ARTICLE OVERVIEW: Tramadol use is unpredictable. In some people it can provoke psychiatric responses. In others, Tramadol has been reported to cause dependence and addiction. However, is more likely to cause side effects, such as dizziness, dry mouth, or nausea. We review how and why Tramadol can be dangerous for you here. Then, we invite you to leave your questions at the end.
TABLE OF CONTENTS
- How it Works
- Short-Term Effects
- Long-Term Effects
- Side Effects
- Signs of Overdose
- Getting Help
What Is Tramadol?
Tramadol is a specific type of narcotic medicine called an “opioid” that is used to treat moderate to moderately severe pain in adults. It is available under the brand names Ultram, Ultram ER, Conzip, and as generics. Tramadol is also available in combination with the pain reliever acetaminophen under the brand name Ultracet and as generics.
Tramadol was FDA-approved for marketing in the United States as a noncontrolled analgesic in 1995. However, soon after its approval there have been reports of diversion and abuse of Tramadol. This led to revisions to the product labeling and the addition of warnings about its abuse by the Food and Drug Administration (FDA).  
How Tramadol Works
How it works? Tramadol is an analgesic medication that is a synthetic analogue of codeine. In terms of the neurotransmitter effects in the brain the spinal cord, Tramadol is a mu opioid receptor agonist. In comparison with other opiates, Tramadol is renowned for having less abuse potential and less respiratory depression.
In addition to its effects on the central nervous system, at the peripheral level, Tramadol inhibits the reuptake of serotonin and norepinephrine. It is likely that these latter effects are an important element in analgesia (pain relief), but they can also explain some of the adverse properties of the drug. In other words, one of the side effects of taking tramadol is euphoria, or an extreme sense of well-being. Feeling high can trigger habitual use, which can develop into addiction.
Onset of action when Tramadol is taken orally as prescribed is usually under an hour. However, intravenous injection brings almost immediate onset of pain relief.
The expected effects of Tramadol in the short term include the following:
1. Anxiety reduction. Tramadol also decreases anxiety levels, leaving people feel relaxed and relaxed due to the way that brain chemistry changes. This effect can make Tramadol addictive.
2. Blocked pain perception. As an analgesic, Tramadol modifies the transmission of pain signals to the brain and spinal cord so that a significant decrease in pain is experienced.
3. Euphoric mood. Tramadol works in a similar way to many antidepressant medications, since it increases serotonin and norepinephrine levels in the brain. As mentioned earlier, this can lead to feelings of euphoria and well-being. For some people, these pleasant symptoms serve to reinforce a pattern of continuous use of this medication, running the risk of generating addiction.
According to NCBI’s PubMed Health, this medicine can also cause the following problems:
- High risk of overdose, which can lead to death.
- Respiratory depression (slowed breathing that can be life-threatening).
- Serotonin syndrome (when used with certain medicines).
- Unusual change in mood or behavior.
More on these side effects below.
If you use Tramadol for a prolonged period of time, you can expect a few predictable outcomes. Tramadol dependence occurs within a few weeks of daily dosing. According to this study, while high dose could be physically safe to some limit, psychiatrically it has many side effects. 
Additionally, possible declines in cognition have been associated with long-term use of Tramadol. Drug dependence, tolerance, and/or addiction are all possible if you take Tramadol long-term. The following effects may occur if you are taking Tramadol for a period of a few months or longer:
Cognitive impairment, associated with many opioid medications. Complex tasks may become more difficult with long-term use of Tramadol, and people may present a danger to themselves or others when driving, or when performing an activity that requires a lot of attention and concentration.
Physical dependence can occur after daily dosing of a few weeks or more. This is an expected body adaptation to the presence of the drug. Once drug dependent, Tramadol will be required for the body to function properly. When you stop taking Tramadol, you can become physically ill due to the appearance of a withdrawal syndrome.
Tolerance, due to changing brain chemistry, as the body adapts, and accustoms to the presence of Tramadol. In cases of increased tolerance, higher doses of the drug will be needed to be able to feel its analgesic and euphoric effects.
Addiction. Long-term use can lead to an addiction to Tramadol. Indeed, Tramadol may be habit forming, especially with prolonged use. Like other types of prescription drug abuse, many people who struggle with Tramadol addiction do not need to obtain their medication from an illicit market to continue their cycle of dependence; they start taking it as prescribed and then take a larger dose on their own when the medication stops working.
According to a review of international studies on the use of Tramadol, the medication may cause the following side effects:
- Changes in mood.
- Difficulty falling asleep or staying asleep.
- Dry mouth.
- Heartburn or indigestion.
- Muscle tightness.
- Uncontrollable shaking of a part of the body.
Some side effects can be serious. For example, this study published in the French medical journal CMAJ in 2013 reported that:
“Generalized seizures and serotonin syndrome can occur with tramadol use, sometimes with modest doses, and particularly when the drug is combined with other serotonergic or proconvulsant agents such as antidepressants.” 
If you, or someone you, know experience any of these symptoms or those mentioned, call your doctor immediately or get emergency medical treatment when appropriate. You may also report side effects to the FDA at 1-800-FDA-1088. Side effects of tramadol that require medical attention include:
- Changes in heartbeat.
- Decreased sexual desire.
