Tramadol

What is tramadol?

Tramadol is used for the relief of moderately severe pain such as after an injury, or operation or pain caused by a terminal illness such as cancer. It is usually used when other milder painkillers such as paracetamol or non-steroidal anti-inflammatories (NSAIDs) don’t work well enough.

• Tramadol belongs to a group of medicines called opioid painkillers. They act on your brain and nervous system to lessen the way you feel pain.
• Other pain relievers such as paracetamol and NSAIDs (ibuprofen, diclofenac, naproxen) may also be used with tramadol. 
• Tramadol is not very effective for nerve pain.
• In New Zealand tramadol is available as capsules and tablets.
• Read more about pain, pain-relief medication, opioid painkillers.

Dose

• The dose of tramadol will be different for different people.
• Tramadol is available in 2 forms, an:
  • immediate release capsule and a
  • controlled release tablet.
• Always take your tramadol exactly as your doctor has told you. Depending on the reason you are taking it, your doctor may advise that you take regular doses or take tramadol only when you need it for pain relief. Make sure you know which is right for you.
• Do not take more than a total of 400 milligrams of tramadol in any 24-hour period. Older adults over 75 years should not take more than 300 milligrams of tramadol in any 24 hour period.
• The pharmacy label on your medicine will tell you how much tramadol to take, how often to take it, and any special instructions.

My dose is:

How to take tramadol

• Timing: You can take tramadol with or without food.
• Capsules: These are usually taken every 4 to 6 hours. The capsules start working quickly to ease pain. Swallow the capsules whole with a glass of water. 
• Tablets: The tablets work slowly over several hours to give a constant and more even pain control — these are called 'modified-release' and often have 'XR' or 'SR' after their brand name. These are usually taken twice daily (12 hours apart) or once daily (at the same time each day). Swallow the tablets whole — do not break or chew them; otherwise they may release the medicine too quickly and cause side-effects.
• Alcohol: Limit or avoid drinking alcohol while you are taking tramadol. Combining tramadol with alcohol can make you more sleepy, drowsy or dizzy.
• Missed dose: If you forget to take your dose, take it as soon as you remember. But, if it is closer to the time of your next dose, just take the next dose at the right time. Do not take double the dose.

Precautions – before starting tramadol

• Do you have liver or kidney problems?
• Do you have breathing problems such as asthma, COPD or sleep apnoea?
• Do you have epilepsy?
• Do you have problems with your bowel such as constipation?
• Are you taking any other medicines? This includes any medicines you buy without a prescription, such as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start tramadol. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Side effects

Like all medicines, tramadol can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Addiction

Addiction is an excessive craving. If you are addicted to tramadol, it means you are not able to control your use of it. It is unusual for people who are prescribed tramadol for a short time or for a terminal illness to become addicted to it. Some people are more likely to develop addiction than others and seem to be very sensitive to the cravings. You may be at risk for addiction if you have mental health problems such as depression or a history of substance abuse, including alcohol and recreational drugs.

To reduce your risk of addiction, tramadol for short-term pain relief should be used for the shortest possible time, at the lowest effective dose, with a plan in place to reduce and withdraw treatment.

Other side effects

Interactions

Tramadol interacts with some other medications and herbal supplements, so check with your doctor or pharmacist before starting tramadol or before starting any new medicines. 

Learn more

The following links have more information on tramadol.

New Zealand Formulary Patient Information: tramadol 
Medsafe Consumer Information sheets: Arrow-Tramadol, Tramal, Tramal SR

References

1. Prescribing tramadol appropriately BPAC, 2018
2. Tramadol hydrochloride New Zealand Formulary