- Rheumatoid Arthritis Slideshow Pictures
- Take the RA Quiz
- Joint-Friendly Exercises to Reduce RA Pain Slideshow
- What is tramadol? How does it work (mechanism of action)?
- What are the uses for tramadol?
- What are the side effects of tramadol?
- Is tramadol a narcotic? Is it addictive?
- What is the dosage for tramadol? How should I take it?
- How does tramadol compare with other pain management drugs?
- Which drugs or supplements interact with tramadol?
- Is tramadol safe to take tramadol if I am pregnant or breastfeeding?
- What else should I know about tramadol?
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.
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
- drowsiness, and
Less commonly reported side effects include
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:
- Excessive tear production
- Muscle pain
- Joint pain
- Abdominal cramps
- Weight loss
- Increased blood pressure
- Respiratory rate
- Heart rate
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
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
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:
- Dizziness/spinning sensation (vertigo)
- Central nervous system (CNS) stimulation
- Weakness/lack of energy
- Dry Mouth
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:
- Upper respiratory symptoms
- Goose bumps (piloerections)
- Rarely hallucinations
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.
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Medications & Supplements
- flurbiprofen (Ansaid is a discontinued brand)
- diflunisal, Dolobid
- indomethacin, Indocin, Indocin-SR (Discontinued Brand in U.S.)
- etodolac, Lodine (Discontinued)
- ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others)
- fenoprofen, Nalfon
- ketoprofen (Discontinued brands: Nexcede, Orudis, Oruvail, Actron)
- celecoxib, Celebrex
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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.
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Ankle Pain and TendinitisAnkle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Back Pain SlideshowBack pain conditions are very common. Learn the truth and get the facts behind myths, remedies, causes and treatment for back pain.
Back Pain QuizThere are numerous causes of chronic lower back pain and only one ailment gets more complaints. What is it? Quiz your knowledge of symptoms, treatments, problems, and reasons for common back pain.
Chronic PainChronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
CoccydyniaCoccydynia is an inflammation of the bony area (tailbone or coccyx) located between the buttocks. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Pain is often worsened by sitting. There are many causes of tailbone pain that can mimic coccydynia including: fracture, pilonidal cysts, infection, and sciatica. Treatment methods include medication and rest.
Elbow PainElbow pain is most often the result of tendinitis, which can affect the inner or outer elbow. Treatment includes ice, rest, and medication for inflammation. Inflammation, redness, warmth, swelling, tenderness, and decreased range of motion are other symptoms associated with elbow pain. Treatment for elbow pain depends upon the nature of the patient's underlying disease or condition.
Fibromyalgia FactsFibromyalgia is a chronic pain condition characterized by symptoms such as fatigue, sleep disturbances, and tender points. Stress reduction, exercise, and medication are the standard treatments for fibromyalgia.
Fibromyalgia QuizFibromyalgia could be the reason for your constant, deep bodily pain. Learn more about this painful condition with the Fibromyalgia Quiz.
Foot Pain SlideshowLearn about common causes of foot pain such as bunions, corns, athlete's foot, plantar warts and more. Get the latest information on treatments for foot pain.
Knee Pain FactsAcute injuries, medical conditions, and chronic use conditions are causes of knee pain. Symptoms and signs that accompany knee pain include redness, swelling, difficulty walking, and locking of the knee. To diagnose knee pain, a physician will perform a physical exam and also may order X-rays, arthrocentesis, blood tests, or a CT scan or MRI. Treatment of knee pain depends upon the cause of the pain.
Low Back PainThere are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Low Back Pain SlideshowDo you suffer from low back pain? Watch this slideshow to see common triggers of lower back pain and what kind of treatments you can get to help find relief.
Neck PainNeck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Nonsteroidal Anti-inflammatory Drugs and UlcersNonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Take the Pain QuizIs pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we call pain.
Reasons You're in PainExamine the varying causes of pain. Pain may be caused by simple, everyday objects, tasks and activities such as the way you sit, wear your hair, what you eat and many other surprising reasons you are in pain.
Restless Leg SyndromeRestless leg syndrome (RLS) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.