Tramadol is a pain medication that is commonly given to people with ongoing moderate or moderately-severe pain. There is also an extended-release version that is a treatment option for people with chronic pain who require around-the-clock pain relief. When used inappropriately or other than intended, tramadol can be addictive.
What is Tramadol?
Tramadol is an opioid-like pain medication that is used to treat chronic pain. It is considered an atypical opioid because it has a slightly different mechanism of action than classic opioids. Opioids traditionally have their effect by binding to opioid receptors in the central nervous system and activating them. The activation leads to pain relief. Tramadol binds weakly to these receptors and therefore is not considered a classic opioid.
Tramadol has the additional effect of inhibiting the reuptake of two neurotransmitters, norepinephrine and serotonin. By inhibiting their reuptake, the effective concentration of both neurotransmitters is increased, allowing them to interact with their receptors more and cause increased signaling in the brain. Both of these neurotransmitters are involved in feeling pleasure, so increasing their availability can lead to a euphoric high. Drugs aimed at inhibiting their reuptake are used to treat depression and other mental health disorders.
Tramadol is classified as a weak opioid due to its weak affinity to opioid receptors that classic opioids bind to. Some questions that commonly arise about tramadol drug classification include:
- Is tramadol an opiate? Opiates are naturally found substances that bind to opioid receptors, such as cocaine and morphine. Tramadol is a synthetic substance and therefore is not an opiate, but rather an opioid.
- Is tramadol a narcotic? Narcotic is another term for opioids, therefore tramadol is a narcotic
The active ingredient in tramadol is tramadol hydrochloride. Other tramadol ingredients that are inactive include pregelatinized corn starch, modified starch (corn), hypromellose, lactose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, sodium starch glycolate, titanium dioxide and carnauba wax.
What is Tramadol Used For?
Tramadol is used to treat a variety of pain conditions, along with other problems and disorders. Tramadol treats:
- Migraine Pain
Tramadol can be used to relieve migraine pain and light and sound sensitivity associated with migraines.
- General Pain
Tramadol is a painkiller used for a variety of different pain ailments. It can be used to treat acute or chronic pain.
It is possible that tramadol may be used for anxiety related to chronic pain. A study in rats showed that it reduced anxiety associated with neuropathic pain, presumably due to its pain-relieving effects. There is limited evidence for using tramadol to treat anxiety in humans.
The same study on tramadol and anxiety also showed that tramadol reduced depression associated with neuropathic pain in rats, again most likely due to its pain-relieving effects. However, caution should be taken in generalizing these results, as physicians have been warned to avoid tramadol use in patients who are depressed due to an increased risk of suicide.
- Premature Ejaculation
Tramadol can be used as a treatment for premature ejaculation. It has been shown effective in some cases, but other times requires a higher dose than is recommended to take daily and therefore may be unsafe.
- Restless Leg Syndrome
One study has shown that tramadol may be more effective than other treatments at relieving the symptoms of restless leg syndrome.
Dosage and Administration
For chronic pain:
- Immediate-release: Initially 25 mg daily in the morning, followed by an increase of 25 mg in separate doses every three days until a dose of 100 mg per day is reached (25 mg, four times a day). After that, the dose can be increased to 50 mg every three days as tolerated until a dose of 200 mg per day is reached (50 mg, four times a day). Then, it can be used in 50 mg to 100 mg doses every four to six hours, not to exceed 400 mg per day.
- Extended-release: Initially 100 mg can be given once daily and tested in 100 mg increments every five days as needed or tolerated. The final dose should not exceed 300 mg per day.
For acute pain:
- Immediate-release: 50 mg to 100 mg can be taken every four to six hours as needed, but should not exceed 400 mg per day
- Extended-release: Extended-release is generally not used for acute pain
- Powder: It is not a prescribed method of administration, but when used recreationally, some people may snort tramadol powder.
- Injection: Tramadol can be injected if it is dissolved in water. This method is highly dangerous and should not be utilized, but is sometimes the route of administration used by people who use tramadol recreationally.
- Tablet or capsule: Tramadol tablets or capsules should be taken orally. They should be directly swallowed and never chewed, crushed, split or dissolved. This method is the only way that tramadol is prescribed.
What Does Tramadol Look Like?
