Always follow the instructions given to you by your doctor. Some tramadol tablets and capsules are slow-release. This means the tramadol is gradually released into your body over either 12 or 24 hours. This type of tramadol takes longer to start working but lasts longer.
It's used for long-term pain. Your doctor will decide the right dose for you, depending on how sensitive you are to pain and how bad your pain is. Your dose may need to be changed several times to find what works best for you.
In general, you will be prescribed the lowest dose that relieves your pain. Dosages vary from person to person. Your dose will depend on how bad your pain is, how you've responded to previous painkillers and if you get any side effects.
Fast-acting tramadol comes as capsules, drops and 2 different tablets — soluble and dissolve-in-the-mouth tablets:. Slow-release tramadol comes as tablets and capsules. It's important to swallow slow-release tramadol tablets and capsules whole with a drink of water. Do not break, crush, chew or suck slow-release tablets and capsules. If you do, the slow-release system will not work and the whole dose might get into your body in one go.
This could cause a potentially fatal overdose. When to take it depends on the type of tramadol that you have been prescribed:. If you're 65 and over, or you have liver or kidney problems, you may be asked by your doctor to take tramadol less often. You can take your tramadol at any time of day but try to take it at the same time every day and space your doses evenly.
For example, if you take tramadol twice a day and have your first dose at 8am, take your second dose at 8pm. If you forget to take a dose, check the information on the patient information leaflet inside the packaging or ask your pharmacist or doctor for advice on what to do. If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
If you need to take tramadol for a long time your body can become tolerant to it. This is not usually a problem but you could get unpleasant withdrawal symptoms if you stop taking it suddenly. If you want to stop taking tramadol, talk to your doctor first. Your dose will usually be reduced gradually so you do not get unpleasant withdrawal effects. Tramadol can cause unpleasant withdrawal symptoms if you come off it suddenly, such as:.
If you have been taking tramadol for more than a few weeks do not stop taking it without speaking to your doctor first. It's important not to take more than your prescribed dose, even if you think it's not enough to relieve your pain. Speak to your doctor first, if you think you need a different dose. If you've taken an accidental overdose you may feel very sleepy, sick or dizzy.
You may also find it difficult to breathe. In serious cases you can become unconscious and may need emergency treatment in hospital. The amount of tramadol that can lead to an overdose varies from person to person.
If you've taken 1 extra dose by mistake, check the information that comes with the medicine packaging or ask your pharmacist or doctor for advice. Generally, you are unlikely to get any symptoms and you can take your next dose as usual.
Get someone else to drive you or call for an ambulance. Take the tramadol box or leaflet inside the packet plus any remaining medicine with you. It's safe to take tramadol with paracetamol , ibuprofen or aspirin aspirin is suitable for most people aged 16 years and over.
Do not take tramadol with codeine-containing painkillers you can buy from a pharmacy. You'll be more likely to get side effects. Some everyday painkillers that you can buy from pharmacies contain codeine, which is a similar medicine to tramadol.
Codeine-containing painkillers that you can buy from pharmacies include co-codamol , Nurofen Plus and Solpadeine. Like all medicines, tramadol can cause side effects although not everyone gets them. Talk to your doctor or pharmacist if the side effects listed below bother you or don't go away. Very common side effects of tramadol happen in more than 1 in 10 people and include:.
Common side effects of tramadol happen in more than 1 in people. They include:. 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.
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Tramadol may interact with other medications. How to take tramadol. Tramadol warnings. Take as directed. Important considerations for taking tramadol.
Are there any alternatives? Methocarbamol, Oral Tablet. It has the least gastrointestinal and renal toxicities [ 65 ]. Drug screening for opioids is generally negative in the patients with tramadol overdose [ 66 ]. In overdose, lethargy, nausea, tachycardia, agitation, seizure, coma, hypotension, hypertension, respiratory depression, dysuria, constipation, dizziness, facial paresthesia, ataxia, headache, edema, movement disorders, perspiration, blurred vision, hallucination, itching, vertigo, palpitation, hypo- and hyper-reflexia, diplopia, multi-organ failure, acute liver failure due to fulminant liver necrosis, renal failure, and urine retention have been reported [ 8 , 17 , 23 , 48 - 51 , 64 , 67 , 68 ].
Dizziness, nausea, constipation, vertigo, and headache are the most common symptoms [ 57 , 69 , 70 ]. Miosis is not as common as that in toxicities with other opioids and is detected in up to one-thirds of the patients probably due to serotonin and norepinephrine reuptake inhibition [ 71 ].
