COMMON BRANDS: Ultram, Ultram ER, Conzip, Fusepaq Synapryn, Rybix ODT, Ryzolt

Tramadol is a prescription drug, oral tablet available as an immediate release and extended release. It is a synthetic pain reliever (analgesic). The actual mechanism of action of the drug is unknown, but it works similar to morphine. Like morphine, tramadol also binds to receptors in the brain (opioid receptors/narcotic) that play an essential role in transmitting the sensation of pain from the body to the brain.

What is Tramadol used for?

See also Warning section.

Tramadol works by relieving moderate to severe pain. This drug work like opioid (narcotic) analgesics. It works in the brain by altering how your body responds to pain.

How to use Tramadol?

Before taking tramadol read the Medication Guide carefully given by your pharmacist and whenever you get a refill. If you have any issues, seek advice from your doctor/physician/ pharmacist.

Take this drug orally as instructed by your doctor/physician, usually every 4 to 6 hours as required for pain relief. You may take this drug either with or without food. If you are suffering from nausea, take this drug with food. Seek advice from your doctor/physician/pharmacist regarding alternate ways to reduce nausea (like lying down for 1 to 2 hours with no or little head movement).

The dose of the drug is based on your medical condition and response to treatment. To decrease the side effects of this drug, your doctor may instruct you to begin with a minimal dose and gradually increase your dose. Follow your doctor’s directions correctly. The maximum recommended dose is 400mg per day. If you are above 75 years, the highest prescribed dose is 300mg per day. Do not increase your dose or avoid taking the medication frequently, and do not take for a longer time than prescribed. Properly stop the medication when so directed. These medications work best if they are used when the first sign of pain occur. This medication may not work well when the pain has worsened.

If you have continuing pain (for example due to arthritis), your doctor/physician may instruct you to take long-acting opioid medicines. In that case, this drug can be used for sudden (breakthrough) pain only as required. Other pain relievers (like acetaminophen, ibuprofen) may be prescribed. Seek advice from your doctor/physician/pharmacist about taking tramadol safely with other drugs.

You may observe withdrawal reactions with this drug if it is regularly used for a long time or at high doses. In such cases, withdrawal symptoms (like restlessness, runny nose, watering eyes, sweating, nausea, muscle aches) may occur if you immediately stop using this drug. To avoid withdrawal effects, your doctor/physician may decrease your dose slowly. Discuss with your doctor/physician/pharmacist for more details, and inform any withdrawal reactions immediately. When this drug is used for a longer duration, it may not work well. Inform your doctor/physician if this medication does not work well.

Although this drug is used for the pain, it sometimes causes addiction. This risk may be higher in case of overuse of or addiction to drugs/alcohol. Take this medicine strictly as prescribed by your doctor/physician to lower the risk of addiction. Seek advice from your doctor/physician/ pharmacist for further details.

Inform your doctor if your pain persists or worsens.

What are the side effects of Tramadol?

See also Warning section.

Nausea, vomiting, constipation, lightheadedness, drowsiness, dizziness, headache may occur. Some of these side effects may lessen after you have been using this medication for a while. If any side effects persist or worsen, which are listed above, inform your doctor/physician/ pharmacist promptly.

To avoid constipation, take adequate fiber in your diet drink plenty of water, and do exercise. Request your pharmacist for help in selecting a laxative (like a stimulant type with stool softener).

To reduce the danger of dizziness and lightheadedness, get up slowly when rising from a sitting position or lying position.

Remember that your doctor/physician has prescribed this medication because the doctor/physician has found the benefits to you are higher than the side effects. Most of the people using this medication do not have serious side effects.

Notify your doctor/physician immediately if you experience any severe side effects, severe stomach/abdominal pain, difficulty urinating, including mental/mood changes (like agitation, hallucinations), signs of your adrenal glands not working well (for example loss of appetite, weight loss, unusual tiredness).

Seek medical assistance promptly if you mark any severe side effects like severe dizziness, fast/irregular heartbeat, fainting, seizure.

This medication may increase serotonin level in brain and rarely cause a severe condition known as serotonin syndrome/toxicity. The risk higher if you are also taking with other drugs that increase the level of serotonin, so inform your doctor/physician/pharmacist of any medicines you may be using (see Drug Interactions section as well). Get medical immediately if you have some of the following symptoms such as fast heartbeat, loss of coordination, hallucinations, severe nausea/vomiting/ diarrhea, severe dizziness, twitching muscles, unusual agitation/restlessness, unexplained fever.

