7 Questions About Tramadol Answered

November 25, 2020

Globally, opioid analgesics have been widely used as mainstay medicaments for the treatment of moderate to severe pain. Tramadol, in particular, is a popular choice of pain-relief medication because of its potency and quick action.

While tramadol is undoubtedly effective in pain management, it is also capable of producing addictive effects, especially when taken in excessively high doses. Unguided use of Tramadol can also result in negative consequences such as coma and death, which is why Tramadol should not be abused and must only be taken under medical supervision.

This article answers some questions you might have regarding this useful but potentially problematic drug.

What Is Tramadol?

First synthesized in 1962, tramadol is an opioid medication and a class IV FDA drug mainly used for relief of moderate to severe pain. It has two forms based on drug delivery: extended-release and immediate-release tramadol. Immediate-release tramadol is indicated for pain lasting less than a week. Extended-release tramadol, on the other hand, is the first agent of choice for pain that lasts more than a week in duration to control pain round-the-clock. Patients for which extended-release tramadol is prescribed should be counselled before drug administration. Both forms are available as drops or as capsules.

How Does Tramadol Work?

Like all other opioids, tramadol works by binding to the mu-, delta-, and kappa-receptors of the brain, which are receptors responsible for the perception of pain. Blocking of these receptors decreases pain-sensation among tramadol users. However, it is also because of this exact mechanism that tramadol is highly addictive as this can also produce feelings of euphoria, stimulation, and relaxation, which can induce substance abuse in the long run.

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In addition, tramadol also has the ability to inhibit reuptake of serotonin and norepinephrine. This mechanism of action is central to Tramadol’s potency as a painkiller, but it is also believed to cause some of its most adverse reactions.

What Is Tramadol Used For?

Tramadol is an FDA-approved pain-relief medication, used mostly for the management of moderate to severe pain. Tramadol is also indicated for off-label use such as in cases of premature ejaculation and restless leg syndrome. Both as-needed and daily use of tramadol have been proven effective for the treatment of premature ejaculation, but patients have reported preference for as-needed therapy because of less side effects compared to daily use

What Are the Side Effects of Tramadol?

Although tramadol is a relatively safe analgesic, it does not come without side effects. The main adverse reactions associated with the use of tramadol are dizziness, nausea and vomiting, constipation, headache, and somnolence. These side effects more often occur at the start of therapy rather than in prolonged use.

Tramadol also has the potential to cause fatal adverse reactions, especially when taken in supra-therapeutic doses. These include CNS depression, coma, respiratory depression, tachycardia, seizures, and cardiovascular collapse.

What Are the Contraindications to the Use of Tramadol?

Patients under twelve years old or those who have a history of hypersensitivity reaction to any opioid are not advised to use tramadol. Similarly, tramadol is contraindicated in patients under 18 years old who underwent tonsillectomy or adenoidectomy. Tramadol is also contraindicated in patients who have a history of bronchial asthma or respiratory depression, as tramadol can cause respiratory arrest in susceptible patients. This is also why tramadol should not be taken together with benzodiazepines, alcohol, or other CNS depressants that can potentially exacerbate respiratory depression and result in coma or death. Tramadol should not also be taken concurrently with MOAs or tricyclic antidepressants. Lastly, patients who are suffering from gastrointestinal obstruction are contraindicated for tramadol.

Is Tramadol Addictive?

Like many other opioid analgesics, continuous exposure to tramadol has the potential to cause addiction. Previous studies have shown that tramadol can produce euphoric and relaxing effects that may lead to physical dependence. It was also found out that patients with chronic pain or those who have a history of addiction are the ones most prone to developing addiction to tramadol. Withdrawal syndrome has also been observed both in abusers and patients who take therapeutic doses for pain control. Because of this, patients who are taking tramadol and are exhibiting signs of abuse or withdrawal must be closely monitored.

What Are the Signs and Symptoms of Tramadol Abuse?

Tramadol dependence and abuse manifest similarly with abuse of other opioid medications. Signs of Tramadol abuse can present as changes in sleeping habits, weight loss, flu-like symptoms, and an uncontrollable urge to take the drug. Unusual behavioral changes can also be observed in some patients, including lack of hygiene and even engaging in criminal activities such as stealing.


Tramadol is an FDA-approved drug indicated for the relief of moderate to severe pain. It comes in drops and capsules and can be delivered as either an extended-release or immediate-release drug. Like all other drugs, tramadol can cause adverse reactions, including headache, nausea, and even potentially fatal conditions such as seizures and respiratory arrest. Abuse of tramadol that leads to physical dependence has also been reported among many chronic users, so close medical supervision must be implemented in order to prevent long-term consequences.

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