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What is Tramadol?

Tramadol is a prescription medication used to treat severe pain, acting in the central nervous system. It works alone or in combination with other drugs to treat chronic pain. Initially, this painkiller was not as tightly regulated as drugs classified as opiates.

However, after the medical community recognized Tramadol abuse and addiction, the FDA changed the drug’s classification in 2014. 

The FDA now considers it a controlled substance, which means it has medical uses, but there is at least a moderate risk of misuse or addiction. This includes limiting the number of refills available and requiring a new prescription every six months.

Despite its risk of misuse and addiction, tramadol is safer than many pain medications. The FDA officially classified it as a Schedule IV opioid analgesic drug. Doctors prescribe it to treat osteoarthritis and other painful conditions. It works by altering how your brain senses pain.

Side Effects & Risks of Tramadol Use

Like all drugs, tramadol produces side effects, including:

  • Drowsiness
  • Headache
  • Dizziness
  • Nausea
  • Vomiting
  • Constipation
  • Sweating
  • Lack of energy
  • Dry mouth

The side effects of tramadol are usually mild and typically ease in a few days of use. However, users of tramadol should speak to their doctor if any of these side effects are severe.

Some users of tramadol experience more severe side effects that require immediate medical attention, including:

  • Serotonin syndrome
  • Breathing problems
  • Physical dependence
  • Adrenal insufficiency
  • Androgen deficiency
  • Seizures
  • Addiction or abuse
  • Overdose or tramadol poisoning

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What are the Symptoms of a Tramadol Overdose?

There is a risk of overdose when using tramadol. Overdose symptoms include:

  • Seizure (frequent)
  • Nausea
  • Vomiting
  • Drowsiness
  • Dizziness
  • Blurred vision
  • Anxiety
  • Apnea or other breathing disruptions
  • Loss of consciousness
  • Coma
  • Death
  • Cold, clammy skin

There are mild occurrences of some of these symptoms when someone begins using tramadol. It’s important to contact your doctor if you have questions about symptoms or if you believe symptoms are severe and not related to your body initially adjusting to the medications. 

What are the Risk Factors for a Tramadol Overdose?

According to the United States Drug Enforcement Administration (DEA), the following people are most likely to abuse tramadol:

  • Those who are already suffering from narcotic addiction
  • Those who are in chronic pain
  • Health professionals

Men are more likely to overdose on prescription painkillers. However, overdose cases in women have risen in recent years.

Centers for Disease Control and Prevention

There are also other risk factors for a tramadol overdose. For example:

Drug and Alcohol Interactions

Oftentimes, mixing tramadol and other medications leads to dangerous drug interactions. Some drugs, when combined with tramadol, can cause respiratory depression and decreased heart rate

Common medications that can moderately or severely interact with tramadol are:

  • Acetaminophen (Tylenol)
  • Alprazolam (Xanax)
  • Celecoxib (Celebrex)
  • Cyclobenzaprine (Flexeril)
  • Duloxetine (Cymbalta)
  • Escitalopram (Lexapro)
  • Pregabalin (Lyrica)

Frequent Doses

The more often you take a drug, the higher the risk of overdose. People using tramadol must keep careful track of their daily doses. This ensures they do not overdose due to forgetting if they have taken their daily dose. 

Large Doses

The higher dose of medication, the greater the likelihood of overdose. This is one of the reasons doctors usually begin with a smaller dose and increase it gradually as the patient responds.

History of Mental Health Issues

People with a history of mental illness might accidentally or intentionally take too much tramadol. The use of this medication should be carefully monitored for people who previously struggled with managing their usage of medications.

Additionally, tramadol’s warning label includes a risk of suicidal ideations. This is especially of concern when the drug is prescribed to people diagnosed with depression or who previously attempted suicide. 

History of Substance Abuse

Tramadol is addictive, though not as highly addictive as other pain medications. However, people with a history of substance misuse or addiction have a risk for misusing tramadol.

Relapse

Another major risk factor for tramadol overdose is relapse. A person in recovery who relapses doesn't have the same tolerance level as they had before they stopped taking the drug. If they attempt to go back to their pre-abstinence dose, their body may not be able to take such high doses anymore. This can lead to fatal outcomes.

Tolerance

Tramadol abuse puts the user in danger of an overdose. This is because abusing tramadol often leads to tolerance. This means that the user will need higher doses of the drug to achieve the desired effects. The more the user craves higher doses of tramadol, the higher the risk for overdose.

How Much Tramadol Results in an Overdose?

A dose of more than 2,000 mg of tramadol can result in an overdose. This is at least five times the recommended daily dose of the drug. Smaller doses pose less of a risk of overdose, but how someone ingests the drug plays a role. 

The faster the dosage makes it into your bloodstream, the higher the risk of overdose.

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Are Tramadol Overdoses Deadly?

They can be. Tramadol overdose typically triggers serotonin syndrome. It might not result in immediate death, but too much serotonin makes you sick and can be fatal over time.