Tramadol converts into a strong opioid drug in the body. In some cases, this change happens faster and more completely than usual, which increases the risk of severe side effects. Get medical assistance immediately if you mark any of the following side effects such as severe drowsiness/difficulty waking up, confusion, breathlessness.

Severe allergic reaction to this drug is very uncommon. However, get medical assistance immediately if you notice any of the following symptoms such as rash, severe dizziness, trouble breathing, itching/swelling (especially of the face/tongue/throat).

This is not a full record of all possible side effects. If you notice any other effects not listed above, contact your doctor/physician/pharmacist.

What are the precautions while using Tramadol?

Before taking tramadol, inform your doctor/physician/pharmacist if you are allergic to it or if you have any other allergies. This product may contain inactive ingredients, that may cause allergic reactions or other issues. Talk to your pharmacist for more details.

Before taking this medication, inform your doctor/physician/ pharmacist about your medical history, especially of brain disorders (like tumor, seizures, head injury), breathing problems (like sleep apnea, asthma, chronic obstructive pulmonary disease-COPD), mental/mood disorders (like confusion, depression, suicidal thoughts), kidney disease, liver disease, personal or family history of overuse or addiction to drugs/alcohol, stomach/intestinal problems (like blockage, constipation, diarrhea due to infection, paralytic ileus), difficulty in urinating (due to enlarged prostate), disease of the pancreas (pancreatitis), gallbladder disease, obesity.

This medicine may cause dizziness or drowsiness or blur your vision. Alcohol or marijuana can cause more dizziness or drowsiness. Avoid driving, or use of machinery, or do anything that requires alertness or clear vision till you can do it safely. Avoid alcoholic beverages. Inform your doctor if you are taking marijuana.

Tramadol may induce a condition that affects the heart rhythm (QT prolongation). QT prolongation can infrequently cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (like severe dizziness, fainting) that need medical attention immediately.

The chances of QT prolongation may increases if you have certain medical issues or you are on other drugs that may cause QT prolongation. Before taking tramadol, inform your doctor/physician/pharmacist about all the medications you are using and if you have the following issues such as certain heart problems (slow heartbeat, heart failure, QT prolongation in the EKG), family history of some heart problems (QT prolongation in the EKG, sudden cardiac death).

Low potassium or magnesium in the blood may enhance your risk of QT prolongation. This risk may rise if you use certain drugs like diuretics/”water pills” or if you have certain medical issues like severe sweating, diarrhoea, or vomiting. Inform your doctor/physician about taking tramadol safely.

Before surgery, inform your doctor/dentist about all the products you are using (including prescription drugs, nonprescription drugs, and herbal products).

Some children may be more sensitive to severe side effects of this drug, for example, confusion, extreme sleepiness or slow/shallow/noisy breathing. (See also Warning section.)

Older adults are more prone to the side effects of this drug, mainly dizziness, drowsiness, confusion, dry mouth, constipation, difficulty urinating, and QT prolongation (see above). Dizziness, drowsiness, and confusion can enhance the risk of falling.

Avoid this medication during pregnancy, used only when needed. Seek advice regarding the risks and benefits of the drug from your doctor/physician.

Tramadol passes into breast milk, and might have undesirable effects on a nursing infant, like unusual sleepiness, difficulty feeding, or trouble breathing. Breastfeeding using this medicine is not recommended. Seek advice from your doctor/physician before breastfeeding.

What are the drug interactions of Tramadol?

Drug interactions may alter how your drug works or may enhance your risk for serious side effects. This list does not consist of all possible drug interactions. Keep a record of all the products you are using including prescription/nonprescription drugs and herbal products and inform your doctor/ pharmacist. Don’t start, stop, or alter the dosage of any medicines without your doctor’s consent.

This drug may interact with specific pain medication like (mixed opioid agonist-antagonists) pentazocine, nalbuphine, butorphanol, and naltrexone.

Using MAO inhibitors with this drug may induce a severe (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, phenelzine, procarbazine, methylene blue, moclobemide, rasagiline, safinamide, selegiline, tranylcypromine) during therapy with this medicine. Avoid most MAO inhibitors for two weeks before and after treatment with this drug. Seek advice from your doctor/physician when to start or stop taking this medication.

The risk of serotonin toxicity/syndrome increases if you are using other drugs that increase serotonin level. Like street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressant SNRIs(duloxetine/fluoxetine), including other SSRIs such as citalopram/paroxetine, tryptophan, among others. The risk of serotonin toxicity/syndrome may be more likely when you start or change the dose of these drugs.

