How does Tramadol work?

Tramadol works by interacting with opiate receptors in the central nervous system to change how the brain and body perceive pain. More here on how fast and how long tramadol works, as well as what makes tramadol work better.

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Tramadol is an opioid medication that’s used to treat moderate to severe pain. Tramadol works by changing the way the brain and body perceive pain. Specifically, tramadol both inhibits serotonin and norepinephrine reuptake AND activates opiate receptors in the central nervous system to enhancing the inhibitory effects on pain transmission in the spinal cord.  How long tramadol lasts depends on immediate release (4-6 hours) vs. extended release versions (24 hours).

More here on how fast tramadol works, for how long, and what you can do to make tramadol work better. Your questions about tramadol are welcomed at the end.

How does tramadol affect the brain and nervous system?

Experts still don’t know the exact reasons why or how tramadol causes pain relief. However, they do know that tramadol is an opium-derived synthetic substance that interacts with opiate receptors in the brain, helping to lessen the sensations of pain, treat withdrawal symptoms, and sometimes create feelings of euphoric pleasure. Further, tramadol has dual mechanisms of action which result in pain relief:

1. enhancement of serotonin and norepinephrine transmission

2. micro-opioid receptor activation

So given the function of tramadol, can you overdose on tramadol? Yes, it is possible to overdose on tramadol.  The recommended daily dose of tramadol is 450 mg per day.

How does tramadol work in the body?

Tramadol works in the body by first affecting the brain. Tramadol is a central nervous system depressant whose effects can result in:

  • dizziness
  • drowsiness
  • loss of consciousness
  • impaired coordination
  • pain relief
  • shallow breathing
  • slowed heart rate
  • nausea/vomiting

Some of these side effects can be dangerous and even life-threatening, but serious side effects normally only occur when tramadol is not taken as directed.

How fast does tramadol work

After oral administration, tramadol is rapidly and almost completely absorbed. Tramadol hits its peak blood plasma level an hour and a half after the drug is taken, at which point it takes full effect. Sometimes people will crush and snort tramadol powder from the tablets to try to get more immediate effects, but this is dangerous and can result in increased adverse effects, nasal infections, or overdose.

How long does tramadol work?

Tramadol has a half life of 6 hours. The immediate-release tramadol tablet will need to be taken every 4-6 hours for continuous pain relief, otherwise the effects will wear off. The extended-release tramadol tablet, used mainly to manage chronic pain, will last for 24 hours. This tablet is only taken once a day.

What makes tramadol work better

There are no specific instructions given from tramadol manufacturers which describe how you can make tramadol work better (Ex. taken with food vs. an empty stomach).  However, there are a few warnings for how to take tramadol safely.  For example, tramadol should not be taken along with other central nervous system depressants like alcohol or benzodiazepines. Tramadol can cause excessive drowsiness and even be dangerous when mixed with other medications. Tramadol needs to be taken exactly as directed, and not crushed, chewed, or snorted.

Does tramadol work for everyone?

No, Tramadol is not right for everyone. In some people, tramadol can have serious side effects or cause an allergic reaction. Plus, tramadol is a habit-forming medication, so it’s not recommended for those with a history of drug or alcohol abuse.

If you experience problems while taking tramadol, you should talk to your doctor immediately about discontinuing the medication. There may be other medications you’re taking which interact with tramadol, so always check with your pharmacist before taking any new medications.

How tramadol works questions

Do you still have questions about how tramadol works or about tramadol in general? Please leave us your tramadol questions below. We will be happy to try to answer your questions ASAP.

Reference Sources: FDA Access Data: Ryzolt
PubMed: Pharmacology of tramadol

PubMed Health: Tramadol
DailyMed: Tramadol Hydrochloride
Toxnet: Tramadol
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.


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  1. Hi, when switching from tramadol to Vicodin (via Drs orders), how long do you have to wait after the last dose of tramadol before starting Vicodin (in order to avoid precipitated withdrawal or any conflict that causes withdrawal type reactions or sick feeling, etc).? I’m just asking as a second opinion just to be sure, as I’ve read that if you don’t wait long enough between them you can feel sick. Thank you

    1. Hi Freda. Use your medication only as prescribed by a doctor. If you have problems with the dosage, consult with your doctor.

  2. How is the time released tramadol released into your system. I seem to get another big does in my system about 12 hours after I take it. Light breathing, heavy arms and fuzzy head.

  3. I have been on ultram max daily for 15 years dealing with accuse Lyme and fibromyalgia.
    I am trying to get off it to see if I still need it.
    I believe I suffer less pain now, my libido has drastically decreased and my metabolism is incredibly slow.
    What is a safe game plan? Is there a nutritional plan to assist? I am exercising 30 minutes daily. I am suffering withdrawal effects, sweating, irratibility, odd pains, sleepless nights, change in food choices.
    How can I manage this? I am 55 year old woman.

