Advertisement

Tramadol, Oral Tablet

Important warnings

FDA warnings
  • This drug has several black box warnings. A black box warning is the most serious warning from the U.S. Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Addiction and misuse warning: This drug can lead to addiction and misuse, which can result in overdose and death. To help avoid these problems, take this drug exactly as prescribed by your doctor. If you have any concerns about this warning, talk with your doctor.
  • Slowed or stopped breathing warning: This drug can slow or stop your breathing. If this isn’t treated immediately, it can cause death. This risk is highest within three days of starting the drug or increasing your dosage.
  • Accidental ingestion warning: If anyone, especially children, takes a dose of this drug by accident even once, it can cause death. This drug should be stored out of reach of children.
  • Life-threatening effects for children warning: In some cases, children’s bodies can process this drug too quickly. This can lead to slowed breathing and death. This drug shouldn’t be used in children younger than 12 years of age. It should also not be used in children younger than 18 years of age who have certain risk factors, or who have just had a tonsillectomy or adenoidectomy.
  • Neonatal opioid withdrawal syndrome warning: If you use this medication for a long time while you’re pregnant, it can cause withdrawal in your baby. Withdrawal in your baby can lead to death. Symptoms of withdrawal can include irritability, hyperactivity, unusual sleep patterns, and a high-pitched cry. They can also include tremor, vomiting, diarrhea, and failure to gain weight.
  • Interactions with certain drugs warning: Taking tramadol with certain drugs can cause varied serious effects. These effects include increased tramadol levels, possibly leading to seizures and serotonin syndrome. They also include reduced effectiveness of tramadol, and opioid withdrawal symptoms. The drugs that can cause these effects include amiodarone, quinidine, erythromycin, ketoconazole, ritonavir, and similar medications.
  • Interactions with benzodiazepines warning: Taking tramadol with benzodiazepines and other similar drugs can cause very serious effects. These effects can include severe fatigue, slowed breathing, coma, and death.

Other warnings

  • Seizures warning: Tramadol can cause or worsen seizures. Your risk of seizures is higher if you’re taking other certain medications. These drugs include other opioid pain drugs or certain medications for depression, other mood disorders, or psychosis. If you take too much tramadol, you may be treated with a medication called naloxone. This drug also raises your risk of seizures.
Advertisement
Advertisement

About

What is tramadol?

Tramadol oral tablet is a prescription drug that’s available as the brand-name drugs Ultram (immediate-release tablet) and Ultram ER (extended-release tablet). Tramadol extended-release oral capsule is available as the brand-name drug Conzip. Immediate-release drugs are released into the body right away. Extended-release drugs are released into the body slowly over time.

All three forms of tramadol are also available as generic drugs. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Tramadol is a controlled substance. This means it can only be used with a doctor’s close supervision.

Why it's used

Tramadol is used to treat moderate to severe pain.

Tramadol may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Tramadol belongs to a class of drugs called opioid agonists. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Tramadol works by changing how your brain senses pain. Tramadol is similar to substances in your brain called endorphins. Endorphins bind to receptors (parts of cells that receive a certain substance). The receptors then decrease the pain messages that your body sends to your brain. Tramadol works in a similar way to decrease the amount of pain your brain thinks you’re having.

Side effects

Tramadol side effects

Tramadol oral tablet may cause drowsiness. You should not drive, use heavy machinery, or perform any dangerous activities until you know how this drug affects you. Tramadol may also cause other side effects.