O-desmethyltramadol impairs consciousness and causes electrocardiographic ECG changes and seizure [ 44 ]. Most of the patients experience only one episode of seizure [ 44 , 47 , 49 , 50 ]. Seizure is more common in young males mean age of 22 — It seems that tramadol causes seizure in a dose-dependent manner [ 3 , 21 , 23 ] while some other studies have not confirmed this [ 43 , 44 , 75 ]. The least tramadol amount that has resulted in seizure is mg.
Tramadol neurotoxicity generally occurs within the first 24 hours postingestion mainly in the first 6 hours and seizures are usually tonic-clinic [ 3 , 6 - 8 , 11 , 21 , 23 , 50 , 75 - 78 ]. Status epilepticus has also been reported [ 6 , 11 , 59 , 76 ]. This shows that tramadol can cause seizure at both therapeutic and toxic levels [ 43 , 52 , 77 , 79 ].
Brain computed tomography CT of the tramadol-intoxicated patients has often been reported to be normal [ 43 , 77 ]. In a study performed to evaluate the risk of idiopathic seizure in tramadol users, only 17 cases of idiopathic seizure were found among patients, all of whom, used tramadol in combination with some other medication; it, therefore, is difficult to relate their seizure to tramadol use [ 71 ].
Seizure is less frequent in the patients who use tramadol with benzodiazepines. Psychological and somatic complications hepatitis C and liver injury were detected in those who had seized. Ethanol can reduce the seizure threshold in tramadol use.
Seizure is also more common in younger patients who have abused tramadol for a long period of time [ 23 ]. Background seizing disorders, medications causing seizure, ethanol withdrawal, CNS depressants, or head injury can affect seizure occurrence in tramadol overdose, as well [ 45 ].
Mydriasis and tachycardia can accompany with a higher risk of seizure [ 44 ]. Risk of seizure was 2-to 6-fold in the patients who had background diseases or consumed other medications.
The risk was also higher in those between 25 and 54 years of age, those who use tramadol for more than 4 times, or those with the history of alcohol abuse, infarction, or head injury [ 74 ]. In another study on 97 patients with seizure, electroencephalographic EEG evaluations were normal in seven and isolated sharp slow-wave feature of EEG was seen in one patients. Tramadol-induced seizure can cause trauma, intra-articular dislocation, and tongue laceration [ 67 , 81 , 82 ].
In a study on 70 rats, it was revealed that tramadol could inhibit electron transfer cycle ETC , cause ATP depletion, and disrupt the mitochondrial integrity.
Apoptosis may also happen due to tramadol use [ 83 ]. In the neonates, tramadol can trigger pentylenetetrazole-induced seizure in an age-dependant manner causing fewer seizures in the neonatal period and more seizures after the lactating period [ 84 ]. Administration of tramadol hydrochloride to a zebrafish caused abnormal behaviors, reduced activity, and reduced brain and body weight. In the zebrafish brain, functional cytoskeletal proteins engaged in the energy metabolism had changed due to tramadol.
Lower levels of ATP synthetase, creatine kinase, pyruvate dehydrogenase, kinase, and aldolase C could be due to the impaired production of energy because of tramadol. Weak regulation of the proteins engaged in the oxidative stress, mitochondrial functional abnormalities, and impaired production and destruction of the proteins represented the neurotoxicity of tramadol Table 1 [ 85 ].
Acute pulmonary hypertension and right heart failure are the uncommon presentations reported in a young tramadol-overdosed patient [ 86 ].
Cardiopulmonary arrest was reported in some cases that had ingested more than 5 g of tramadol [ 8 ]. Higher doses of tramadol can block sodium channels and cause Brugada pattern in the ECG [ 11 , 47 ] which can be accompanied by ventricular dysrhythmias including ventricular fibrillation [ 11 ]. Almost one-thirds of the patients had terminal 40 msec frontal plane axis deviation and one-fourth had QT prolongation more than 0.
Some cases of right heart failure, resistant shock, asystole, hypotension especially systolic , and sinus tachycardia have also been recorded [ 6 , 35 , 44 , 49 ]. Hypertension has also been reported. The least tramadol dose that has resulted in hypertension and agitation is mg [ 49 ]. Eleven suspected cases of tramadol-related angioedema have been reported from Sweden.
Tramadol causes respiratory depression with less frequency in comparison with other opioids [ 28 , 57 , 88 ]. Renal failure is a probable risk factor for respiratory depression [ 28 , 89 ]. Tramadol overdose can cause respiratory depression; but in therapeutic oral doses, it does not cause respiratory complications.
In a study on IV administration of 50 to 75 mg of tramadol, no significant changes were detected in the respiratory rate, respiratory volume per minute, and arterial PaO2 [ 90 ].