Other drugs may affect the removal of tramadol from the body, that might affect how tramadol works. For examples quinidine, azole antifungals (like itraconazole), HIV drugs (like ritonavir), macrolide antibiotics (like erythromycin), rifamycins (like rifampin), drugs used to treat seizures (like carbamazepine), among others.

The risk of severe side effects (like severe drowsiness/dizziness, slow/shallow breathing) may increase if this drug is taken with other products which also cause breathing problems or drowsiness. Inform your doctor/physician/pharmacist if you are using other products for example other opioid pain or cough relievers (like codeine, hydrocodone), alcohol, marijuana, drugs for sleep or anxiety (like alprazolam, lorazepam, zolpidem), muscle relaxants (like carisoprodol, cyclobenzaprine), or antihistamines (like cetirizine, diphenhydramine).

Read the labels carefully of all your medicines (allergy or cough-and-cold products) as they may contain ingredients that may cause drowsiness. Get information from your pharmacist about taking those products safely.

This medication may intervene with certain laboratory tests (amylase/lipase levels), maybe causing false test results. Ensure that laboratory personnel, and all your doctors/physicians know you use this drug.


Tramadol has the potential to cause abuse and addiction, which may cause severe, possibly fatal, breathing problems. To reduce risk, your doctor/physician prescribe you low dose for the shorter period. The chances of severe breathing problems are higher when you start this drug at a high dose or if you take the dose/strength wrongly. Avoid taking this medication along with alcohol or with other medicines which can cause drowsiness or breathing problems. This may cause very severe side effects or even death. Other drugs can alter the removal of tramadol from your body as well, which may affect the mechanism of action tramadol. Keep a note of what other medications you should avoid while taking tramadol. Also, see Drug Interactions section. Get medical assistance immediately if you mark any of these side effects, such as slow/shallow breathing, unusual lightheadedness, difficulty waking up, severe drowsiness/dizziness.

Keep this medicine in safely to prevent misuse or abuse. If someone unintentionally swallows this drug, get medical help immediately.

Before using this medication, inform your doctor/physician if you are pregnant or if you plan to become pregnant. This drug may sometimes affect the fetus if used in the first two months of pregnancy. Also, using it for a prolonged time or in high doses near the delivery date may harm the unborn baby. To reduce the risk, take the smallest quantity of dose strength for the shortest time. Babies born to mothers using this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Notify your doctor/physician immediately if you mark any signs in your newborn baby (for example non stop crying, slow/shallow breathing, irritability, diarrhea, vomiting, poor feeding or difficulty in weight gaining.

Children under 12 years must avoid using products that contain tramadol. Children between 12 and 18 years old must avoid tramadol after surgeries (for example tonsil/adenoid removal). Talk to your doctor/physician/pharmacist about the risks and benefits of this medication.

What are the forms and strengths of Tramadol?

Generic: Tramadol
Form: Immediate-release oral tablet
Strength: 50mg
Form: Extended-release oral tablet
Strengths: 100mg, 200mg, 300mg

Brand: Ultram
Form: Immediate-release oral tablet
Strength: 50mg

What is the dosage of Tramadol?

For Moderate to Severe Pain:

Adult (18–64 years):

Immediate-release tablet:

Generally daily dosage: Total daily dosage may be increased by 50mg as tolerated every 3 days to reach 200mg/day (50mg 4 times a day).
Maintenance dosage: 50–100mg every 4–6 hours as needed.
Maximum dosage: 400mg per day.

Extended-release tablet:

Starting dosage: Generally, the dosage starts from 100mg once per day. Your doctor may increase your dose by adding an extra 100mg every 5 days.
Maximum dosage: 300mg per day.

Immediate-release tablet:


Children (below 17 years):

Typical dosage: Total daily dosage may be increased by 50mg as tolerated every 3 days to reach 200mg/day (50mg 4 times a day).
Maintenance dosage: 50–100mg every 4–6 hours as needed.
Maximum dosage: 400mg per day.

Note: There is no information if this form is safe for children. It is better to avoid the use of this drug in children below 17 years.

Extended-release tablet:


Children (0–17 years):

There is no information if this form of tramadol is safe and effective for children. It must be avoided in children below 17 years.