More common side effects

The more common side effects of tramadol can include:

  • dizziness
  • headache
  • drowsiness
  • nausea and vomiting
  • constipation
  • lack of energy
  • sweating
  • dry mouth

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Serotonin syndrome. Symptoms can include:
    • fast heart rate
    • high blood pressure
    • body temperature that’s higher than normal
    • reflexes that are stronger than normal
    • lack of coordination (control of your movements)
    • nausea and vomiting
    • diarrhea
    • agitation
    • hallucinations (seeing or hearing things that aren’t real)
    • coma
  • Serious breathing problems. Symptoms can include:
    • slowed breathing rate
    • very shallow breathing (little chest movement with breathing)
    • fainting, dizziness, or confusion
  • Physical dependence and withdrawal when stopping the drug. Symptoms can include:
    • feeling irritable, anxious, or restless
    • trouble sleeping
    • increased blood pressure
    • fast breathing rate
    • fast heart rate
    • dilated (large) pupils
    • teary eyes
    • runny nose
    • yawning
    • nausea, vomiting, and a loss of appetite
    • diarrhea and stomach cramps
    • sweating
    • chills
    • muscle aches, back pain, or joint pain
  • Adrenal insufficiency. Symptoms can include:
    • long-lasting tiredness
    • muscle weakness
    • pain in your abdomen
  • Androgen deficiency. Symptoms can include:
    • tiredness
    • trouble sleeping
    • decreased energy
  • Seizures
  • Addiction or misuse of this drug

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Advertisement
Advertisement
Advertisement

Interactions

Tramadol may interact with other medications

Tramadol oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Drugs you should not use with tramadol

Do not take these drugs with tramadol. Doing so can cause dangerous effects in the body. Examples of these drugs include:

  • Carbamazepine. Taking this medication with tramadol may make tramadol less effective in relieving your pain. It also decreases the amount of tramadol in your body and increases your risk of seizures.

Interactions that increase your risk of side effects from other drugs

Taking tramadol with certain medications raises your risk of side effects from those drugs. This is because the amount of those drugs in your body may be increased. Examples of these drugs include:

  • Depression drugs, such as sertraline, fluoxetine, paroxetine, citalopram, escitalopram, duloxetine, or venlafaxine
    • You may have increased levels of serotonin (a hormone in your body). This can cause a condition called serotonin syndrome. Symptoms can include feeling agitated or restless, a fast heartbeat, increased body temperature, nausea, or vomiting.
    • If you take one of these drugs with tramadol, your doctor may monitor you more often and adjust your dosage of the drug as needed.
  • Monoamine oxidase inhibitors (MAOIs), including isocarboxazid, phenelzine, or selegiline
    • You may have increased levels of serotonin (a hormone in your body). This can cause a condition called serotonin syndrome. Symptoms can include feeling agitated or restless, a fast heartbeat, increased body temperature, nausea, or vomiting.
    • If you take one of these drugs with tramadol, your doctor may monitor you more often and adjust your dosage of the drug as needed.
  • Linezolid
    • You may have increased levels of serotonin (a hormone in your body). This can cause a condition called serotonin syndrome. Symptoms can include feeling agitated or restless, a fast heartbeat, increased body temperature, nausea, or vomiting.
    • If you take this drug with tramadol, your doctor may monitor you more often. They may also adjust your dosage of tramadol as needed.
  • Lithium
    • You may have increased levels of serotonin (a hormone in your body). This can cause a condition called serotonin syndrome. Symptoms can include feeling agitated or restless, a fast heartbeat, increased body temperature, nausea, or vomiting.
    • If you take this drug with tramadol, your doctor may monitor you more often. If you have symptoms of serotonin syndrome, your doctor may switch you to a different drug that doesn’t interact with tramadol.
  • St John’s wort
    • You may have increased levels of serotonin (a hormone in your body). This can cause a condition called serotonin syndrome. Symptoms can include feeling agitated or restless, a fast heartbeat, increased body temperature, nausea, or vomiting.
    • If you take this drug with tramadol, your doctor may monitor you more often and adjust your dosage of St. John’s wort as needed.
  • Headache drugs, such as sumatriptan, rizatriptan, or zolmitriptan
    • You may have increased levels of serotonin (a hormone in your body). This can cause a condition called serotonin syndrome. Symptoms can include feeling agitated or restless, a fast heartbeat, increased body temperature, nausea, or vomiting.
    • If you take one of these drugs with tramadol, your doctor may monitor you more often and adjust your dosage of the drug as needed.
  • Hypnotics, such as zolpidem, temazepam, or estazolam
    • You may have slowed breathing, decreased blood pressure, a decreased heart rate, or confusion.
    • If you take one of these drugs, talk with your doctor about whether tramadol is safe for you. Your doctor may prescribe a lower dosage of the hypnotic for you.
  • Benzodiazepines, such as alprazolam, clonazepam, diazepam, or lorazepam
    • You will be at increased risk of confusion, slowed or stopped breathing, decreased blood pressure, a decreased heart rate, coma, or earth.
    • If you take one of these drugs, talk with your doctor about whether tramadol is safe for you. Your doctor may prescribe a lower dosage of the benzodiazepine drug for you.
  • Anti-psychotic drugs, such as chlorpromazine or thioridazine
    • You may have slowed breathing, decreased blood pressure, a decreased heart rate, or confusion.
    • If you take one of these drugs, talk with your doctor about whether tramadol is safe for you. Your doctor may prescribe a lower dosage of the antipsychotic drug for you.
  • Anesthesia drugs, such as succinylcholine, pentothal, or propofol
    • You may have slowed breathing, decreased blood pressure, a decreased heart rate, or confusion.
    • If you take one of these drugs, talk with your doctor about whether tramadol is safe for you. Your doctor may prescribe a lower dosage of the anesthesia drug for you.
  • Opioid drugs for pain, such as hydrocodone, oxycodone, or morphine
    • You will be at increased risk of confusion, slowed or stopped breathing, decreased blood pressure, a decreased heart rate, coma, or death.
    • If you take one of these drugs, talk with your doctor about whether tramadol is safe for you. Your doctor may prescribe a lower dosage of either tramadol or the other opioid drug.

