Tramadol: Dosage & Side Effects

Tramadol is a prescription medication used to treat moderate to moderately severe pain. It is sold under the brand name Ultram in the United States, and as Ralivia, Dromodol and other names elsewhere. It is intended to work by changing the way the central nervous system responds to pain.

Tramadol is effective on two fronts: About 20 percent of its painkilling effects come from opioids, and 80 percent from ingredients that inhibit the reuptake of serotonin and norepinephrine, two chemicals in the brain associated with mood and responsiveness to pain, said Dr. Lewis Nelson, a professor of emergency medicine at New York University’s Langone Medical Center.

Because tramadol has less opioid content than other addictive painkillers such as oxycodone, hydrocodone and morphine, “a lot of doctors inappropriately view this as safer,” Nelson told Live Science. But tramadol carries risks: People can still abuse and overdose on tramadol because of its opioid component. Its interaction with serotonin can also affect people taking other serotoninlike drugs, such as antidepressants, he said.

However, tramadol’s opioid and serotonergic effects are important because they allow tramadol to treat both pain and the psychological components of pain, he said.

Researchers first synthesized tramadol in the 1970s, and the Food and Drug Administration approved it for treatment of acute and chronic pain in 1995. The Drug Enforcement Administration identified it as a Schedule IV drug in 2014 to show that tramadol has potential for abuse.

Tramadol is available in several forms: tablet, orally disintegrating tablet, extended-release capsule and extended-release tablet, orally disintegrating tablet and suspension. The extended-release tablets and capsules are prescribed for patients who need round-the-clock pain relief.

Safe dosage of tramadol varies based on the patient and his or her needs. For chronic pain, doctors often prescribe a low dose at first, usually after surgery. Doctors also prescribe tramadol to treat arthritis, fibromyalgiaand other chronic pain conditions. According to the National Institutes of Health (NIH), the regular tablet and disintegrating tablet are usually taken with or without food every four to six hours as needed. The extended-release tablet and extended-release capsule should be taken once a day.

Patients should not take a larger dose or take it more often or for a longer period of time than prescribed. The NIH advises that if you miss a dose, take it as soon as you remember, unless it is very close to the time for the next dose. Then, skip the missed dose and continue the regular schedule. The dosage may be increased by the doctor, but should not be increased by the patient.

It is also important not to suddenly stop taking tramadol, according to the NIH. Doing so may cause withdrawal symptoms, such as nervousness, panic, sweating, difficulty falling asleep, runny nose, chills, nausea, diarrhea and hallucinations. Your doctor will likely decrease your dose gradually.

Children younger than 12 should not take tramadol, according to 2017 rules from the Food and Drug Administration (FDA). “Our decision today was made based on the latest evidence and with this goal in mind: keeping our kids safe,” Dr. Douglas Throckmorton, deputy center director for regulatory programs at the FDA’s Center for Drug Evaluation and Research, said in a statement.

As noted, tramadol can interact with drugs that affect serotonin levels, such as antidepressants, sometimes leading to serotonin syndrome, described as uncontrollable shaking, altered mental status, rigidity and high body temperature, Nelson said.

Seizures have been reported both in animals and humans taking tramadol. Seizures can happen even at recommended doses, but are more common if a person misuses or overdoses on the drug, or if tramadol interacts with another drug, especially antidepressants, according to a 2009 study published in the journal Psychiatry.