What is tramadol?

Tramadol is an opioid medicine only available with a prescription from your doctor.

How does tramadol work?

Tramadol works directly on opioid receptors in the central nervous system and reduces feelings of pain by interrupting the way nerves signal pain between the brain and the body.

It also increases the amounts of serotonin and noradrenaline in the brain, which helps with pain relief.

What is tramadol used for?

Tramadol is used for the relief of moderate to severe pain. It should only be used when other forms of non-opioid pain relief have not been successful in managing pain or are not tolerated.

What forms of tramadol are there?

Tramadol is most commonly available as an oral tablet. Liquid and injectable forms are also sometimes used.

Tramadol is also available in a combination tablet together with paracetamol. Your doctor will prescribe the right form of tramadol for your situation.

If you are prescribed tramadol and paracetamol together, make sure you don’t take any other medicines that also contain paracetamol. This increases your chance of paracetamol overdose.

What are the possible side effects of tramadol?

All opioids, including tramadol, can have side effects that include life-threatening breathing problems. The likelihood of these is higher:

• when you first take tramadol
• after a dosage increase
• if you are older
• if you have an existing lung problem

Many of the side effects of tramadol are similar to those of other opioids, and include:

• constipation
• headache or dizziness
• fatigue or drowsiness (especially right after a dose)
• loss of appetite, nausea and vomiting
• sweating
• muscle weakness

Some other tramadol-specific side effects include:

• sleep disorders
• rash
• depression
• fever

In rare cases, tramadol can cause anaphylaxis-like reactions and life-threatening skin reactions.

Always take medicines exactly as prescribed by your doctor.

What are the risks associated with tramadol?

Opioids are strong pain-relief medicines and can cause life-threatening breathing problems.

Tramadol may make it difficult for you to drive or operate heavy machinery due to drowsiness. If you have recently started taking an opioid medicine, or changed the dosage, you are more likely to have an accident. Ask your doctor whether it is legal for you to drive while taking tramadol. Also contact your car insurer, as you may not be covered for accidents that occur while you are taking tramadol.

If your kidney or liver function is impaired, your doctor may reduce your dose or decide that tramadol is not appropriate for you.

There are other factors that may limit your use of tramadol — for example, if:

• you drink alcohol
• you take other medicines that can cause drowsiness, such as benzodiazepines
• you if you take certain antidepressant medicines — this is due to the increased chance of serotonin toxicity (poisoning)

Your doctor is the best person to advise you on whether tramadol is the right medicine for you, how much you need and how long to take it for. Your doctor will also guide you on when and how to stop taking tramadol.

Opioid tolerance and dependence

If you use opioid medicines, you may also develop tolerance. This means that you may need to take larger amounts of the opioid to get the same effect. The chance of side effects also increases with a higher dose.

You may also become dependent on this medicine if you take it regularly, even if you take it exactly as prescribed and for a short time only. Your doctor will monitor how you use tramadol to reduce your chance of harm, including through misuse, abuse and addiction.

If you are concerned that you are becoming addicted to or dependent on tramadol let your doctor know so that you can get help. You can also call the National Alcohol and Other Drug Hotline (1800 250 015) for 24/7 support and treatment information.

Do not stop taking tramadol suddenly, as you may experience withdrawal symptoms.

Opioid overdose

If you take too much tramadol (known as an overdose), it’s important to get immediate medical attention. Overdose of opioid medicines can cause you to stop breathing.

Symptoms of overdose include:

• feeling sleepy
• difficulty breathing
• loss of consciousness
• pinpoint (very small) pupils

How do I take tramadol?

It is important to follow the directions given to you by your doctor or pharmacist when taking tramadol.

Some tramadol tablets prescribed by doctors are ‘controlled-release’ or ‘sustained-release’. Make sure to swallow them whole — do not chew or crush them.

Never take an opioid medicine that was prescribed for someone else or give another person an opioid that was prescribed for you. Your doctor is the best person to guide you on whether tramadol is the right medicine for you, how much you need and how long to take it for.

How do I dispose of medicines safely?

It's important you dispose of unwanted opioid medicines safely. Unused medicines can be returned to any pharmacy. Don't keep unused tramadol ‘just in case’, as this can lead to dangerous or inappropriate use.

Keep tramadol out of reach of children and pets. Never throw medicines into a garbage bin or flush them down the toilet, as this is dangerous to others and harmful to the environment.

When should I see my doctor?

If your pain is not well controlled by tramadol or you have any new or unexpected side effects, see your doctor.

Are there any alternatives to tramadol?

Everyone's pain is unique, and different pain-relief medicines will work in different circumstances. Some people’s pain will respond well to non-opioid medicines, which generally have fewer problems and side effects.

Always check with your doctor or pharmacist before making any change to the dosage or type of medicine you take.

If you have chronic (long-term) pain, your doctor might suggest lifestyle changes to help manage the discomfort. This may include:

• improving your physical fitness
• activity pacing
• social activities
• relaxation techniques
• overall health management

Find out more about options for managing chronic pain.

Resources and support

Asking about your treatment or medicine is important to help you understand your options. Here's a guide to questions to ask your pharmacist or doctor before taking any medicine.

See this list of medicines that contain tramadol to read the consumer medicines information (CMI) leaflet for the brand prescribed. You can also:

• Call 1300 MEDICINE (1300 633 424) to talk about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link helpline (1300 340 357), which is staffed by volunteers with personal experience of chronic pain.
• Go to Painaustralia to find pain services and programs in your area.
• Learn more about prescription opioids on Choosing Wisely.

Languages other than English

The Alcohol and Drug Foundation has translated their guide to using medicines safely into many community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

Learn more about chronic pain management for Aboriginal and/or Torres Strait Islander peoples at the Pain Management Network.