Tramadol is a strong painkiller from a group of medicines called opiates, or narcotics. It's used to treat moderate to severe pain, for example after an operation or a serious injury. If you have long term pain, your doctor may also prescribe it if weaker painkillers no longer work.
Tramadol does not stop the pain completely, but you will not be able to feel it as much.
Tramadol is available only on prescription. It comes as tablets, capsules and liquid drops that you swallow. It can also be given by injection, but this is usually only done in hospital.
Who can take tramadol
Most adults and children aged 12 and over can take tramadol.
Tramadol is not suitable for some people. Before starting the medicine, tell your doctor or pharmacist if you have:
- ever had an allergic reaction to tramadol or any other medicine
- a condition which causes seizures or fits
- a head injury
- an addiction to alcohol, strong painkillers or recreational drugs
- breathing difficulties
- kidney or liver problems
- ever had a reaction to other strong painkillers
Dosage and strength
Tramadol comes as:
- standard tablets – these contain 50mg of tramadol
- slow-release tablets – these contain 50mg, 75mg, 100mg, 150mg, 200mg, 300mg or 400mg of tramadol
- standard capsules – these contain 50mg of tramadol
- slow-release capsules – these contain 50mg, 100mg, 150mg or 200mg of tramadol
- drops that you swallow – this contains 100mg of tramadol in 1ml of liquid
- soluble tablets – these contain 50mg of tramadol
- tablets that dissolve in the mouth (orodispersible) – these contain 50mg of tramadol
- an injection (usually given in hospital)
Tramadol drops, injections and some tablets and capsules will start to work within 30 to 60 minutes. They're used for pain that is expected to last for only a short time. You may be told to take this type of tramadol only if you need it for pain that can come and go.
Dosages vary from person to person. Your doctor will decide the right dose for you, depending on how sensitive you are to pain, how bad your pain is, how you responded to previous painkillers and if you get any side effects.
Your dose may need to be changed several times to find what works best for you. In general, you will be prescribed the lowest dose that relieves your pain.
How to take standard tablets and capsules
Swallow each tablet or capsule whole with a glass of water.
How to take drops
Mix the drops into a glass of water then drink the whole contents of the glass.
How to take soluble tablets
Dissolve each tablet in a drink of water (more than a mouthful or a sip) and drink
How to take tablets that dissolve in the mouth
Make sure your hands are dry before handling the tablet. Pop the tablet out of its pack and put it on your tongue. Suck the tablet, do not chew it. After it has melted, swallow or have a drink of water. You can also dissolve the tablet in a glass of water if you prefer.
How to take slow-release tablets and capsules
It's important to swallow slow-release tramadol tablets and capsules whole with a drink of water.
Slow-release tablets and capsules release the medicine into your body over either 12 or 24 hours. This type of tramadol takes longer to start working but lasts longer. It's used for long-term pain.
Do not break, crush, chew or suck slow-release tablets and capsules. If you do, the slow-release system will not work and the whole dose might get into your body in one go. This could cause an overdose, which can be dangerous.
When to take it depends on the type of tramadol that you have been prescribed:
- standard tablets and capsules – usually 3 to 4 times a day
- drops – usually 3 to 4 times a day
- slow-release tablets and capsules – usually once or twice a day
If you're 65 or over, or you have liver or kidney problems, your doctor may ask you to take tramadol less often.
You can take your tramadol at any time of day but try to take it at the same time every day, and space your doses evenly. For example, if you take tramadol twice a day and have your first dose at 8am, take your second dose at 8pm.
How long to take it for
Depending on why you're taking tramadol, you may only need to take it for a short time. For example, if you're in pain after an injury or operation, you may only need to take tramadol for a few days or weeks at most.
You may need to take it for longer if you have a long-term condition.
Talk to your doctor if you're unsure how long you need to take tramadol for.
If you forget to take it
This will depend on which type of tramadol you are taking.
If you forget to take a dose, check the information inside the packaging or ask your pharmacist or doctor for advice on what to do.
Never take 2 doses at the same time to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
If you need to take tramadol for a long time your body can become used to it.