Older adults (65 years and above):

The liver and kidneys of older adults might not work efficiently. This can cause your body to metabolize drugs more slowly. As a result, more amount of drug stays in your body for a longer time. This increases the risk of side effects. Your doctor may initiate at a lower dose or different dosing schedule. This help to maintain the levels of drug and avoid from building up too much in your body. If you are above 75 years, your maximum dosage of the immediate-release tablet is 300mg per day.

Special Considerations:

Kidney disease:

Immediate-release tablet:

If you have serious kidney problems, your doctor may prescribe you 50–100mg every 12 hours.

Maximum dosage: 200mg per day.

Extended-release tablet:

If you have serious kidney problems, avoid using this form of tramadol.

Liver disease:

Immediate-release tablet: If you have serious liver problems, your doctor may prescribe you 50mg every 12 hours.

Extended-release tablet: If you have serious liver problems, you should not use the extended-release tablet.

Most common questions asked about Tramadol / Q&A’s:

Is Tramadol OK for you?

Tramadol elicits its narcotic properties via brain’s opioid receptors. Similar to other drugs in this class. Some people may be at risk of addiction if used for an extended period, large doses, non-medical purposes, or with other substances, such as alcohol, sedatives or other painkillers. So, you must stick to what your doctor has advised.

What are the signs of Tramadol addiction?

Tramadol addiction is characterized by compulsive drug seeking behavior, inability to limit its use, difficulty in functioning without it. The most dangerous symptom of tramadol abuse is serotonin syndrome which is characterized by confusion, agitation, jerky muscles, rigid muscles, tremors, lack of coordination, seizures and coma.

Is Tramadol a narcotic?

Tramadol is centrally-acting, oral synthetic, a narcotic-like analgesic used for the treatment of moderate to severe pain in adults. Tramadol is classified under a class of drugs known as opiate (narcotic). It works by changing the way the brain and nervous system respond to pain.

Is Tramadol the same as Vicodin?

Tramadol (Ultram) and Vicodin (hydrocodone and acetaminophen) are both prescription opiates and narcotics for pain. The significant difference is tramadol is a synthetic drug, and a weak pain reliever. Whereas, Vicodin contains hydrocodone which is a natural obtained from the poppy plant and acetaminophen which is a synthetic drug. Vicodin is a reliable and more potent pain reliever compared to Tramadol.

What does Tramadol do?

Tramadol is used in the treatment of moderate to severe pain. It works by altering or changing the way the brain, and the nervous system responds to pain. Tramadol is a serotonin-norepinephrine reuptake inhibitor (SNRI) and acts by binding to the opioid receptors in both pre-synaptic and post-synaptic neurons.

How does Tramadol work to relieve pain?

Tramadol binds to receptors in your brain, thereby changing your perception of pain. However, tramadol also allows the chemical messengers like nor-epinephrine and serotonin to remain available to your brain for a more extended period by blocking pain signals in your spinal cord.

Is Tramadol a controlled substance?

Yes, tramadol is now a controlled substance in more than 50 states in America by the U.S. Drug Enforcement Administration (DEA) and under schedule IV of the Controlled Substances Act (CSA).

How many times can I get a refill of Tramadol?

In the U.S, tramadol containing prescription may only be refilled up to five times within a six month period from the date on your prescription. After five refills or after six months, whichever occurs first, a new prescription is needed. This rule applies to all controlled substances under the schedule III and IV.

What type of drug is Tramadol classified as?

Tramadol is classified under the class of drugs called opiate or narcotic analgesics. It is a synthetic drug (produced in the lab) that works by altering the way the central nervous system respond to pain.

How long does it take for a Tramadol to kick in?

Fast-acting tramadol takes 30 to 60 minutes for the pain to subside. The pain relief effect subsides after 4 to 6 hours. Slow acting tramadol can take up to a day or two to start working, but the pain relief will last for a longer duration.

Can I drive while taking Tramadol?

No, you must avoid driving or use of any machinery which requires attention or alertness while using tramadol as this drug causes drowsiness or make you sleepy.

What is the strongest painkiller known to man?

In general, opioid analgesics are the strongest and the most potent pain relievers available. In particular, the most potent drug in this class is morphine, when compared to other opioid drugs.


TheMedPharma has made every effort to make sure that all the information is factually correct, comprehensive, and up-to-date. However, this website should not be considered as a substitute for the advice, knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or licensed health care professional before taking any medication. The drug information contained herein is subjected to changes if required. The lack of warnings or other information for a given drug does not mean that the drug or its combination is safe, effective or appropriate for use in all patients.