Tramadol - Use | dose | Side Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.

Tramadol is a drug from the group of opioid analgesics. It works by binding to specific receptors in the central nervous system which relieves pain. Since it can cause dependence in patients who use it, its use is justified only in the treatment of moderately severe pain (e.g. postoperative pain, pain caused by kidney stones or gallstones and pain due to malignant disease). Tramadol rarely causes constipation and addiction compared to other opioid analgesics.1 Some studies even claim that this drug does not cause addiction, due to its favorable pharmacokinetic and pharmacodynamic characteristics.2

Tramadol proved to be an excellent drug for the treatment of perioperative pain, because it does not have detrimental effects on the function of the heart, lung, kidney or liver. It is suitable for the treatment of perioperative pain even in smokers as well as in obese patients.3


Tramadol should not be used in the following conditions:

  • In patients who are allergic to this medicine.
  • In patients with acute alcohol or drug poisoning.
  • In patients who are taking medicines called MAO inhibitors. If you took any of the MAO inhibitors in the last two weeks, inform your doctor about it before you start using Tramadol.
  • In patients suffering from epilepsy.
  • In patients who are being treated for addiction.

Certain precautions should be taken in the following situations:

  • If you have severely impaired renal function.
  • If you have elevated intracranial pressure.
  • If you have disorders of consciousness.
  • If you have severely impaired liver function.

The manufacturer states that this drug should be used only for short periods and under strict medical supervision in patients who have a tendency to develop dependency.

The manufacturer also states that thus drug can cause tolerance, or the phenomenon that analgesic effect diminishes after long-term use of this drug, so patients need to take higher doses in order to achieve pain relief. Therefore, Tramadol should be used for the shortest possible time.

Tramadol, pregnancy and breastfeeding

Long-term use of this drug during pregnancy can lead to the occurrence of abstinence syndrome in infants. In one study conducted in Sweden, which has included 1,750 women who have used Tramadol during pregnancy, it was found that this drug has teratogenic potential and increases the risk of cardiovascular malformations.4 Therefore, Tramadol should not be used during pregnancy.

Tramadol is excreted into breast milk in small concentrations, but it is not necessary to stop breastfeeding if you apply only one dose of the Tramadol. However, if you take more than one dose of this medicine, it is necessary to stop breastfeeding.


Tramadol exists in the form of tablets, capsules, oral drops, injections and suppositories. The dosage depends mainly on the intensity of pain.

Recommended dosage of Tramadol capsules in patients above age of 12: 50-100 mg daily. The maximum daily dose is 400 mg.

Tramadol capsules are not suitable for use in children under the age of 12.

It is necessary to reduce the dose in patients above the age of 75.

Tramadol capsules can be taken regardless of meals.


Risk of side effects is increased if you take Tramadol concurrently with any of the following medicines:

  • Benzodiazepines, such as:
    • alprazolam
    • midazolam
    • bromazepam
    • diazepam
    • lorazepam and others.
  • Other opioid analgesics (e.g., morphine, oxycodone, hydrocodone, and codeine).
  • Antidepressants, such as:
    • sertraline
    • paroxetine
    • fluoxetine
    • isocarboxazid
    • tranylcypromine
    • phenelzine and moclobemide
  • Coumarin anticoagulants.

Tramadol should never be applied simultaneously with alcoholic beverages.

Side effects

In a study conducted in the Netherlands which included patients who used this drug during the period from 1992 to 2003, it was found that the most common side effects of Tramadol are nausea, constipation and withdrawal symptoms (irritability, nervousness, restlessness, confusion, hyperactivity and insomnia).5

Tramadol affects the levels of serotonin in the blood and can cause serotonin syndrome6 (syndrome which is characterized by serious side effects). The risk of serotonin syndrome is significantly higher if Tramadol is administered with other drugs that increase serotonin levels in the blood.

Other side effects of the Tramadol include:

  • Tachycardia
  • Sensation of heart beating
  • Feeling like your heart is skipping a beat
  • Low blood pressure
  • Hallucinations
  • Anxiety
  • Sleep disorders and nightmares
  • Physical and psychological dependence
  • Dyspnea
  • Muscle weakness
  • Speech disruptions
  • Expansion of the eye pupils


  1. NCBI link 1
  2. NCBI link 2
  3. NCBI link 3
  4. NCBI link 4
  5. NCBI link 5
  6. NCBI link 6

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If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.

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