Interactions that increase your risk of side effects from tramadol

Taking tramadol with certain medications raises your risk of side effects from tramadol. This is because the amount of tramadol in your body may be increased. Examples of these drugs include:

  • Digoxin
    • If you take this drug with tramadol, your doctor may monitor the amount of digoxin in your body.
  • Warfarin
    • If you take this drug with tramadol, your doctor may monitor the amount of warfarin in your body and your INR (international normalized ratio) more often. They may also adjust your warfarin dosage as needed.

Interactions that can make your drugs less effective

When tramadol is used with certain drugs, it may not work as well to treat your condition. This is because the amount of tramadol in your body may be decreased. If you take one of these drugs with tramadol, your doctor may monitor you more often. They may also adjust your tramadol dosage as needed. Examples of these drugs include:

  • Antibiotics, such as erythromycin or telithromycin
  • Antidepressants, such as bupropion or amitriptyline
  • Antifungal drugs, such as voriconazole or ketoconazole
  • Heart rhythm drugs, such as amiodarone or quinidine
  • Protease inhibitors, such as ritonavir, atazanavir, or darunavir
  • Rifampin

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Other warnings

Tramadol warnings

Tramadol oral tablet comes with several warnings.

Allergy warning

Tramadol can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your face, lips, throat, or tongue
  • severe itching
  • hives (itchy welts)
  • blistering or peeling skin

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it or other opioids before. Taking it again could be fatal (cause death).

Alcohol interaction

The use of drinks that contain alcohol can increase your risk of certain side effects from tramadol. These include slowed breathing, decreased heart rate, decreased blood pressure, or confusion. You should not drink alcohol while taking tramadol.

Warnings for people with certain health conditions

For people with seizures: If you have seizures or history of seizures, tramadol can cause or worsen seizures. Talk with your doctor about whether tramadol is safe for you.

For people with mental health problems: If you have thoughts about intentionally hurting yourself, or have hurt yourself, do not take tramadol.

For people with addiction problems: If you have problems with addiction, such as addiction to alcohol or drugs, do not take tramadol. Also avoid this drug if you have a history of addiction.

For people with head injuries: Tramadol can increase the pressure inside your head. This can worsen your condition or make it harder for doctors to diagnose or find the cause of problems in your brain. Talk with your doctor about whether tramadol is safe for you.

