Know the basics
What is tramadol used for?
This medication is used to help relieve moderate to moderately severe pain. Tramadol is similar to narcotic analgesics. It works in the brain to change how your body feels and responds to pain.
How should I take tramadol?
Take this medication by mouth as directed by your doctor, usually every 4 to 6 hours as needed for pain relief. You may take this drug with or without food. If you have nausea, it may help to take this drug with food. Ask your doctor or pharmacist about other ways to decrease nausea (such as lying down for 1 to 2 hours with as little head movement as possible).
The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully. The maximum recommended dose is 400 milligrams per day. If you are older than 75 years, the maximum recommended dose is 300 milligrams per day. Do not increase your dose, take the medication more frequently, or take it for a longer time than prescribed. Properly stop the medication when so directed.
Pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.
If you have ongoing pain (such as due to arthritis), your doctor may direct you to also take long-acting narcotic medications. Other non-narcotic pain relievers (such as acetaminophen, ibuprofen) may also be prescribed with this medication. Ask your doctor or pharmacist if you have any questions about using tramadol safely with other drugs.
This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as restlessness, watering eyes, runny nose, nausea, sweating, muscle aches) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.
When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.
Along with its benefits, this medication may rarely cause abnormal drug-seeking behavior (addiction). This risk may be increased if you have abused alcohol or drugs in the past. Take this medication exactly as prescribed to lessen the risk of addiction.
Tell your doctor if your pain persists or worsens.
How do I store tramadol?
Tramadol is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store tramadol in the bathroom or the freezer. There may be different brands of tramadol that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.
You should not flush tramadol down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.
Know the precautions & warnings
What should I know before using tramadol?
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of Rybix™ ODT, Ryzolt™, and Ultram® tablets in children younger than 16 years of age. Safety and efficacy have not been established.
Appropriate studies have not been performed on the relationship of age to the effects of Ultram® ER extended-release tablets in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of tramadol in the elderly. However, elderly patients are more likely to have unwanted side effects (e.g., constipation; lightheadedness, dizziness, or fainting; stomach upset; weakness) and age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving tramadol.
Is it safe to take tramadol during pregnancy or breast-feeding?
There isn’t enough information about the safety of using this medication during pregnancy and breast-feeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication.
Know the side effects
What are the side effects of tramadol?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using tramadol and call your doctor at once if you have any of these serious side effects:
- agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting;
- seizure (convulsions);
- a red, blistering, peeling skin rash; or
- shallow breathing, weak pulse.
Less serious side effects may include:
- dizziness, spinning sensation;
- constipation, upset stomach;
- drowsiness; or
- feeling nervous or anxious.
Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.
Know the interactions
What drugs may interact with tramadol?
Tramadol may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Eslicarbazepine Acetate
- Methylene Blue
- Morphine Sulfate Liposome
- Peginterferon Alfa-2b
- St John’s Wort
- Valproic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Does food or alcohol interact with tramadol?
Tramadol may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.
What health conditions may interact with tramadol?
Tramadol may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:
- Alcohol abuse, history of or
- CNS depression or
- Depression, history of or
- Drug abuse, history of or
- Head injury or
- Hormonal problems or
- Increased pressure in the head or
- Infections of the central nervous system (CNS) or
- Mental illness, history of or
- Phenylketone allergy, history of or
- Respiratory depression (hypoventilation or slow breathing) or
- Seizures or epilepsy, history of or
- Stomach problems, severe—Use with caution. The chance of serious side effects may be increased.
- Breathing or lung problems (e.g., asthma, hypercapnia), severe—Should not be used in patients with this condition.
- Kidney disease or
- Liver disease (including cirrhosis)—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
- Phenylketonuria (PKU)—The orally disintegrating tablet contains phenylalanine, which can make this condition worse.
Understand the dosage
The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this medication.
What is the dose of tramadol for an adult?
For mild to moderate severe chronic pain not requiring rapid onset of analgesic effect:
Initial dose: 25 mg every morning
Titration: increase in 25 mg increments as separate doses every 3 days to reach 100 mg per day taken as 25 mg 4 times per day. Then the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg per day taken as 50 mg 4 times per day.
Maintenance: After titration, tramadol 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg per day.
For the management of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time:
Initial Dose: 100 mg once daily and titrated up as necessary by 100 mg increments every five days to relief of pain and depending upon tolerability.
Maximum Dose: Extended-release tablets should not be administered at a dose exceeding 300 mg per day.
For patients in whom rapid onset of analgesic effect is required and for whom the benefits outweigh the risk of discontinuation due to adverse events associated with higher initial dose:
Dose: 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours, not to exceed 400 mg per day.
Tramadol Extended-Release (ER):
Patients not currently treated with tramadol immediate-release (IR):
Initial dose: 100 mg once daily and titrated up as necessary by 100 mg increments every 5 days to relief of pain and individualized according to patient need and tolerability.
Maximum dose: 300 mg per day
Patients currently on tramadol IR (immediare release):
Calculate the 24-hour tramadol IR dose:
Initial dose: Round down to the next lowest 100 mg increment. The dose may subsequently be individualized according to patient need and tolerability.
Maximum dose: 300 mg per day
Due to limitations in flexibility of dose selection with tramadol ER, some patients maintained on immediate release products may not be able to convert.
What is the dose of tramadol for a child?
4 to 16 years:
Immediate release formulations: 1 to 2 mg/kg/dose every 4 to 6 hours
Maximum single dose: 100 mg
Maximum total daily dose is the lesser of: 8 mg/kg/day or 400 mg/day
16 years and older:
Initial dose: 50 to 100 mg every 4 to 6 hours
Maximum dose: 400 mg/day
Alternatively, for patients not requiring a rapid onset of effect, side effects may be decreased by initiating dosage at 25 mg/day and increasing by 25 mg every 3 days up to 25 mg 4 times a day. Dosage may then be increased by 50 mg every 3 days as tolerated to 50 mg 4 times a day.
16 years and older:
Oral disintegrating tablet (ODT):
Initial: 50 to 100 mg every 4 to 6 hours
Maximum: 400 mg/day
Alternatively, for patients not requiring a rapid onset of effect, side effects may be decreased by initiating dosage at 50 mg/day and increasing by 50 mg every 3 days up to 50 mg 4 times a day.
Maximum: 400 mg/day
16 years and older:
Initial: 100 mg once daily
Titrate by 100 mg increments every 2 to 3 days if needed for pain control
Maximum: 300 mg/day
How is tramadol available?
Tramadol is available in the following dosage forms and strengths: Capsule, soluble tablet, orodispersible tablet (dissolves in the mouth), modified-release tablets and capsules, and injection
What should I do in case of an emergency or overdose?
In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.
Symptoms of overdose may include:
- decreased size of the pupil (the black circle in the center of the eye)
- difficulty breathing
- extreme drowsiness
- coma (loss of consciousness for a period of time)
- slowed heartbeat
- muscle weakness
- cold, clammy skin
What should I do if I miss a dose?
If you miss a dose of tramadol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Tramadol. https://www.drugs.com/tramadol.html. Accessed July 15, 2016,
Tramadol. https://medlineplus.gov/druginfo/meds/a695011.html. Accessed July 15, 2016.
Tramadol. http://www.webmd.com/drugs/2/drug-4398-5239/tramadol-oral/tramadol-oral/details. Accessed July 15, 2016.
Review Date: January 4, 2017 | Last Modified: January 4, 2017