If trying to identify the tramadol pill, know that the 50 mg tablets are white and capsule shaped with a coating surrounding it. The coating is imprinted “ULTRAM,” regarding the brand name, on one side and “06 59” on the other side.
The brand names for tramadol are:
- Ultram ER
It is marketed under the generic name and brand names.
Other Names and Street Names for Tramadol
Other names for tramadol stem from its recreational use. Tramadol street names include:
- Chill Pills
Tramadol Side Effects
Tramadol side effects include:
- Itchy skin
- Excessive sweating
How Long Does Tramadol Stay in Your System?
How long tramadol stays in your system depends on the type of tramadol used and the dosage. It also depends on a variety of factors such as weight and age. In general, tramadol can be detected in the different parts of the body for different amounts of time, including:
Up to 24 hours
Starts to be detected at two hours and continues to be detected up to 40 hours
Up to 90 days
Detected at 10 and 16 hours post IV use. There is no indication of how long it continues to be detected
Tramadol addiction can occur if a person uses it for reasons other than its intended use or at doses that exceed the recommended amount. When used at higher doses or administered using a route other than recommended, tramadol can have a euphoric effect. Addiction occurs over time when the person craves the drug for the high it provides.
How long does it take to get addicted to tramadol? This answer depends on a variety of factors, including the demographics of the person using the drug (age, weight, health, family history, etc.), how much tramadol they are using at once and the route of administration they are using. A person that already has a substance use disorder of another kind may also be at increased risk of becoming addicted to tramadol.
Key Points: Understanding Tramadol
A few key points to remember about tramadol include:
- Tramadol is a pain reliever that works in a manner similar to opioids but has additional effects
- Tramadol should be used according to the dosing recommended by a physician, which will vary depending on the condition treated and what form of tramadol is being used
- Tramadol has the potential to be addicting if it is used in ways other than recommended
- If addiction and dependence develops, withdrawal symptoms can occur when drug use stops
If you struggle with tramadol addiction, contact The Recovery Village Palm Beach to speak with a representative about how addiction treatment can work for you. Take the first step toward a healthier future, call today.
Food and Drug Administration. “Tramadol Prescribing Information.” May 2010. Accessed July 26, 2019.
Drug Enforcement Administration “Tramadol.” October 2018. Accessed July 26, 2019.
Silberstein, S.; Freitag, F.G.; Rozen, T.D.; Kudrow, D.B.; Hewitt, D.J.; Jordan, D.M.; Fisher, A.C.; Rosenthal, N.R. “Tramadol/acetaminophen for the treatment of acute migraine pain: findings of a randomized, placebo-controlled trial.” Headache, December 2005. Accessed July 26, 2019.
Caspani, O.; Reitz, M.C.; Ceci, A.; Kremer, A.; Treede, R.D.“Tramadol reduces anxiety-related and depression-associated behaviors presumably induced by pain in the chronic constriction injury model of neuropathic pain in rats.” Pharmacology, Biochemistry and Behavior, September 2014. Accessed July 26, 2019.
Dion, G.R.; Teng, S.E.; Achlatis, E.; Fang, Y.; Amin, M.R. “Treatment of Neurogenic Cough with Tramadol: A Pilot Study.”Otolaryngology Head Neck Surgery, July 2017. Accessed July 26, 2019.
Zou, Y.; Ling, Y.; Kong, G.; Tang, Y.; Huang, Q.; Zhang, L.; Wei, L.“Effect of Tramadol Pretreatment on Sufentanil-Induced Cough.” Journal of Perianesthesia Nursing, June 28, 2019. Accessed July 26, 2019.
Martyn-St James, M.; Cooper, K.; Kaltenthaler, E.; Dickinson, K.; Cantrell, A.; Wylie, K.; Frodsham, L.; Hood, C. “Tramadol for premature ejaculation: a systematic review and meta-analysis.” BMC Urology, January 30, 2015. Accessed July 26, 2019.
Lauerma, H.; Markkula, J.“Treatment of restless legs syndrome with tramadol: an open study.” The Journal of Clinical Psychiatry, April 1999. Accessed July 26, 2019.
Food and Drug Administration. “Ultram.” Accessed July 26, 2019.
Dhesi, Manraj; Maani, Christopher V. “Tramadol.” StatPearls Publishing, January 6, 2019. Accessed July 26, 2019.
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