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Tramadol Symptoms and Signs

In May 2010, the U.S. Food and Drug Administration mandated updated tramadol warning labels due to the drug’s mu-opioid agonist activity, potential for abuse and possible criminal diversion. Moreover, tramadol-related deaths were linked to individuals with a previous history of emotional disturbances, suicidal thoughts or attempts and/or a history of abusing tranquilizers, alcohol or other drugs impacting the central nervous system (CNS).1 Tramadol is believed to have additive effects when used in combination with alcohol, sedatives, tranquilizers, other opioids or illicit drugs, leading to potentially fatal CNS or respiratory depression. In addition, taking migraine drugs called triptans (e.g. Imitrex, Zomig and Relpax) with tramadol may increase the risk of a dangerous drug interaction called serotonin syndrome.2

Dependence and Overdose Risk

Habitual users and those who abuse tramadol can develop tolerance, which can lead to physical and psychological dependence or addiction. Tolerance necessitates increasing the frequency of doses or the amount taken to achieve the desired effects, raising the risk of accidental overdose. Any of the following symptoms may be signs of an overdose and 911 should be called without delay:2

  • Pinpoint pupils
  • Slow breathing or difficulty breathing
  • Extreme drowsiness
  • Cold, clammy skin
  • Slow or irregular heartbeat
  • Seizures
  • Loss of consciousness
  • Serotonin syndrome
  • Life-threatening allergic or skin reactions
  • Angioedema (fluid swelling under the skin)
  • Orthostatic hypotension (low blood pressure upon standing up)
  • Suicidal thoughts or actions
  • Coma2,3

Tramadol Side Effects

When prescribed by a physician and taken as directed, tramadol can provide consistent pain relief. The occurrence of side effects may be more frequent in older adults. Tramadol can have the following undesired side effects, similar to other opioid drugs, even when taken as prescribed.2,3,4,5

  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Lightheadedness
  • Flushing
  • Dizziness
  • Drowsiness
  • Headache
  • Congestion
  • Sore throat
  • Itching
  • Loss of appetite
  • Dry mouth
  • Fatigue
  • Breathing difficulty
  • Weakness2,3,4,5

Behavioral Signs of Tramadol Abuse

Abuse of tramadol can result in feelings of euphoria or numbness, a sensation of being detached from one’s body, lethargy and being overly relaxed and calm. Like other opioids, tramadol abuse may be associated with the following behaviors:6

  • Development of cravings when not using the drug
  • Development of tolerance effects such as escalating drug intake to achieve the same effects
  • Use for nonmedical purposes
  • Inability to control use
  • Continually taking the drug regardless of negative physical or psychological repercussions
  • Drug-seeking behavior such as continually “losing” prescriptions, arriving at clinics at the end of business hours, refusing examinations or tampering with medical records or prescriptions
  • Doctor-shopping to obtain prescriptions
  • Failing to perform as expected at work or school due to drug-related impairments
  • Neglecting friends and family in order to use or obtain drugs6
  1. Ultram (tramadol hydrochloride), Ultracet (tramadol hydrochloride/acetaminophen): Label Change. U.S. Food and Drug Administration website. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm213264.htm Published May 25, 2010. Accessed February 20, 2017.
  2. Tramadol: 9 Things You Should Know. Drugs website. https://www.drugs.com/slideshow/tramadol-facts-1192. Published January 9, 2017. Accessed February 20, 2017.
  3. Tramadol Abuse. Drug Abuse website. http://drugabuse.com/library/tramadol-abuse/ Accessed February 20, 2017.
  4. Tramadol: 77,299 reports from FDA and social media. EHealthMe website. http://www.ehealthme.com/drug/tramadol/ Accessed February 20, 2017.
  5. Tramadol and Hydrocodone. Heathline website. http://www.healthline.com/health/pain-relief/tramadol-vs-hydrocodone?m=0&rw1#Comparison2 Published March 31, 2015. Accessed February 20, 2017.
  6. Signs, Symptoms, and Risks of Tramadol Addiction. The Fix website. https://www.thefix.com/content/tramadol-addiction Published January 21, 2015. Accessed February 20, 2017.
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