Sounds like 'tra-ma-doll'

Tramadol is used for pain relief. Find out how to take it safely and the possible side effects.

On this page, you can find the following information:

Type of medicine Also called
  • It belongs to a group of medicines known as analgesics (pain killers)
  • Opioid pain reliever
  • Tramal®
  • Arrow-Tramadol®

What is tramadol?

Tramadol is used for the relief of moderate to severe pain (eg, after a serious injury or operation) or for 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 non-opioid pain relievers such as paracetamol and NSAIDs (ibuprofen, diclofenac, naproxen) may also be used with tramadol. 
  • Tramadol is not very effective for nerve pain.
  • It is not safe in children under 12 years old.
  • Read more about painpain-relief medication and opioid painkillers.

In what forms is tramadol available?

In Aotearoa New Zealand tramadol is available on prescription as:

  • capsules (50 mg)
  • modified release tablets (50 mg, 100 mg, 150 mg, 200 mg)
  • liquid (10 mg per mL).


  • The dose of tramadol will be different for different people.
  • Take as prescribed: 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.
  • Maximum dose: Do not take more than a total of 400 mg of tramadol in any 24-hour period. Older adults over 75 years should not take more than 300 mg of tramadol in any 24 hour period.
  • If your pain is not reducing: Do not increase the dose or take an extra dose. See your doctor for advice.
  • The pharmacy label on your medicine will tell you how much tramadol to take, how often to take it, and any special instructions.

How to take tramadol

  • Timing: You can take tramadol with or without food.
  • Capsules: These are usually taken every 4–6 hours when needed. The capsules start working quickly to ease pain. Swallow the capsules whole with a glass of water (200–250 mLs). 
  • 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 '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.
  • Liquid: Measure your dose carefully with an oral syringe or a measuring spoon.
  • Duration: If you need to take tramadol for more than a few weeks, make a treatment plan with your doctor. Your plan may include details of how and when to stop taking this medicine.
  • Alcohol: Limit or avoid drinking alcohol while you are taking tramadol. Combining tramadol with alcohol can make you more sleepy, drowsy or dizzy. More serious effects include coma and death.
  • Missed dose: If you forget to take your dose, take it as soon as you remember. But, if it is close to the time of your next dose, just take the next dose at the right time. Do not take double the dose.
  • Do not share: Tramadol is prescribed only for you. If shared, it can cause harm.

Taking other medicines with tramadol

Your doctor may recommend taking non-opioid pain relievers such as paracetamol and NSAIDs (ibuprofen, diclofenac, naproxen) as well. If taken regularly, they can reduce how much tramadol you need to take and also reduce any side effects of tramadol.

Do not take other opioid medicines without checking with your doctor.

If you are taking any other medicines or starting a new medicine, check with your doctor or pharmacist to make sure they are safe to take with tramadol. This includes any medicines you buy without a prescription (over the counter), such as herbal and complementary medicines or recreational drugs.

Precautions before starting tramadol

  • Have you ever had a seizure (fits)?
  • Do you have liver or kidney problems?
  • Do you have breathing problems such as asthma, COPD or sleep apnoea?
  • Are you pregnant or breastfeeding?
  • Do you have problems with your bowel such as constipation?

If you answered yes to any of these questions 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.

Tramadol is addictive
  • 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.
  • If you're addicted to tramadol, you may find it difficult to stop taking it or feel you need to take it more often than necessary. Talk to your doctor if you're worried about addiction or if you want to know more about how to prevent withdrawal symptoms.

Possible 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.

Side effects What should I do?
  • Feeling sleepy, dizzy, tired or 'spaced out'
  • Reduced concentration
  • This is common when starting tramadol or after increasing the dose.
  • They should wear off within a week or two.
  • Tell your doctor if they carry on for longer.
  • Be careful when driving or using tools until you know how this medicine affects you.
  • Do not drink alcohol.
  • Feeling sick (nausea) or vomiting
  • This common when you first start taking tramadol.
  • Mostly this settles and goes away.
  • Tell your doctor if this is bothering you.
  • You may need an anti-sickness tablet at times.
  • Constipation
  • Ask your doctor to prescribe a suitable laxative, which you will need to take on a regular basis. 
  • You also need to eat more fruit, vegetables, brown bread, bran-based breakfast cereals and drink plenty of water. Read more about how to ease and prevent constipation.
  • Headache, dry mouth, altered vision
  • These are quite common when you first start taking tramadol and usually go away with time.
  • Tell your doctor if these symptoms bother you.
  • Frequent mood changes, anxiety, depression, thoughts of suicide, abnormal behaviours, hallucinations
  • Tell your doctor immediately or ring Healthline 0800 611 116.
  • Signs of an allergic reaction such as skin rashes, itches, swelling of the face, lips, mouth, or difficulty breathing  
  • Tell your doctor immediately or ring Healthline 0800 611 116.
  • Signs of serotonin syndrome such as feeling agitated and restless, heavy sweating, shivering, fast heart rate or irregular heartbeat, headache, diarrhoea (runny poo) and rigid or twitching muscles
  • You are at increased risk of serotonin syndrome if you recently started taking tramadol, or recently increased the dose. You also have an increased risk if you are taking it with another medicine that increases serotonin.
  • Tell your doctor immediately or ring Healthline 0800 611 116.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.

Learn more

The following links have more information on tramadol.

Tramadol Patient Information  NZ Formulary, NZ 
Arrow-Tramadol capsules, Medsafe Consumer Information sheet, NZ
Tramal SR modified release tablets, Medsafe Consumer Information sheet, NZ
Risks of opioid medicines Medsafe, NZ
Tramadol Talk to Frank, UK 


  1. Prescribing tramadol appropriately BPAC, NZ, 2018
  2. Tramadol hydrochloride NZ Formulary, 2022

Useful resources for healthcare professionals

Arrow tramadol Medsafe, NZ
Tramal SR Medsafe, NZ
Spotlight on tramadol Medsafe, NZ
Tramadol - the Highs and Lows Medsafe, NZ
Tramadol – safe prescribing – consider the risks SafeRx, Waitematā DHB, 2019
Making strong opioids safer for patients Health Quality & Safety Commission, NZ, 2016

Credits: Sandra Ponen, Pharmacist. Reviewed By: Maya Patel, MPharm PGDipClinPharm, Auckland Last reviewed: 18 Mar 2022