misused prescription pain relievers in the past year and 0.5% misused tramadol in the past year.10
Even though tramadol is known to have a lower potential for misuse per its drug scheduling, it is still possible to misuse tramadol. Misuse can occur when you take it to get high or use it for unintended purposes.2, 7
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes tramadol addiction as an opioid use disorder (OUD).11 To receive an OUD diagnosis, a person needs to experience clinically significant distress or impairment from their opioid use and meet at least 2 of the following criteria over a 12-month period:11
- Using opioids in larger amounts or over a longer period than was intended.
- A persistent desire or unsuccessful efforts to cut down or control opioid use.
- Spending a lot of time in activities necessary to obtain opioids, use opioids, or recover from its effects.
- Craving, or a strong desire or urge to use opioids.
- Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continuing to use opioids despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
- Giving up important social, occupational, or recreational activities because of opioid use.
- Recurrent opioid use in situations in which it is physically hazardous, such as driving or operating machinery.
- Continued opioid use despite knowing that you have a persistent or recurrent physical or psychological problem that is probably caused or exacerbated by opioids.
- Tolerance, which means you need an increased amount of the substance to achieve desired effects, or you experience a significantly diminished effect with continued use of the same amount of the drug.
- Withdrawal, which means you experience unpleasant effects when you stop using opioids, and/or you take opioids to relieve withdrawal symptoms.
Tramadol Side Effects
There are many potential side effects of tramadol. Tramadol side effects can be short- or long-term. Common side effects of tramadol usually start after initial treatment and do not often continue if you use it for maintenance.5 Side effects typically occur during the first seven days of therapy or after an adjustment in your dose.12
Short-term effects of tramadol can include:5
Long-term effects are not widely reported but can include an increased risk of tolerance and dependence.13
Tramadol side effects in the elderly may be more likely, especially because they often use multiple medications, and their bodies tend to metabolize substances more slowly.12
People who use high doses of tramadol, and especially those who use it in combination with monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs), can have a risk of developing serotonin syndrome, which can produce symptoms like convulsions, hyperthermia, muscle rigidity, and pain.2
Risks of Tramadol Use
Although it is generally safe when taken as prescribed, tramadol use is not without risk.
As mentioned above, people should not use tramadol in combination with MAOIs or SSRIs due to the risk of serotonin syndrome.2
Tramadol has been associated with an increased risk of suicide and should not be used by people who may be suicidal.13 Anaphylactoid reactions have also been reported by people using tramadol, even after the first dose.13 People with a history of anaphylactoid reactions to codeine and other opioids should avoid tramadol.13
Tramadol should be used cautiously and in lower dosages in people who use depressants such as alcohol, opioids, anesthetic agents, narcotics, phenothiazines, tranquilizers, or sedative-hypnotics.13 People who use tramadol with these substances can suffer from an increased risk of the central nervous system (CNS) and respiratory depression.13
An opioid overdose can occur when a person has enough opioids to potentially cause life-threatening symptoms such as respiratory depression, which can lead to suffocation and death.8, 13 Overdose can occur if you use tramadol on its own or with other substances such as sedatives, tranquilizers, muscle relaxants, antidepressants, or other CNS depressant drugs.13
According to the National Institute on Drug Abuse (NIDA), there were 14,139 prescription opioid overdose deaths in 2019, but this rate increased to 16,416 in 2020.15
Opioid overdose can cause symptoms such as:16
- Small, constricted pupils.
- Falling asleep or loss of consciousness.
- Slow, shallow breathing.
- Choking or gurgling sounds.
- Limp body.
- Pale, blue, or cold skin.
If you suspect that someone has overdosed, even if you’re not sure, it’s better to treat it as an overdose. Overdose can be deadly and requires immediate medical attention. You can save someone’s life by taking the following steps:16
- Call 911 immediately.
- Administer naloxone, if available. Naloxone is a life-saving medication that can rapidly reverse opioid overdose.
- Keep the person awake and ensure that they remain breathing.
- Lay the person on their side to prevent choking.
- Stay with the person until emergency personnel arrives.
Find Treatment for Tramadol Addiction
If you or someone you care about is struggling with tramadol addiction, treatment may help. You can enter inpatient or outpatient rehab, depending on your unique needs and situation. Common treatments for prescription opioids include medications and behavioral therapies.17
Medications can include:17
- Buprenorphine and methadone bind to the same opioid receptors in the brain as opioids. These medications can ease or prevent cravings and withdrawal symptoms.
- This medication blocks opioid receptors and prevents opioids from having an effect. In other words, you won’t experience a high if you misuse them, which may assist with relapse prevention.
Behavioral therapies that you may receive can include:
- Cognitive behavioral therapy (CBT) can help you make changes to unhelpful thoughts or behaviors that may contribute to substance misuse.17
- Multidimensional family therapy (MFT) was developed to help adolescents struggling with opioid misuse. It addresses underlying family dynamics that may contribute to substance misuse and helps improve a person’s ability to function without substances.17
- Motivational enhancement/interviewing helps people find and develop the motivation to enter and remain in treatment.18
It’s never too late to seek help if you or a loved one is struggling with tramadol addiction. Treatment can help you take back control of your life and start the path to recovery. American Addiction Centers (AAC) is here to help by calling our free, confidential helpline at to learn about your treatment options and to check your insurance coverage.