Tramadol Uses & Abuse Potential

Tramadol should be used with caution due to the risk of side effects associated with tramadol use, as well as the drug's potential for abuse.

Tramadol hydrochloride, a medication sold under the brand names Ultram and Conzip, is unique in that it possesses properties of both opioid narcotics and mood-elevating antidepressants.

While tramadol is weaker than other opioid drugs and has a valuable role in modern medical care, it should be used with caution due to the risk of side effects associated with tramadol use, as well as the drug’s potential for abuse.

Tramadol Medical Uses

Tramadol is used primarily to treat mild, moderate, or severe pain, including both acute and chronic pain related to a wide range of different conditions. Less frequently, tramadol is also used to treat treatment-resistant restless leg syndrome.

Forms Of Tramadol

Tramadol is available in several different forms, including immediate-release tablets and extended-release tablets.

Immediate-release tablets work to control pain within an hour after being taken, with effects that last around six hours. Extended-release tablets are intended to provide continuous pain management over an extended period of time.

Certain combination tramadol products also include the pain relief medication acetaminophen, the active ingredient in Tylenol.

Tramadol Abuse Potential

While tramadol is a low-potency opioid drug, it can still be used to achieve a euphoric high in large doses.

Prolonged use or abuse of tramadol can also lead to the development of both physical dependence and addiction, with withdrawal symptoms that are especially drawn-out compared to withdrawal from other opioid drugs.

Tramadol was originally approved for medical use in the United States in 1995, the same year the opioid medication oxycodone was approved. At the time, tramadol was not considered to be either an opioid pain medication or a controlled substance, despite working along similar lines as other, more potent opioid analgesics.

Schedule IV Controlled Substance

After many reported cases of tramadol abuse, dependence, and addiction, tramadol was reclassified as a schedule IV-controlled substance in 2014.

A schedule IV drug signifies that while the drug is considered to have a relatively low potential for abuse, addiction, and dependence, this risk does exist and the drug should be prescribed and used with care.

Tramadol Side Effects

Older adults appear to be the most likely to experience certain common side effects of tramadol use, which can include:

  • constipation
  • itchiness
  • nausea
  • sleepiness
  • headache
  • nervousness
  • tremors
  • muscle tightness
  • changes in mood
  • heartburn or indigestion
  • dry mouth

Less common and increasingly serious side effects, adverse effects, and signs of allergic reaction include:

  • hives
  • rash
  • blisters
  • hoarseness
  • difficulty swallowing or breathing
  • swelling in the face, throat, or extremities
  • nausea and vomiting
  • loss of appetite
  • muscle weakness
  • dizziness
  • changes in heart rhythm
  • sleep apnea
  • loss of consciousness
  • seizures

Tramadol should not be used by pregnant women or those who are breastfeeding, due to the risk of certain birth defects as well as infant drowsiness, difficulty breastfeeding, and serious breathing problems.

Tramadol Drug Interactions

While tramadol is less likely to cause serious overdose events than more powerful opioids, overdoses can occur with very high doses or (more commonly) when tramadol is taken along with certain substances either intentionally or accidentally.

These interactions can result in:

Opioid Overdose

Opioid drugs work by changing the way nerves respond to pain signals and causing sedation, slowing your overall activity in the central nervous system.

During an overdose this effect can cause drowsiness followed by severe breathing problems, potentially leading to brain damage or death. It may also impair your gag reflex, which can cause death if you were to choke on your own vomit.

Tramadol may contribute to overdoses when used with other CNS depressants, including:

  • benzodiazepines like diazepam (Valium) or alprazolam (Xanax)
  • ethanol (drinking alcohol)
  • other opiate/opioid drugs like codeine or oxycodone

It should also be noted that naloxone, an inverse agonist for opioid receptors and an effective opioid overdose antidote, has only a limited effect on tramadol overdoses and may increase the chance of a harmful seizure if administered.

Serotonin Syndrome

Unlike other opioid painkillers, tramadol acts as a serotonin–norepinephrine reuptake inhibitor (SNRI). Other SNRI drugs are used as antidepressants, which means that the use of tramadol may boost your mood and positivity.

However, if tramadol is taken with other serotonergic (serotonin-increasing) drugs it can lead to a dangerous condition known as serotonin syndrome. Symptoms of serotonin syndrome may include:

  • high body temperature
  • agitation
  • increased reflexes
  • tremors
  • sweating
  • dilated pupils
  • diarrhea
  • headache
  • high blood pressure

Serotoninergic prescription drugs and supplements that should not be taken with tramadol due to the risk of serotonin syndrome include:

  • selective serotonin reuptake inhibitors (SSRI): citalopram, escitalopram, fluoxetine, paroxetine, sertraline
  • serotonin norepinephrine reuptake inhibitors (SNRI): duloxetine, desvenlafaxine, levomilnacipran, milnacipran, venlafaxine
  • monoamine oxidase inhibitors (MAOI): isocarboxazid,  selegiline, phenelzine, tranylcypromine, linezolid
  • tricyclic antidepressants (TCAs): amitriptyline, amoxapine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trimipramine
  • amphetamines, including ADHD medications
  • pethidine (meperidine)
  • St. John’s wort
  • ecstasy (MDMA)
  • kratom

If you struggle with tramadol dependence or addiction, contact Northeast Addictions Treatment Center today for information on our outpatient treatment programs.

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