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Tramadol: Dosage & Side Effects

Ultram (tramadol) tablets label
A label for 50 mg of Ultram (tramadol) tablets.
Credit: National Institutes of Health.

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 many other names elsewhere. Tramadol is a type of opioid analgesic and can be habit-forming. It is intended to work by changing the way the central nervous system responds to pain.

Dosage

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, fibromyalgia and other chronic pain conditions. According to the National Institutes of Health, 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 nervousness, panic, sweating, difficulty falling asleep, runny nose, chills, nausea, diarrhea and hallucinations. Your doctor will likely decrease your dose gradually.

Side effects

Common side effects of tramadol include:

  • Abdominal problems, such as diarrhea, constipation, nausea, or stomach pain
  • Depression, including feelings of sadness and discouragement
  • Skin problems, such as itchiness, rash, or sweating
  • General aches and pains in the muscles and joints

Some side effects are more rare than others, such as:

  • Swollen joints
  • Weight changes
  • Severe headaches
  • Falling down
  • Confusion
  • Severe cough

Some rare side effects warrant a call to the doctor. These include:

  • Blisters under the skin
  • Blood in the urine
  • Chest pain
  • Convulsions
  • Darker urine
  • Fainting
  • Indigestion
  • Numbness in the extremities
  • Yellowed eyes or skin

Addiction

Though it is not classified as a controlled substance in most states, tramadol can still be abused. Even when used at prescribed doses, prolonged use can cause addiction.

Tramadol is designed for oral use only, and the tablets should not be crushed for the purpose of inhalation or injection. Snorting the drug increases the intensity of the effect of the drug, but brings it in large doses into the bloodstream. These large doses can cause overdose and increase the risk of adverse side effects, like seizures. Other serious side effects of snorting tramadol include coma, breathing problems, hallucinations and heart attacks.

Overdose

Deaths from tramadol overdose have increased over the past two decades. Because many prescribers view tramadol as a "safer" opioid than something stronger, such as morphine, patients often ignore dosage instructions or drug interaction warnings. Those abusing the drug build tolerance over time and unsafely increase their dosages so that they can continue to achieve the high.

If you or someone you know has possibly overdosed, emergency help must be contacted at once. Signs of an overdose can include convulsions or seizures, trouble breathing, irregular breathing, pale or blue lips and skin, and pinpoint pupils in the eyes. Some patients may have decreased awareness or responsiveness to the point of loss of consciousness.

Who should not take tramadol

Tramadol should not be used in patients with a history of drug or alcohol abuse, or a history of suicide attempts. It should not be taken at the same time as alcohol, street drugs, narcotic pain meds, sedatives, or medication used to treat mental illness.

Taking tramadol increases the risk of seizures for those with a history of seizures, a head injury, a metabolic disorder, or those taking antidepressants, muscle relaxers and narcotics. Before taking tramadol, be sure to inform your doctor if you have kidney disease, cirrhosis or other liver disease, a stomach disorder, or a history of depression and mental illness.

Appropriate studies have not yet been performed on tramadol use in children under 16 years. As a result, safety and efficacy are unknown. It should be used sparingly in the elderly, as they are more likely to have unwanted side effects such as constipation, lightheadedness, dizziness, fainting, and stomach upset, as well as age-related kidney or liver disease.

Tramadol for dogs and cats

For dogs and cats, tramadol is used often as a pain reliever for post-surgery pain or chronic conditions like cancer or arthritis. It is also used as a cough suppressant in pets. It's most often used in dogs, though it can be used for cats as well.

Tramadol is used as an alternative to non-steroidal anti-inflammatory drugs (NSAIDs) or in conjunction with them. Because tramadol works differently than NSAIDs, they can be used as an alternative for pets who cannot take NSAIDs. The tablets can be given to pets with or without food, but dosage instructions from the vet must be followed. Just like in humans, if the medication has been used long term, do not abruptly stop giving it for risk of withdrawal symptoms. Work with your vet to wean your pet off of tramadol properly.

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