Tramadol

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Aug 04, 2022

Warnings

Tramadol Risks, Warnings, and Complications

Tramadol can cause severe health problems, especially in certain high-risk patients. Some of the risks of tramadol use include:

RESPIRATORY DEPRESSION: Taking high doses of tramadol can cause respiratory depression (irregular or slowed breathing) and can lead to coma and death. Always take tramadol at the prescribed dose and frequency. Seek immediate medical attention if you notice your lips or fingers turning blue due to low oxygen while on tramadol. There is an increased risk of breathing problems on tramadol in older adults (age 65 and over) and people who use alcohol, street drugs, or other medications like benzodiazepines (Valium, Xanax) that can also cause slow breathing.
RISK OF WITHDRAWAL, OPIOID ADDICTION, AND OVERDOSE: Stopping tramadol suddenly, especially after taking it for a long time, can lead to potentially life-threatening withdrawal symptoms. Always talk to your healthcare provider before stopping tramadol. Your doctor may advise you to reduce the dose gradually.
Tramadol can be habit-forming, especially with long-term use. You can develop a psychological and physical dependence on this medicine. Take tramadol exactly as prescribed. Tell your doctor if you have a history of excessive alcohol use, street drug abuse, or mental illness, as this can put you at higher risk of tramadol abuse and addiction. Do not take more tramadol or take it more frequently than prescribed by your healthcare provider. Avoid using alcohol, illegal substances, and other sedating medicines while on tramadol.
SEROTONIN SYNDROME AND SEIZURE RISK: A potentially life-threatening condition called serotonin syndrome can occur with the use of tramadol. Risk factors include concomitant use of certain antidepressants and triptans (migraine medications). Symptoms of serotonin syndrome may include nausea, vomiting, diarrhea, confusion, agitation, hallucinations, fast heartbeat, fluctuations in blood pressure, high body temperature, incoordination, and coma. Concomitant use of tramadol and certain antidepressants can also increase seizure risk.
DRUG INTERACTIONS: Tramadol can interact with your other medications and can affect how it works, increasing your risk of serious and potentially life-threatening side effects. Give your health care provider and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, supplements, and herbal products.
OPIOID WITHDRAWAL IN NEWBORN BABIES: Taking tramadol during a pregnancy can lead to opioid withdrawal symptoms in the newborn baby which can be life-threatening. If you’re pregnant, talk to your doctor about pain pills that are safe to take.
FATAL OVERDOSE IN CHILDREN AND ADULTS: Accidental intake of too much tramadol by adults, and especially by children, can lead to a deadly overdose. Call your local poison control center immediately and seek emergency medical care if this happens. Keep all medications safely out of reach of children.

Talk to your doctor or pharmacist for medical advice and risk evaluation if you are at a high risk of complications or adverse effects from tramadol use.

Precautions Before Starting Tramadol

Tell your doctor if you have ever had an allergic reaction to tramadol, other opioid medications, or any other drugs. Your pharmacy can give you a list of ingredients

Give your health care provider a complete medical history. Tramadol may not be right for people with certain medical conditions, such as blockage in the stomach or intestines, paralytic ileus (condition in which digested food does not move through the intestines), seizures, brain or spine infections, urination problems, suicidal ideation (thoughts or plans of harming oneself), liver disease, or kidney disease. If you have phenylketonuria, you should not take the disintegrating tablets of tramadol because they contain aspartame.

Give your doctor a complete list of all your medications, including prescription and nonprescription drugs, vitamins, dietary supplements, and herbal products, especially tryptophan or St. John’s Wort. This can help avoid serious interactions between tramadol and your other medications.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. Women who are breastfeeding should not take tramadol. This medicine can pass into breast milk and cause drowsiness and shallow breathing in the infant.

Taking tramadol can cause constipation. Talk to your doctor about diet or medications to prevent or treat constipation before starting tramadol.

Talk to your doctor if you are planning on having children in the future. Tramadol can decrease fertility in both women and men.

Precautions During Use of Tramadol

Keep all your doctors’ appointments while on tramadol. Your health care provider might gradually increase your dose of tramadol.

Call your doctor if you become pregnant while on tramadol.

Tramadol can cause drowsiness and dizziness. Do not drive or operate machinery until you know how this medicine affects you. Avoid drinking alcohol while on tramadol as this can make these side effects worse or cause dangerous breathing problems.

You can feel dizzy when going from a lying or sitting position to standing while on tramadol. Get up slowly, rest your feet on the ground for a short while, and then stand up to prevent falls.

Tell all your doctors you are on tramadol before surgery, including dental surgery.

Tramadol Drug Interactions

Taking tramadol with certain drugs can affect how the medications work. Possible interactions between drugs can also increase the risk of serious side effects. Your healthcare professional may choose a different medication for you, change the dose or frequency of your medications, and/or closely monitor you for side effects if there are known interactions between tramadol and your other drugs.

You should not take tramadol if you are taking or have taken monoamine oxidase (MAO) inhibitors within the past two weeks. Examples of MAO inhibitors include linezolid (Zyvox), phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate), methylene blue, and selegiline (Eldepryl, Emsam, Zelapar).

There can also be possible interactions between tramadol and the following medications:

Blood thinners (anticoagulants) like warfarin (Coumadin, Jantoven)
Antidepressants like bupropion (Wellbutrin, Aplenzin, Zyban); mirtazapine (Remeron); selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac, Selfemra, Sarafem), citalopram (Celexa), fluvoxamine (Luvox), sertraline (Zoloft) and paroxetine (Paxil, Pexeva); serotonin norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta), desvenlafaxine (Khedezla, Pristiq), venlafaxine (Effexor), and milnacipran (Savella); tricyclic antidepressants like amoxapine, amitriptyline, clomipramine (Anafranil), doxepin (Zonalon, Silenor), desipramine (Norpramin), imipramine (Tofranil), protriptyline (Vivactil), nortriptyline (Pamelor), and trimipramine (Surmontil); and serotonin modulators like trazodone (Oleptro)
Skeletal muscle relaxers like cyclobenzaprine (Amrix)
Antitussives (cough medicines) like dextromethorphan
Heart medications like digoxin (Lanoxin)
Water pills (diuretics)
Triptan medications used to treat migraine headaches such as eletriptan (Relpax), almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), and sumatriptan (Imitrex, in Treximet)
Psychiatric drugs like lithium (Lithobid)
Antihistamines like promethazine (Phenergan)
Medications used to treat irritable bowel syndrome (5-HT3 receptor antagonists) like ondansetron (Zuplenz, Zofran), dolasetron (Anzemet), alosetron (Lotronex), palonosetron (Aloxi), and granisetron (Kytril)

The above list does not include all the possible drug interactions of tramadol. To prevent dangerous interactions, give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products.

Also tell your doctor if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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