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If you have short-term pain from something like surgery or long-term chronic pain, your doctor may prescribe you a drug called tramadol. Tramadol is an opioid prescribed for both short and long-term pain in adults.

Like all medications, tramadol has side effects, and you may have heard that it can cause liver or kidney damage. Read on to learn if this is true, and more about the uses, effects, and addiction potential of tramadol.

Tramadol is a type of opioid that is used for moderate to moderately severe pain in adults. Specifically, tramadol is synthetic, or made in a lab. It’s also used off-label for premature ejaculation and restless leg syndrome.

Tramadol is a generic name for medication also sold under the brand names Ultram, Ultram ER, and Conzip. It’s also sold in combination with acetaminophen as a generic and under the brand name Ultracet.

Both extended and immediate release formulas are available, though the immediate release formula should only be used for less than a week at a time. Both formulas are sold in capsule form.

The Food and Drug Administration (FDA) classifies tramadol as a class IV drug, which means it has some risk for addiction or dependence but is approved for medical use.

Warnings about Tramadol and opioids

The federal regulatory agency has issued several warnings about tramadol, including:

  • contraindication (the FDA’s strongest warning) that tramadol shouldn’t be used by children under 12
  • contraindication against children under 18 using tramadol to treat pain after having their tonsils or adenoids removed
  • warning that people between 12 and 18 who are obese or have obstructive sleep apnea or lung disease shouldn’t use tramadol
  • that people who are breastfeeding should not use tramadol

Like with all opioids, people who use tramadol do have a risk of becoming addicted, even if the medication is prescribed for medical use.

Using tramadol exactly as directed can help reduce the risk of dependence. Do not take more often than your doctor tells you to, and do not crush, chew, break, or dissolve tramadol capsules. It’s possible to have an opioid overdose, which can be fatal if you take too much tramadol.

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Tramadol is metabolized, or broken down, by your liver. This means there’s a chance it can cause liver damage. However, liver damage is not common if you take tramadol at typical, prescribed doses. If they do occur, they are often mild and resolve on their own.

Because there’s a slight risk of liver damage from tramadol, your doctor will do a baseline liver function test before you start taking this medication. If you’re taking tramadol long-term, they will continue to monitor your liver function to make sure everything is okay.

Tramadol is not directly toxic to your kidneys, but it can be dangerous for people with chronic kidney disease.

Tell your doctor if you have liver or kidney disease. They may choose a different medication for you, or they may give you a lower dose or space out your doses.

Liver and kidney damage are both more likely if you take high doses of tramadol. In addition, if you overdose on tramadol, that can cause acute liver or kidney failure. That’s one more reason to only take tramadol as prescribed.

Tramadol can make you feel sleepy or drowsy. It can also slow down your movements, as well as your breathing. Because of this, you shouldn’t take tramadol with alcohol, benzodiazepines, or other medications that depress the central nervous system.

It can also make you feel dizzy or lightheaded when you get up from lying down, so take it slow when you get up and keep your feet on the floor for a bit before standing.

Other side effects of tramadol include:

If you take tramadol long-term, your doctor should continue to monitor your blood pressure, respiratory system, and mental status, to make sure you don’t have any dangerous side effects.

If you stop taking tramadol suddenly, it can cause withdrawal symptoms. Always talk with your doctor before you stop taking tramadol, especially if you’ve been taking it for a long time. They’ll help you taper off.

Finding help

The Centers for Disease Control and Prevention (CDC) has a resource page on opioid use. If you or someone close to you needs help for a substance use disorder, you can talk with your healthcare team or contact the Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline at 1-800-662-HELP. You can also find information online at SAMHSA’s Behavioral Health Treatment Services Locator.

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Tramadol can be an important treatment for adults with moderate to moderately severe pain, but it also comes with caveats and warnings. Children under 18 should not take tramadol, especially after having their tonsils or adenoids removed, if they have obesity, or have sleep apnea. In addition, pregnant people shouldn’t use tramadol.

For most people, tramadol will probably not cause liver damage. If it does, the damage is likely to be mild and go away on its own. But tramadol can be dangerous for people with existing liver or kidney issues. Talk with your doctor about your options if you have liver or kidney problems and are prescribed tramadol. They may give you another medication.