Risks associated with tramadol
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The bottom line
Tramadol is a synthetic opioid prescribed for pain. Common side effects are nausea, vomiting, constipation, dry mouth, sweating, headache, tiredness, drowsiness, and dizziness. It can also cause seizures and serotonin syndrome. It is addictive and leads to physical dependence. Serious toxicity can occur because of interactions with drugs and supplements.
Prevention tips
Store tramadol up, away, and out of reach of children.
Take tramadol exactly as prescribed.
Do not split, crush, or chew extended-release tablets and capsules.
Take tramadol with food to minimize gastrointestinal discomfort.
Avoid driving or operating machinery until you know how a particular dose of tramadol affects you.
Check with your doctor or pharmacist before mixing tramadol with other medications and supplements.
Have naloxone available in case of an overdose.
This really happened
A 22-year-old man experienced anxiety and agitation and was transported to the emergency department by ambulance. He had a history of depression and tramadol dependence. His mother was managing his medications, and he was taking 400 mg of tramadol twice a day. He was anxious and sweating and had dilated pupils. He also had elevated blood pressure and pulse, hyperreflexia (overactive reflexes), and ankle clonus (involuntary up-and-down bouncing of the foot). Tramadol was stopped and replaced with methadone. His symptoms resolved within 48 hours. His symptoms met the criteria for a diagnosis of serotonin syndrome due to chronic high-dose tramadol alone.
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How does tramadol work?
Tramadol is synthetic opioid prescribed for pain. It acts on mu-opioid receptors which mediate pain relief. It also blocks serotonin re-uptake, causing a buildup of serotonin in the synapse. Serotonin is a neurotransmitter that regulates mood.
Side effects of tramadol
The most common side effects are nausea, vomiting, constipation, dry mouth, sweating, headache, tiredness, drowsiness, and dizziness. More serious side effects include sleep apnea (pauses in breathing during sleep) and severe allergic reactions including skin rashes, hives, and throat or facial swelling.
What should I do if someone accidentally takes tramadol or takes too much tramadol?
If someone swallows tramadol, or you have a question about using tramadol safely, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day. Call 911 if life-threatening symptoms have already developed.
Can tramadol cause seizures or serotonin syndrome?
Yes, tramadol can cause seizures or serotonin syndrome. Seizures have been reported with therapeutic doses as well as with overdoses. Serotonin syndrome usually is the result of taking tramadol along with another drug or herbal substance that is serotonergic. Symptoms of serotonin syndrome include agitation, confusion, disorientation, tremors, exaggerated reflexes, muscle rigidity or spasms, fever, sweating, increased heart rate and blood pressure, dilated pupils, diarrhea, and vomiting.
Is tramadol addictive?
Yes, tramadol is addictive. It has the potential to be abused and cause physical dependence. It is a Schedule IV controlled substance in the US. Withdrawal symptoms include anxiety, goose bumps, abdominal cramps, diarrhea, insomnia, and a heightened sense of pain.
Symptoms of a tramadol overdose
Tramadol overdose results in lethargy, coma, respiratory depression, seizures, decreased blood pressure and pulse, small pupils, decreased bowel sounds, and flaccid muscles, meaning muscles that are limp and weak.
What medicines or substances interact with tramadol?
Medications or substances that are central nervous system (CNS) depressants interact with tramadol to cause sedation and respiratory depression. This includes alcohol, sedatives, sleeping pills, benzodiazepines such as diazepam (Valium), muscle relaxants, and other opioids. Drugs that lower the seizure threshold, such as some antidepressants and antipsychotics, can increase seizure risk. Drugs with serotonergic properties including antidepressants such as monoamine oxidase (MAO) inhibitors and selective serotonin reuptake inhibitors (SSRIs), and migraine drugs such as triptans, can increase the risk of serotonin syndrome.
The herbal supplement St. John’s wort is also serotonergic, so it can interact to cause serotonin syndrome. Ketoconazole (an antifungal) and erythromycin (an antibiotic) can interfere with the way the liver breaks down tramadol, which raises tramadol levels in the body.