This is not usually a problem but you could get unpleasant withdrawal symptoms if you stop taking it suddenly.
If you want to stop taking tramadol, talk to your doctor first. Your dose will usually be reduced gradually so you do not get withdrawal effects.
Tramadol can cause unpleasant withdrawal symptoms if you come off it suddenly, such as:
- feeling agitated
- feeling anxious
If you have been taking tramadol for more than a few weeks, do not stop taking it without speaking to your doctor first.
It's important not to take more than your prescribed dose, even if you think it's not enough to relieve your pain. Speak to your doctor first if you think you need a different dose.
Taking too much tramadol can be dangerous.
If you've taken too much, you may feel very sleepy, sick or dizzy. You may also find it difficult to breathe. In serious cases you can become unconscious and may need emergency treatment in hospital.
The amount of tramadol that can lead to an overdose is different for everyone.
If you've taken 1 extra dose, check the information that comes with the medicine packaging or ask your pharmacist or doctor for advice. Generally, you are unlikely to get any symptoms from 1 extra dose and you can take your next dose as usual.
- you have taken 2 or more extra doses of tramadol
If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the tramadol box or leaflet inside the packet plus any remaining medicine with you.
Common side effects
These common side effects of tramadol happen in more than 1 in 100 people. There are things you can do to help cope with them.
Serious side effects happen in less than 1 in 100 people.
Call your doctor or contact 111 now if you:
- feel dizzy, tired and have low energy – these can be a sign of low blood pressure
- have hallucinations (seeing or hearing things that are not there)
- feel confused
- feel very sleepy
- have trouble peeing or you cannot pee at all
- have a seizure or fit
- have breathing difficulties or short shallow breathing
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to tramadol.
These are not all the side effects of tramadol. For a full list, see the leaflet inside your medicine packet.
Tramadol and pregnancy
Tramadol is not usually recommended while you’re pregnant.
There is not enough safety information to say whether tramadol can cause problems for your baby. If you take tramadol at the end of pregnancy, there's a risk that your baby may have become used to having tramadol. This means that they could have withdrawal symptoms in the first few days of life.
However, it's important to treat pain in pregnancy. For some pregnant women with severe pain, tramadol might be the best option. Your doctor is the best person to help you decide what's right for you and your baby.
If your doctor or health visitor says your baby is healthy, you can take tramadol while breastfeeding. However, it is best to only take tramadol for a few days if possible. If you need to take it for longer, talk to your doctor.
Tramadol passes into breast milk in very small amounts, and it’s unlikely to cause side effects in your baby.
If your baby is not feeding as well as usual, has constipation, or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife.
- your baby is unusually sleepy
- your baby has breathing problems
There's no clear evidence to suggest that taking tramadol will reduce fertility in men.
However, for women it may affect your periods (menstrual cycle).
Speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.
Cautions with other medicines
Some medicines can affect the way tramadol works and increase the chances of you having side effects.
Tell your doctor if you are taking any medicines:
- for depression
- for mental health problems
- for pain relief
- to help you sleep
- to reduce tension or anxiety
- to treat symptoms of an allergy
- to help prevent blood clots (such as warfarin)
- to treat an infection
Some medicines may weaken or shorten the effect of tramadol. Tell your doctor if you're taking:
- carbamazepine to treat epilepsy
- buprenorphine, a painkiller
- Ondansetron, to stop you feeling sick
- Rifampicin, an antibiotic
Do not take medicines called monoamine oxidase inhibitors or MAOIs (which are used to treat depression) with tramadol. The combination can cause significant side effects such as anxiety, confusion and hallucinations.
Some everyday painkillers that you can buy from pharmacies contain codeine, which is a similar medicine to tramadol. Codeine-containing painkillers that you can buy from pharmacies These include co-codamol, Nurofen Plus and Solpadeine. Do not take these pharmacy-bought painkillers with tramadol because you are more likely to get side effects.
Mixing tramadol with herbal remedies and supplements
There's not enough information to say that other complementary medicines and herbal remedies are safe to take with tramadol. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.
HealthUnlocked contains information from NHS Digital, licensed under the current version of the Open Government Licence