For people with stomach problems: Tramadol can make certain stomach problems worse. It can also make it harder for doctors to diagnose or find the cause of problems. Talk with your doctor about whether tramadol is safe for you.

For people with kidney problems:

  • Tramadol immediate-release tablet: If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body well. This may increase the levels of tramadol in your body and cause more side effects.
  • Tramadol extended-release tablet or capsule: If you have severe kidney problems, you should not use the extended-release forms of tramadol.

For people with liver problems:

  • Tramadol immediate-release tablet: If you have liver problems or a history of liver disease, your body may not be able to process this drug well. This may increase the levels of tramadol in your body and cause more side effects.
  • Tramadol extended-release tablet or capsule: If you have severe liver problems, you should not use the extended-release forms of tramadol.

For people with breathing problems: Tramadol may slow your breathing and cause shallow breathing. Shallow breathing means you take small, short breaths. If you already have a breathing problem, such as asthma, talk with your doctor about whether this drug is safe for you.

Warnings for other groups

For pregnant women: Tramadol is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus. Call your doctor right away if you become pregnant while taking this drug.

For women who are breastfeeding: Tramadol may pass into breast milk and cause serious effects in a child who is breastfed. These effects can include slowed breathing and death.

Tramadol isn’t recommended for use by breastfeeding women. Talk to your doctor if you breastfeed your child. You’ll need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The kidneys or liver of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects. Seniors 65 years of age and older are at higher risk of side effects from the extended-release forms of this drug.

For children:

Tramadol immediate-release tablet: It’s not known if this drug is safe and effective for children. It should not be used in children younger than 17 years old.

Tramadol extended-release tablet and extended-release capsule: It’s not known if this drug is safe and effective for children. It should not be used in people younger than 18 years old.

Advertisement
Advertisement

Dosage

How to take tramadol

This dosage information is for tramadol oral tablet and capsule. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: tramadol

  • Form: immediate-release oral tablet
  • Strength: 50 mg
  • Form: extended-release oral tablet
  • Strengths: 100 mg, 200 mg, 300 mg
  • Form: extended-release oral capsule
  • Strengths: 100 mg, 150 mg, 200 mg, 300 mg

Brand: Ultram

  • Form: immediate-release oral tablet
  • Strength: 50 mg

Brand: Ultram ER

  • Form: extended-release oral tablet
  • Strengths: 100 mg, 200 mg, 300 mg

Brand: Conzip

  • Form: extended-release oral capsule
  • Strengths: 100 mg, 150 mg, 200 mg, 300 mg

Dosage for moderate to severe pain

Adult dosage (ages 18–64 years)

Immediate-release tablet:

  • Typical starting dosage: 25 mg once per day, in the morning
  • Dosage increases: Your doctor may slowly increase your dose by 25 mg every 3 days to reach 100 mg per day. After that, your dose may be increased by 50 mg every 3 days as tolerated.
  • Maintenance dosage: 50–100 mg every 4–6 hours as needed
  • Maximum dosage: 400 mg per day

Extended-release tablet or capsule:

  • If you’re not currently taking tramadol immediate-release tablets:
    • Typical starting dosage: 100 mg once per day
    • Dosage increases: Your doctor may slowly increase your dose by 100 mg every 5 days.
    • Maximum dosage: 300 mg per day
  • If you’re currently taking tramadol immediate-release tablets:
    • Typical starting dosage: Your doctor will determine your new dosage based on your previous immediate-release dosage.
    • Dosage increases: Your doctor may slowly increase your dose every 5 days.
    • Maximum dosage: 300 mg per day

Child dosage (ages 0–17 years)

Immediate-release tablet:

  • Child dosage (aged 17 years):
    • Typical starting dosage: 25 mg once per day in the morning
    • Dosage increases: Your child’s doctor may slowly increase your child’s dose by 25 mg every 3 days to reach 100 mg per day. They may then increase the dose by 50 mg every 3 days as tolerated by your child.
    • Maintenance dosage: 50–100 mg every 4–6 hours as needed
    • Maximum dosage: 400 mg per day
  • Child dosage (ages 0–16 years):
    • It’s not known if this form of tramadol is safe and effective for children younger than 17 years old. It should not be used in children of this age group.

