Tramadol: for Pain (Ultram, Ultram ER, Conzip)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Get a Grip on Rheumatoid Arthritis

What is tramadol? How does it work (mechanism of action)?

Tramadol is a synthetic (man-made) pain reliever (analgesic). Researchers and doctors do not know the exact mechanism of action of tramadol, but it is similar to morphine. Like morphine, tramadol binds to receptors in the brain (narcotic or opioid receptors) that are important for transmitting the sensation of pain from throughout the body to the brain.

Like other narcotics used to treat pain, patients taking tramadol may abuse the drug and become addicted to it.

Tramadol is not a nonsteroidal anti-inflammatory drug (NSAID), therefore, it does not have the increased risk of stomach ulcers and internal bleeding that can occur with NSAIDs.

What are the uses for tramadol?

Doctors prescribe tramadol to manage moderate to moderately severe pain.

Extended release tablets are used for moderate to moderately severe chronic pain in adults who require continuous treatment for an extended period.

Tramadol should not be used to treat pain in children younger than 12 years of age, and it should not be used to treat pain after surgery to remove the tonsils and/or adenoids in children younger than 18 years of age. Children between 12 and 18 years of age who are overweight or have breathing problems such as obstructive sleep apnea or severe lung disease should not receive tramadol.

What are the side effects of tramadol?

Tramadol is generally well tolerated, and side effects are usually temporary.

Commonly reported side effects include

Less commonly reported side effects include

Some patients who received tramadol have reported seizures. It may cause serotonin syndrome when combined with other drugs that also increase serotonin (see drug interactions section).

Is tramadol a narcotic? Is it addictive?

Tramadol is a narcotic and is addictive. Tramadol is a Schedule IV controlled substance that has been associated with addiction, abuse, and misuse. Tramadol may be addictive, even at the dosage your doctor has prescribed. Abuse or misuse of tramadol can lead to overdose and death.

Like other opioids, people who take tramadol for a long time will develop withdrawal symptoms if your doctor reduces the dosage, or if you suddenly stop taking tramadol.

Withdrawal symptoms that may occur include:

Infants born to mothers who were taking tramadol during the pregnancy will develop symptoms of withdrawal and difficulty breathing.

What is the dosage for tramadol? How should I take it?

  • The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain.
  • The maximum dose is 400 mg/day.
  • To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 25-50 mg every 3 days to reach 50-100 mg/day every 4 to 6 hours.
  • The recommended dose for extended release tablets is 100 mg daily, which may be increased by 100 mg every 5 days, but not to exceed 300 mg /day. To convert from immediate release to extended release, the total daily dose should be rounded down to the nearest 100 mg. Extended release tablets should be swallowed whole and not crushed or chewed.
  • Tramadol may be taken with or without food.

Quick GuideRheumatoid Arthritis (RA) Symptoms & Treatment

Rheumatoid Arthritis (RA) Symptoms & Treatment

How does tramadol compare with other pain management drugs?

To review how tramadol compares to other pain medications, please refer to this information.

Which drugs or supplements interact with tramadol?

  • Carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol) reduces the effect of tramadol by increasing its inactivation in the body.
  • Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50% to 60%.
  • Combining tramadol with monoamine oxidase inhibitors or MAOIs (for example, tranylcypromine [Parnate]) or selective serotonin inhibitors (SSRIs), for example, fluoxetine (Prozac), may result in severe side effects such as seizures or a condition called serotonin syndrome.
  • Tramadol may increase central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers, or sedative hypnotics. This can reduce the level of consciousness or lead to respiratory insufficiency.

Is tramadol safe to take tramadol if I am pregnant or breastfeeding?

Researchers have not established the safety of tramadol during pregnancy, The safety of tramadol during pregnancy has not been established.

Mothers who are breastfeeding should not take tramadol because the infant may develop side effects, and will develop symptoms of withdrawal and difficulty breathing.

What else should I know about tramadol?

Tramadol is available as:
  • Tablets (immediate release): 50 mg.
  • Tablets (extended release): 100, 200, and 300 mg.
  • Capsule (extended release): 100, 200, 300 mg.

Tramadol should be store at room temperature, 15 C to 30 C (59 F to 86 F). It should be stored in a sealed container.

Ultram, Ultram ER, and Conzip are the current brand names available for tramadol in the US. Discontinued brands include Rebix OTD, and Ryzolt.

Tramadol is available in generic form, and you need a prescription for it from your doctor or other health care professional.

The FDA approved tramadol in March 1995.

Reference: FDA Prescribing Information

Summary

Tramadol hydrochloride (Ultram) is a centrally acting opioid painkiller (analgesic) indicated for the management of moderate to moderately severe pain in adults. Pain relief (analgesia) begins approximately within one hour after administration and reaches a peak in approximately two to three hours. Apart from analgesia, tramadol administration may produce a constellation of symptoms (including dizziness, somnolence, nausea, constipation, sweating and pruritus) similar to that of other opioids. In contrast to morphine, tramadol has not been shown to cause histamine release. At therapeutic doses, tramadol has no effect on heart rate, left-ventricular function or cardiac index. Orthostatic hypotension has been observed.

Side effects of tramadol include:

The dosage of tramadol should be started at 25 mg/day in the morning, and adjusted in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg four times daily). Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 20days to reach 200 mg/day (50 mg four times daily). After adjustment, tramadol 50 to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg/day. Tramadol is supplied in 50 mg tablets.

Withdrawal symptoms may occur if tramadol is discontinued abruptly. Reported withdrawal symptoms have included:

There are reports of acute overdosage with tramadol. Signs and symptoms can manifest by respiratory depression, sleepiness progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, seizures, slow heart rate, low blood pressure (hypotension), cardiac arrest, and death. Deaths due to overdose have been reported with abuse and misuse of tramadol.

Tramadol may interact with quinidine, fluoxetine, paroxetine, amitriptyline, ketoconazole, erythromycin, SSRIs, MAOIs, triptans, linezolid, lithium, St. John's wort, carbamazepine, rifampin, and digoxin. There are no adequate and well-controlled studies of tramadol in pregnant women. Tramadol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Neonatal seizures, neonatal withdrawal syndrome, fetal death and stillbirth have been reported during post-marketing. Tramadol is not recommended for obstetrical preoperative medication or for post-delivery analgesia in nursing mothers because its safety in infants and newborns has not been studied.

Other drugs in the same class as tramadol include codeine hydrocodone (Zohydro ER), oxycodone (OxyContin, Roxicodone), methadone hydromorphone (Dilaudid, Exalgo), morphine (Avinza, Kadian, MSIR, MS Contin), fentanyl (Actiq, Duragesic). If you have questions about this drug talk to your doctor, pharmacist, or other medical professional.

REFERENCE: FDA Prescribing Information for tramadol.

Treatment & Diagnosis

Medications & Supplements

Prevention & Wellness

Quick GuideRheumatoid Arthritis (RA) Symptoms & Treatment

Rheumatoid Arthritis (RA) Symptoms & Treatment

Subscribe to MedicineNet's Arthritis Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

FDA Logo

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

See more info: tramadol on RxList
Reviewed on 8/17/2017
References
Reference: FDA Prescribing Information

Health Solutions From Our Sponsors