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Tramadol FAQs and Facts

While the reported potential for tramadol abuse appears lower than that of other prescription opioids, abuse of tramadol is increasing growing. As the prescription opioid epidemic continues, an increase in the risk of tramadol abuse may occur as many prescribers turn to tramadol as an alternative treatment for pain. Read the following tramadol facts to discover the similarities and differences between tramadol and the far more popular drug hydrocodone and its benefits versus risks.

Are Tramadol Side Effects the Same as Hydrocodone?

Chemically the drugs are different, therefore the side effects are somewhat different. Tramadol has a methoxybenzene structure and belongs to a class of organic compounds known as anisoles. Hydrocodone belongs to a class of organic compounds known as morphinans. Tramadol has a half-life of 6.3 hours versus hydrocodone’s half-life of 1.25 to three hours, which means hydrocodone stays in the body for a shorter period of time than tramadol. Tramadol is a weak opioid receptor agonist while hydrocodone has a moderate impact on opioid receptors.

Tramadol has more potential for common side effects because it also inhibits norepinephrine and serotonin. It is associated with mood problems and an increased risk of suicide in depressed individuals. Tramadol may also cause seizures, which is generally not typical for opioid drugs. The incidence of attacks is increased in people with a history of seizures and those who combine tramadol with antipsychotics, antidepressants, alcohol or illicit drugs. Hydrocodone is subject to far greater abuse than tramadol and has a serious risk of respiratory depression, which can be fatal.1

Tramadol High – Fact or Fiction?

Tramadol carries a relatively low risk of addiction because its euphoric effects are mild compared to OxyContin. However, tramadol does impart mu-opioid agonist activity, triggering chemical reactions in the brain to stimulate feelings of well-being. In clinical trials, 7% of people reported central nervous system stimulation symptoms such as euphoria up to one week after starting regular doses of tramadol. This number increased to 14% when people took tramadol for 31 to 90 days. In one study, opioid abusers who were given high-dose tramadol reported that it gave them an enjoyable “high” similar to codeine and somewhat less intense than oxycodone. In a different study, subjects were given a typical therapeutic dose and rated tramadol as pleasurable and something they would like to “take again.”2,3

How Is Tramadol Abused?

Although it is currently not subject to widespread abuse like oxycodone and hydrocodone, taking it in any manner other than prescribed might be considered abuse. Tramadol is commonly abused with other substances and is frequently mixed with alcohol. Misusing tramadol and any other opioids increases the risk of adverse side effects. While misuse enables users to achieve a stronger euphoric high, it also increases the intensity of the drug’s effects on the body and the risk of dependency. Tramadol is abused in the following ways:4

  • Chewing
  • Injecting
  • Smoking
  • Snorting
  • Taking higher doses than prescribed
  • Ingesting more frequently than prescribed
  • Combining it with alcohol or other drugs4

Are Seizures a Common Side Effect of Tramadol?

The exact incidence is unknown since the majority of studies have been small. Tramadol-related seizures are short, tonic-clonic seizures that are self-limiting, like other drug-related seizures. Reports of seizures following tramadol overdoses have occurred in intravenous tramadol as a premedication, drug abusers and tramadol intoxication. In all cases, high blood tramadol concentrations likely induced the seizures. However, the relationship between tramadol dose and seizure activity is controversial. One study reported high doses of tramadol triggered seizure activity, suggesting this side effect is dose-dependent. Data from other studies implied seizures were not dose-dependent.5

In a case study, a 51-year-old man diagnosed with laryngeal cancer presented with severe head, neck and shoulder pain. He was treated with oral tramadol drops in divided doses equal to 75 mg per day. Two days later, he returned to the clinic. His wife reported that 10 minutes after he’d taken the drug, he began shaking, lost consciousness for about one minute and was sweating profusely. He was hospitalized and monitored, and although oral tramadol was stopped, he experienced two short generalized tonic-clonic seizures in the hospital the same day. Brain imaging findings were normal and neurological metastasis findings were not determined. No seizures occurred during follow-up. Based on this case, the authors believe low-dose tramadol is capable of inducing seizures. They stressed the importance of monitoring seizure activity and other side effects of prolonged tramadol use, especially in the treatment of cancer pain.5

  1. Tramadol vs Hydrocodone. Drug Details website. http://drugsdetails.com/tramadol-vs-hydrocodone/ Published December 12, 2016. Accessed February 21, 2017.
  2. Does Tramadol get you high? Addiction Blog website. http://prescription-drug.addictionblog.org/does-tramadol-get-you-high/ Published July 22, 2011. Accessed February 21, 2017.
  3. Is Tramadol the New OxyContin? Drug Abuse website. http://drugabuse.com/library/is-tramadol-addictive/ Accessed February 21, 2017.
  4. How is Tramadol Abused? Addiction Blog website. http://prescription-drug.addictionblog.org/how-is-tramadol-abused/ Published November 4, 2013. Accessed February 21, 2017.
  5. Beyaz SG, Sonbahar T, Bayar F, Erdem AF. Seizures associated with low-dose tramadol for chronic pain treatment. Anesth Essays Res. 2016;10(2):376-378. doi:10.4103/0259-1162.177181.
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