Extended-release tablet or capsule:

  • Child dosage (ages 0–17 years):
    • It’s not known if these forms of tramadol are safe and effective for children. They should not be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • The liver and kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.
  • Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.
  • If you’re older than 75 years, your maximum dosage is 300 mg per day.

Special considerations

Kidney disease:

  • Tramadol immediate-release tablet: If you have severe kidney problems, your doctor will likely prescribe you 50–100 mg every 12 hours. The maximum dosage is 200 mg per day.
  • Tramadol extended-release tablet or capsule: If you have severe kidney problems, you should not use these forms of tramadol.

Liver disease:

  • Tramadol immediate-release tablet: If you have severe liver problems, your doctor will likely prescribe you 50 mg every 12 hours.
  • Tramadol extended-release tablet or capsule: If you have severe liver problems, you should not use the extended-release tablet or capsule.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.

Advertisement

Take as directed

Take as directed

Tramadol oral tablet is used for short-term or long-term treatment. Your length of treatment depends on how severe your pain is. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your pain may continue. If you stop taking the drug suddenly, you may have symptoms of withdrawal, which can include:

  • feeling irritable, anxious, or restless
  • trouble sleeping
  • increased blood pressure
  • fast breathing rate
  • fast heart rate
  • dilated (large) pupils
  • teary eyes
  • runny nose
  • yawning
  • nausea, vomiting, and loss of appetite
  • diarrhea and stomach cramps
  • sweating
  • chills
  • muscle aches, back pain, or joint pain

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • breathing that’s slow or shallow
  • trouble speaking
  • confusion
  • extreme tiredness
  • cold and clammy skin
  • muscle weakness
  • constricted (very small) pupils
  • seizures
  • dangerously slow heart rate
  • low blood pressure
  • dangerous heart problems such as an irregular heart rhythm or cardiac arrest (when the heart suddenly stops beating)
  • coma
  • death

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. If you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: You should feel less pain.

Advertisement
Advertisement

Important considerations

Important considerations for taking tramadol

Keep these considerations in mind if your doctor prescribes tramadol oral tablet for you.

General

  • You can take tramadol with or without food
  • Cutting or crushing this drug
    • Do not cut or crush the extended-release tablet or capsule. You should swallow these forms whole.
    • You can cut or crush the immediate-release tablet.
  • Not every pharmacy stocks all forms or brands of this drug. When filling your prescription, be sure to call ahead.

Storage

  • Store this drug at room temperature between 59°F and 86°F (15°C and 30°C).
  • Keep this medication in a tightly closed container.
  • Keep this drug away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. Your doctor will write the number of refills authorized on your prescription. There’s a limit to the number of refills you can get for this prescription. You or your pharmacy may have to contact your doctor for a new prescription if you need this medication refilled.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Breathing rate. Your doctor may monitor you for any changes in your breathing pattern. They may check this more carefully when you first start taking tramadol and after any increase in dosage.
  • Kidney function. Blood tests can help your doctor check how well your kidneys are working. If your kidneys aren’t working well, your doctor may lower your dose of this drug or prescribe a different pain medication.
  • Liver function. Blood tests can help your doctor check how well your liver is working. If your liver isn’t working well, your doctor may lower your dose of this drug or prescribe a different pain medication.
  • Risk of misuse or addiction. Before your doctor prescribes tramadol for you, they will assess your risk of misusing or becoming addicted to opioid medications. If your doctor thinks this is a risk for you, they may prescribe a different pain medication.

Hidden costs

You may need to have blood tests during your treatment with tramadol. The cost of these tests will depend on your insurance coverage.

Insurance

Many insurance companies require a prior authorization for certain forms or brands of this drug. This means your doctor may need to get approval from your insurance company before your insurance company will pay for the prescription.

Alternatives

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Article resources
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement