Tramadol dangers

Dangers of Tramadol include serious side effects, drug interactions, overdose or addiction (especially when not taken as prescribed). Plus, you can die or experience serious side effects of Tramadol if you are diagnosed with certain medical conditions, which we explore in more detail here.

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Reviewed by: Dr. Dili Gonzalez, M.D. Dr. Juan Goecke, M.D.

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.


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). [1] [2]

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.

Short-Term Effects

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.

Long-Term Effects

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. [3]

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.

Side Effects

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.
  • Dizziness.
  • Drowsiness.
  • Dry mouth.
  • Headache.
  • Heartburn or indigestion.
  • Muscle tightness.
  • Nervousness.
  • Sleepiness.
  • Sweating.
  • Uncontrollable shaking of a part of the body.
  • Vomiting.

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.” [4]

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:

  • Agitation.
  • Blisters.
  • Changes in heartbeat.
  • Confusion.
  • Decreased sexual desire.
  • Difficulty swallowing or breathing.
  • Fast heartbeat.
  • Fever.
  • Hallucinations (seeing things or hearing voices that do not exist).
  • Hives.
  • Hoarseness.
  • Inability to get or keep an erection.
  • Irregular menstruation.
  • Loss of appetite.
  • Loss of consciousness.
  • Loss of coordination.
  • Nausea, vomiting, or diarrhea.
  • Seizures.
  • Rash.
  • Severe muscle stiffness or twitching.
  • Shivering.
  • Sweating.
  • 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. [5] [6]

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.
  • Seizure
  • Unconsciousness.

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. [7]

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 [8]

Getting Help

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. [9]

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: [1] FDA: Tramadol Hydrochloride
[2] FDA: FDA Restricts Use Of Prescription Codeine Pain And Cough Medicines And Tramadol Pain Medicines In Children; Recommends Against Use In Breastfeeding Women
[3] NCBI: Medical And Psychiatric Effects Of Long-Term Dependence On High Dose Of Tramadol.
[4] NCBI: Tramadol
[5] FDA: Tramadol Information
[6] MEDLINEPLUS: Tramadol
[7] HHS: Opioid Overdose Prevention
[8] BCHD: You Can Stop Overdose Death
[9] DRUGABUSE: Opioid Risk Tool
DEA: Tramadol
FDA: Ultram
SAMHSA: Reports Highlight Rise In Tramadol-Related Hospital Emergency Department Visits
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.
Medical Reviewers
Dr. Dili Gonzalez, M.D. is a general surgeon practicing women's focused medici...
Dr. Goecke is a medical doctor and general surgeon with personal experience of...

All of the information on this page has been reviewed and verified by a licensed medical professional.


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  1. I have not seen any changes in pain management in taking 150mg of tramadol. As a matter of fact the pain in my knees is far worse than it ever has been. How long must I wait to feel a decrease in knee pain?.
    Is it possible this drug is not for me?

    1. Hi ulana. It is possible that you are not responding well to this medication. That is why it is important to consult with your doctor and explain your situation.

  2. I was taking tramal 50mg since a long due to pain in leg muscles : I did not know it is hazardous : I am trying to get rid of it ; but how should I do

  3. I would like to know about any interactions tramadol might have with klonapin, ambien, sertraline, briviact, vimpat locosimide. These are some of the meds a family member has been prescribed. I need a definite answer so I can ask my drs to adjust these meds, for safety reasons. Seems these days the patient is responsible for keeping track of what these white coats are doing! And it’s a damn shame! it’s like going to medical school or a short class every time we go to the dr or have a hospital stay. And all the research that is done when your loved one is sick– is usually done by you, not a dr or a medical team- why?! Then what are we paying so much for?! Really?! Sure seems like we do a lot of the work, and if THEY agree then they sign paperwork, oh and read images. But, give me a minute and I could too!! So, yes please, some clarification would be nice. Thank you

  4. I have been taking this drug for over twenty years for spinal problems, but in the last four years have suffered epileptic episodes including tremors memory loss etc. I also had a heart attack and whilst having after treatment the doctor discovered I had been having heart arrhythmia for at least ten years. I have tried to find an alternative, and have reduced the amount I take, but now have a lot more pain. I live in Mexico, where not all medicines are available.
    Many thanks


    1. Hi Richard. Please use Tramadol only as prescribed by a doctor. It seem that alcohol is out from your system, since you haven’t drank in a week.

  5. Well, I have Suffered from Chrinic pain for Many years! I initially used Over the Counter Meds, as my Pain intensified I finally went to a local Pain Management Specialist!! The Medications Really did help at first, but as time progressed it became a Prison I was Shackeld to!! Now I have taken the steps to Wean myself off Opiates and have a New start in life! That sounds Great however my Wife of over 24 Years is Ditching me when I need her the Most! The Moral of the Story is keep your priorities in tact because my Life pretty much Sucks now and I am 46 and know nothing other than my Wife and Family life that is going down the Crapper of Life!!! I don’t even have Drugs to Ease the Pain! I am Feeling it at Full Force!!! Heed my Warning so you Do Not end up a 46 year old Heartbroken person that is Only Happy when I am Asleep and Cannot Feel!!! Dean

  6. New Zealand Medsafe “failed” to add the FDA Tramadol suicide risk.
    My life, and my whole family have had our lives destroyed by negligence, Tramadol is a dangerous drug.
    The New Zealand government has trued to conceal my story.
    Read more here:,
    Search key words: Paul Riddler, Human Rights Complaints New Zealand.

  7. My son, an Army Iraq veteran, died of an overdose of Tramadol. Coroner ruled suicide. VA disputes this and denies any fault. Medical records clearly indicate: do not prescribe narcotics, suicidal. My question: Isn’t this medication known for causing suicidal thoughts/ideation? They claim they were in their medical rights to prescribe it to a patient with a history of drug/alcohol use. I pointed out and clearly outlined their mistakes in the medical records. Other VA hospitals did not prescribe it for the reasons mentioned above. They claim they took him off suicide watch but records indicate otherwise. Any comments on this drug would be appreciated. No accountability. No one cares. 22 Vets commit suicide every day.

  8. Hi I’m 16 years old almost 17, I’m just after having knee surgery and will have another one in 6 weeks I dislocated my knee cracked 2 small pieces of bone off , reptured my acl , torn my LCL and have a minscal tear I’m in severe pain all the time so prescribed tramadol since mid December, injuru happened 9 the Dec. My question is I’m really young and feel like I’m relying on tramdol a lot im always counting down the hours until I can take more.. I’ve been sleeping a lot more and I feel like a ‘junkie’ when I try to not take them and take over the counter meds instead I start to sweat and get dissy, I’m really afraid that I’m addicted to them but they are the only pain relief that’s working for me. So if I went to my doctor and said it to him will I be on a less pain relief that won’t work? I’ve to take 6 33mg a day. I was first on 50mg once at night but niw its 33mg of tramadol and paracetamol in the one tablet – 2 3 times a day.
    Any advice?

  9. Hi Ashraf. Tramadol addiction can lead to lowered libido and loss of interest in intimacy. However, increased libido is reported only by a few people who take Tramadol. More female patients were experiencing increase in sexual drive, and they were 40-49 years of age. Still, this effect was only reported by 0,01% of people who were taking Tramadol.

  10. I have a Tramadol addicted woman. Could Tramadol change the manner of woman against her husband, i mean does it encourage her to search for another man to make love? Does Tramadol addiction help in that?

  11. Hello Samantha. Tramadol has been shown to cross the placental barrier, and it’s advised not to be used during pregnancy unless it’s absolutely inevitable. Animal studies have revealed evidence of embryotoxicity and fetotoxicity, but there are no controlled data in human pregnancy. I’d suggest talking to a doctor and a gynecologist to review all the options available. Congratulations on soon being a mom!

  12. Hey Ummm y question to you is what are the risks in carrying a baby n taking tramadol I take 300mg a day I’m 6 months pregnant .I’m trying to taper myself off of them as much as possible can u please help me out on this I really would love to quit cold Turkey but I know that the withdrawal will be hell for me as well as my baby. I really hope you can give me some insightful information on this
    Thank-you in advance

  13. Someone close to me was addicted to heroin and tamadol and crack cocaine she overdose by using tamadol and heroin and now is in a coma. I don’t recommend anyone doing this. God Bless.

  14. Since having rny gastric bypass surgery 1.5 years ago, i cannot EVER have any nsaids for pain. I can have tylenol and Tramadol _only_ . No injected nsaids either. Tramadol is a life saver for an occasional injury i get while mending a fence, kayaking, etc. Making it a narcotic? It would be a great disservice to a large and growing number of people.

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