- Difficulty swallowing or breathing.
- Fast heartbeat.
- Hallucinations (seeing things or hearing voices that do not exist).
- Inability to get or keep an erection.
- Irregular menstruation.
- Loss of appetite.
- Loss of consciousness.
- Loss of coordination.
- Nausea, vomiting, or diarrhea.
- Severe muscle stiffness or twitching.
- Swelling of the eyes, face, throat, tongue, lips, hands, feet, ankles, or lower legs.
- Weakness or dizziness.
Significant risks, including death, are also associated with Tramadol use. These risks are heightened in certain people or when Tramadol is mixed with other substances or psychoactive drugs.
For example, Tramadol should not be used in people with suicidal thoughts or tendencies, since sometimes the medication can aggravate these conditions; people suffering from depression or mood disorders should also avoid it.
Furthermore, the simultaneous administration of Tramadol with central depressant substances, including alcohol, can potentiate the effects on the central nervous system. Tramadol is also risky in combinations with a variety of other prescription drugs, because it interacts with several different types of medications, including, but not limited to:
- Drugs that inhibit cytochrome P-450 such as ritonavir, quinidine, paroxetine, fluoxetine, sertraline, amitriptyline and isoniazid, ketoconazole and erythromycin should be avoided in persons who are being treated simultaneously with Tramadol, since they can enhance toxicity by increasing its plasma concentration.
- Herbal supplements such as St. John’s Wort may increase too much serotonin, causing serious side effects including confusion, chills, and muscle cramps.
- Isolated cases of serotonin syndrome (syndrome that occurs when there are large amounts of serotonin in the body) have been reported. This occurs with the concomitant use of Tramadol and serotonergic drugs, such as selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), serotonin/noradrenaline reuptake inhibitors (venlafaxine, duloxetine, and desvenlafaxine), MAO inhibitors (nialamide, tranylcypromine, moclobemide, selegiline, and linezolid), antidepressants tricyclics (imipramine, trimipramine and clomipramine) and mirtazapine can cause serotonin toxicity.
- The simultaneous or previous administration of carbamazepine may reduce the analgesic effect or reduce the duration of the action.
- Tramadol can cause seizures and increase the potential for seizures of selective serotonin reuptake inhibitors, serotonin / norepinephrine reuptake inhibitors, tricyclic antidepressants, antipsychotics, and other medications that reduce the seizure threshold (such as bupropion, mirtazapine, tetrahydrocannabinol).
For more contraindications, see the FDA Tramadol drug safety info and this MedLine Plus Tramadol entry.  
Signs of Overdose
It is important to recognize the signs of Tramadol poisoning as early as possible to prevent harm. There are a few distinct signs of Tramadol overdose to look out for, they include:
- Cold, clammy skin.
- Decreased size of the pupil.
- Difficulty breathing.
- Extreme drowsiness.
- Heart attack.
- Loss of consciousness for a period.
- Muscle weakness.
- Slowed heartbeat.
An overdose may result in death, so any of the above signs should be treated as a serious medical emergency that requires immediate medical attention. The U.S. Surgeon General recommends naloxone at-home injection kits or sprays to prevent overdose. 
Naloxone is a medication that can be used to block some of the immediate effects of Tramadol on the body and potentially help save someone’s life in the event of an overdose. It can be given through a nasal spray or injected into the muscles. When you call 9-1-1 in time, naloxone may be given intravenously if administered by medical personnel.
Baltimore City’s Training on How to Use Naloxone 
Drugs like Tramadol can create a compulsive “need” for the drug in users, and cause unpleasant withdrawal symptoms, which make it hard to quit using. Withdrawal symptoms of Tramadol can occur even after a few days of prescribed use.
The good news is that there is help for people physically dependent or mentally addicted to Tramadol. You can first take a look at this Opioid Risk Tool to self-report and assess risk of a problem. Then, talk with your prescribing doctors. 
A local doctor or clinic should be able to direct you to resources and help you deal with drug dependence and/or cases of addiction. They may use a medical or therapeutic approach, or a combination of the two. In addition, you can look for local support groups, like Narcotics Anonymous. Other medical professionals you can turn to for help include:
- A medical doctor who specializes in addiction (ASAM Members)
- Psychiatrists (APA General Members)
- Psychologists (APA Members)
- A detox clinic
- An addiction treatment center
Or, you can give us a call at the phone number listed on this page.
If you have any more questions about the risk or danger of taking Tramadol, please leave your questions here. We try to respond to all legitimate questions with personal and prompt replies.
Reference Sources:  FDA: Tramadol Hydrochloride
 FDA: FDA Restricts Use Of Prescription Codeine Pain And Cough Medicines And Tramadol Pain Medicines In Children; Recommends Against Use In Breastfeeding Women
 NCBI: Medical And Psychiatric Effects Of Long-Term Dependence On High Dose Of Tramadol.
 NCBI: Tramadol
 FDA: Tramadol Information
 MEDLINEPLUS: Tramadol
 HHS: Opioid Overdose Prevention
 BCHD: You Can Stop Overdose Death
 DRUGABUSE: Opioid Risk Tool
SAMHSA: Reports Highlight Rise In Tramadol-Related Hospital Emergency Department Visits
All of the information on this page has been reviewed and verified by a licensed medical professional.