Tramadol

💊 What is Tramadol used for?

• •The label says tramadol is used in adults to manage pain severe enough to require an opioid analgesic, when alternative treatments are inadequate. The label notes that other pain treatments, such as non-opioid pain medicines, may be tried first, and that opioids should be reserved for patients for whom other options are ineffective, not tolerated, or otherwise inadequate.

How it works

The label describes tramadol as an opioid agonist, which means it acts on opioid receptors in the body to reduce pain. The label also explains that the body changes tramadol into other compounds that are more potent opioid agonists.

How it is usually taken

• •The label says to take tramadol exactly as your prescriber directs. People are usually told to use the lowest effective dose for the shortest time needed. Do not change your dose on your own. The label says that for short-term (acute) pain, you may only need it for a few days. Follow the instructions from your prescriber or pharmacist about how often to take it and the daily maximum. Do not stop taking it suddenly after regular use without talking to your prescriber.

Comes as

• •Tablets: 50 mg, pale yellow, capsule-shaped, film-coated tablets marked "355" and "U".

⚠️ Tramadol side effects

🛑 Who should not take Tramadol, and who should be careful

The label says not to take it if

• 🚨You have severe asthma, trouble breathing, or other lung problems. The label says it is contraindicated in significant respiratory depression and in acute or severe asthma without monitoring or resuscitation equipment.
• 🚨You have a bowel blockage or narrowing of the stomach or intestines (the label lists known or suspected gastrointestinal obstruction, including paralytic ileus).
• 🚨You are allergic to tramadol, any other ingredient in the product, or opioids.
• 🚨You have taken a monoamine oxidase inhibitor (MAOI), a medicine used for depression, within the last 14 days.
• 🚨The label says tramadol is contraindicated in children younger than 12 years of age.
• 🚨The label says it is contraindicated in children younger than 18 years of age after tonsil or adenoid removal.

Tell your doctor before taking it if

• •Tell your prescriber if you have had a head injury or seizures.
• •Tell your prescriber if you have liver, kidney, or thyroid problems.
• •Tell your prescriber if you have trouble urinating.
• •Tell your prescriber if you have pancreas or gallbladder problems.
• •Tell your prescriber if you have a history of abuse of street or prescription drugs, alcohol addiction, opioid overdose, or mental health problems.
• •Tell your prescriber if you are pregnant or planning to become pregnant, or if you are breastfeeding.
• •Tell your prescriber if you live in a home with small children or someone who has abused street or prescription drugs.
• •Tell your prescriber about all prescription and over-the-counter medicines, vitamins, and herbal supplements you take.
• •The label says not to drive or operate heavy machinery until you know how tramadol affects you, because it can cause sleepiness, dizziness, or lightheadedness.
• •The label says to store tramadol securely, out of sight and reach of children and others in the home, including visitors.

🔀 Tramadol with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Monoamine oxidase inhibitors (MAOIs): do not use with MAOIs or within 14 days of stopping them.
• •Benzodiazepines and other CNS depressants, including alcohol: can cause severe drowsiness, decreased awareness, breathing problems, coma, and death.
• •Other opioid medicines: combined use can cause severe drowsiness, breathing problems, coma, and death.
• •Gabapentinoids such as gabapentin or pregabalin: combined use can cause severe drowsiness and breathing problems.
• •CYP2D6 inhibitors, such as quinidine, fluoxetine, paroxetine, and bupropion: these can increase tramadol levels and raise the risk of seizures and serotonin syndrome, and can change how the medicine works when started or stopped.
• •CYP3A4 inhibitors: these can increase tramadol levels and raise the risk of serious side effects, including seizures and serotonin syndrome.
• •Serotonergic drugs: the label says they can increase the risk of serotonin syndrome.
• •Street drugs: combined use with CNS depressants can cause severe side effects, according to the label.
• •Tell your prescriber or pharmacist about all medicines you take, including over-the-counter medicines, vitamins, and herbal supplements.

Alcohol and food

The label says not to drink alcohol or use prescription or over-the-counter medicines that contain alcohol while taking tramadol, because alcohol can cause severe sleepiness, breathing problems, coma, and death. The label does not give specific food instructions.

🤰 Tramadol in pregnancy and breastfeeding

Pregnancy

The label says tramadol may cause fetal harm. Animal studies showed effects on fetal weight and development at doses related to the human maximum dose. Use of opioids for an extended period during pregnancy can cause neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Talk to your prescriber if you are pregnant or planning a pregnancy.

Breastfeeding

The label says breastfeeding is not recommended. Tramadol passes into breast milk and may harm the baby. Watch infants closely for more sleepiness than usual, breathing difficulties, or limpness, and seek immediate medical care if these occur.

🗓️ Storage, missed doses and taking too much

Storage

Store at 20 to 25 degrees C (68 to 77 degrees F). Store securely, out of sight and reach of children and others in the home. The label says to dispose of unused or expired tramadol by taking it to a DEA-registered collector or drug take-back program. If none is available, the label describes mixing it with dirt, cat litter, or coffee grounds, sealing it in a plastic bag, and throwing it in the trash. More information is at www.fda.gov/drugdisposal.

If a dose is missed

The label says that if you miss a dose, take your next dose at your usual time. Do not take more than your prescribed dose to make up for a missed one. Ask your prescriber or pharmacist if you have questions.

If too much is taken

The label says acute overdose can cause slowed breathing, sleepiness that progresses to stupor or coma, limp muscles, cold and clammy skin, small pupils, seizures, and death. Get emergency help or call 911 right away if you think someone has taken too much. The label says to ask your prescriber about medicines such as naloxone or nalmefene that can be used in an emergency to reverse an opioid overdose.

🗒️ Questions to ask about Tramadol

• How long will I need tramadol, and when should I check back with you about my pain?
• What should I do if my pain is not controlled by my current dose?
• What signs should make me call you or seek emergency care while taking this medicine?
• Should I have naloxone or nalmefene at home in case of an emergency?
• Which of my other medicines, supplements, or alcohol could be unsafe with tramadol?
• How should I safely store and dispose of unused tablets?
• What should I do if I have been taking tramadol regularly and want to stop?

❓ Tramadol: frequently asked questions