    1. Hi Gena. First, I suggest that you speak with your doctor to help you create an individualized tapering schedule. Moreover, consult with a pharmacist to recommend some over-the-counter aid, home remedies, vitamins and supplements to ease withdrawal. Also, consider some alternative methods to manage pain. Here’s some suggested reading:

  4. I had a hip replacement 16 days ago, I started out taking hydrocodone acetaminophen 5-325, after 11 days post op, I started. Taking trampoline 50mg every 7 to 9 hours, I would like to switch to Tylenol and stop the tramadol, is this a good option for me, or is it best to stay on the tramadol, it’s been 8.5 hrs. Since my last pill, ready to go to sleep, but need something to dull the pain enough to sleep, I wake up about 7 hours after my tramadyl and then take a pill and can’t go back to sleep for several hours, not sure why/

  5. after an accident at work in 2007 that involved serve whiplash and many many MANY attempts at managing my pain my gp has put me on Tramadol… He has also diagnosed me with fibromyalgia… Tramadol has been a life saver for me, I can see a light at the end of the tunnel now, I wish this was a long term solution but for now I am just happy to have something the help control the pain. For now I simply do not care about the possible withdrawal effects, for now the pain relief far out-ways any side effects I have read about.

  6. I have been taking tramadol for 4 months for broken knee cap. I tstill have pain but want to stop tramadol. I usually take two a day, 3 max. Should or can I stop?

    1. Hi Joanne. Depends on whether you can take the pain coming from your knee or not. Tramadol is not recommended for long-term use, but you will have to discuss with your doctor what are some other possibilities for managing pain if you will be first tapering and then completely stop. In any case and regardless of what you decide is best for you, tramadol should not be stopped cold turkey.

  7. I’m a 71 year old lady with painful arthritis and my right arm very painful to move I been given tramadol 50 mg I have stomach problem due to years of a taken painkillers with out food. will they work better after food?

  8. Hi my question is: can long term tramadol abuse cause any sort of nervous system damage? nerve damage at all? or is it possible I am experiencing withdrawal? I have been taking about 100 to 250mg of tramadol for the last two years every other day and rarely go longer than two weeks without using. I have become just completely nervous for no apparent reason I cannot socialize most of the time. I cant control my nervousness and anxiety.

    1. Hello Daniel. You will need a structured program to help you quit tramadol and doctors can also help you manage your anxiety. After long-term use some nerve damage can be irreversible, but I believe that our brain is amazing at healing itself if given enough time. As many others have already confirmed – it really gets better with time.

  9. If Tramadol works in the body by first affecting the brain, does that means the medicine is bad and one should not take the medicine?

    1. Hello bettyflakes. Tramadol has a number of side effect which you can explore here: As for the effects on the brain, Tramadol is one addictive drug: I hope the provided information help you better understand the things about this medication you may not have been warned about by a doctor. Also, due to it’s fats dependence-forming potential, Tramadol is not recommended for more that 2 weeks or 1 month (tops).

  10. I take Adivan 1mg 3 times a day (10A.M.-3 P.M. and 9:30 P.M.) Mehtadone 5MG 3 times a day ( 1@9 a.m., 2-1/2 @ 3 p.m. and 5 mg @ 9 p.m.) Gabapentin 600 mg. ( 1 @ 9 a.m.- 1 @ 3 p.m. and 1 1/2 @ 9 p.m.) and 50 mg. Tramadol @ 4 p.m. and 3 200 MG. Motrin a day. 400 at bed, 10: p.m. How is that for a safe mixture? It does pretty much kill the pain unless I lift, twist or walk too much, until about 8:30. However, my muscles feel weaker. I often feel pretty dead headed, but can function body movement wise better. But I also do not think I am getting good restful sleep.

  11. Tramadol can influence mood and can affect the way the body perceives pain. However, tramadol is habit forming. You can do a search for ” tramadol arthritis ” to learn more about how tramadol is used in the treatment of chronic pain. Best of luck to you!

  12. What do you mean you do not understand “without drinking”??!! I said exactly what it means!! I did not drink the night before, or the night before, or the night before, or the night before, etc. etc. I was prescribed tramadol orignally for pain 1 50 mg 3 times a day. However, by pure accident, I found out that by taking 2 pills (100 mg) before I go to bed, it takes care of the issues I stated before.

  13. Without drinking, I feel hung over, weak in the arms and legs, body aches, tingling in the hands, no energy, high blood pressure, fever. However, if I take 100 mg of Tramadol right before I go to bed, I feel just fine the next day. Can you please explain this and why does tramadol heal whatever is wrong with me.

  14. Hello Cindy. Seek a tapering schedule/calendar from your prescribing doctor or local pharmacist. How quickly you come off tramadol will depend on a few individual factors. However, tramadol withdrawal can induce seizures (unlike other opioids), so a slow and gentle taper is usually recommended (rather than cold turkey).

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