Sixteen cases of non-fatal hepatobiliary dysfunction due to tramadol ingestion have been reported [ 74 ]. Tramadol has caused centrilobular congestion and focal necrosis of the liver cells and minimal vacuolization in the kidney tubular cells of the rats. No changes were detected in the lactate dehydrogenase, blood urea nitrogen BUN , aspartate aminotransferase AST , and malondialdehyde MDA ; however, alanine aminotransferase ALT increased significantly showing the possible hepatotoxicity of tramadol [ 91 ].
It was shown that acute or chronic toxicity did not affect liver weight or cause histopathological changes in its tissue [ 17 , 92 ]. In the rats, mu receptor activation increases glucose use or decreases the liver gluconeogenesis which results in the low levels of plasma glucose in diabetic rats [ 88 , 93 ]. It has been shown that tramadol improves the peripheral metabolism of glucose by central activation of the mu receptors.
Therefore, central and peripheral metabolisms of glucose unite and cause hypoglycemia. It has also been suggested that tramadol changes the liver glucose output regulated by other organs likely CNS [ 93 ].
Some patients discontinue tramadol consumption because of nausea and vomiting. It has been shown that slow titration decreases the frequency of tramadol discontinuation due to these complications [ 94 ]. In long-term studies on rats and mice, no tramadol-attributed carcinogenic changes were detected. Histopathologic evaluations showed increased risk of hepatic adenoma in the males and non dose-related pulmonary adenoma in females.
No specific mutations or chromosomal impairments were detected in rats, mice, or hamsters due to tramadol use. Oral administration of tramadol was reported to have no carcinogenic effects on the mice and rats.
No mutations or increased risk of gene toxicity were detected in human-beings, either [ 17 ]. Tramadol can cause urinary retention because of opioid agonistic effects that can increase the tonicity of the bladder sphincter [ 68 ].
Also, it was shown to have hazardous effects on the growth, survival, and reproduction system of Daphnia Magna with the most effects on the latter. Long-term exposures decreased expression of the vtg gene which is an important biomarker in the reproduction of the oviparous animals [ 64 , 95 ]. In a study by Matthiesen et al, low dose of tramadol had no effect on the fertility, giving birth, and lactation of the rats and had no teratogenic effects on the fetus [ 17 ].
These results are however in contrast to the results withdrawn by Bornas who mentioned that laboratory studies had confirmed the teratogenic effects of tramadol on the animals. Tramadol and M1 metabolite can cross the placenta easily because of their low molecular weights [ 55 ].
Bleeding time BT , clotting time CT , prothrombin time, partial thromboplastin time, and body temperature were not affected by tramadol [ 17 ]. But, leukocytosis has been reported [ 44 ].
Tramadol overdose may result in increased creatine phosphokinase CPK which may be seen with or without seizure and can be accompanied by acute renal failure Table 2 [ 13 ]. Serotonin syndrome SS is a potentially fatal syndrome due to increased synthesis, decreased metabolism, increased release, and reuptake inhibition of serotonin or direct agonism at the serotonin receptors [ 5 , 53 ]. This syndrome is often due to complex interactions between the consumed medications.
Three key clinical features of this syndrome include:. Neuromuscular hyperactivity tremor, clonus, myoclonus, hyper-reflexia, stiffness, impaired coordination.
Autonomic hyperactivity profuse sweating, fever, tachycardia, tachypnea, chills, nausea, diarrhea, vomiting. Usually, SS happens after tramadol overdose or its concurrent use with other medications especially antidepressants; however, it may happen even after a single therapeutic dose of tramadol [ 5 , 98 , ]. Some people who take opioids keep naloxone name brand Narcan on hand.
Naloxone is a drug that reverses the effects of opioids on the central nervous system. In the event of a tramadol overdose, the person suffering will not likely be able to give themselves naloxone. It is often up to another person present to administer the medication. Every day in the U. Anyone who takes tramadol is at risk for potential dependence, addiction, and overdose.
However, those who abuse this narcotic medication will be at an increased risk. Tramadol is often prescribed due to its dual benefits of being able to treat pain while being less addictive. However, tramadol can still be habit-forming. People who take this drug over long periods can become physically dependent on the drug, which could cause a person to take large or frequent doses. Over time, the body becomes accustomed to having high amounts of the drug in order to function normally.
If a person suddenly stops or decreases their use, the body may display symptoms of opioid withdrawal. These symptoms can be extremely uncomfortable, including nausea, sweating, and muscle cramps. To avoid withdrawal symptoms, some people may take higher doses of tramadol than prescribed. People who suffer from mental health conditions are at an increased risk for opioid abuse and overdose.
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