Symptoms of serotonin syndrome include:

  • Tremors
  • Nausea
  • Sweating
  • Muscle spasms
  • Rapid spike in blood pressure
  • Rapid breathing
  • Elevated heart rate
  • Muscle rigidity
  • Shivering
  • Fever
  • Diarrhea
  • Seizures
  • Agitation
  • Confusion

Mixing tramadol with other medications, including antidepressants and antipsychotics, increases the risk of serotonin syndrome. 

What are the Long-Term Effects of a Tramadol Overdose?

Using too much tramadol puts a person at risk for a variety of different symptoms. For example:

  • Drug tolerance. The more you use the drug, the more you need to achieve the same pain-relieving effect. This increases your risk of addiction.
  • Physical dependence. In addition to thinking you need the drug to function, tramadol also poses a risk of physical dependence. This occurs when your body cannot function without the drug.
  • Withdrawal. Symptoms of withdrawal are common after someone overdoses on tramadol because their bodies are used to the presence of the drug. Withdrawal is also a problem for long-term users even if they have not overdosed.
  • Seizures. People abusing tramadol have a high risk of seizures. Epilepsy elevates this risk.
  • Respiratory problems. Slow, shallow breathing is common among people who have abused tramadol.
  • Adrenal insufficiency. Tramadol affects the adrenal glands, which control hormone balance in the body. When the adrenals no longer manage hormones effectively, users experience constant fatigue, lack of appetite, and muscle weakness.
  • Kidney and liver damage. These organs are responsible for processing drugs in the system. Overdose taxes their performance.
  • Cognitive impairment. Long-term tramadol use and overdose cause cognitive decline. People who have used too much of the drug lack mental sharpness and might be unable to perform complex tasks.
  • Personal problems. Drug abuse leads to problems in one’s life, including issues in school, at work, and with loved ones.

How to Avoid Opioid Overdoses

There are several tools available for reducing the risk of opioid overdose. For example:

  • Improve prescribing of these drugs. Changes to clinical practice guidelines ensure patients have access to safe, effective pain relief without the risk of misuse or overdose. Medical professionals are encouraged to weigh the risks and benefits of prescribing opioids to patients.
  • Prescription drug monitoring programs (INSPECT). Healthcare professionals must know what and how much of a drug is in use by patients.
  • Insurance program changes. Insurance companies can require prior authorization, limit quantities, and conduct drug utilization reviews, creating a more detailed record and added control of tramadol use.
  • Patient education programs. The more patients understand the risks and dangers of a drug, the less likely they are to misuse it. It’s also important for users of the drug to know how to properly store and dispose of tramadol. Patients must also be educated about safe dosing and taught how to track their use of tramadol to avoid accidental overdose.
  • Increased access to evidence-based treatment options. People who are misusing tramadol need access to affordable and effective treatment.
  • Increased access to mental health support. The tramadol disclaimer includes an increased risk of suicide. Patients prescribed tramadol must be encouraged by their healthcare provider to seek mental health support when needed. 

Treatment Options for Opioid Abuse & Addiction

Opioid use disorder is difficult to overcome. Fortunately, there are several options for help. These include:

  • Medication-Assisted Therapy (MAT) When it comes to medication-assisted therapy for opioid use disorder, there are three types approved: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone help manage withdrawal symptoms as you detox. Naltrexone blocks the receptors that opioids bind to, making it impossible to get high from them. Medication-assisted therapy is most effective when combined with other therapies.
  • Inpatient Programs — Inpatient programs are the most intensive addiction treatment options. These programs guide you through medical supervised detoxification, behavioral therapy and other services such as medication-assisted therapy. They typically last 30, 60 or 90 days, but may be longer if necessary.
  • Partial Hospitalization Programs (PHPs) Intensive outpatient programs are the next level of addiction treatment, providing similar services to inpatient programs such as detoxification and behavioral therapy. The difference is that the patient will return home to sleep, and some programs will include transportation and meals. PHPs are ideal for both new patients as well as those who have completed inpatient treatment but still need intensive care.
  • Outpatient Programs Outpatient programs provide a well-rounded treatment program for people with a high motivation to recover. These programs are flexible and can be made around for your schedule, and can be customized to work best for you. These programs work for new patients as well as those that complete an inpatient or partial hospitalization program.

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Resources

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Clarot, F., et al. “Fatal Overdoses of Tramadol: Is Benzodiazepine a Risk Factor of Lethality?” Forensic Science International, vol. 134, no. 1, 24 June 2003, pp. 57–61.

"Treat Opioid Use Disorder." Centers for Disease Control and Prevention, 2019.

Tramadol: MedlinePlus Drug Information.” Medlineplus.gov, Oct. 2019.

Center for Drug Evaluation and Research. “Tramadol Information.” FDA, 3 Nov. 2018.

Shermling, Robert H. M.D. “Is Tramadol a Risky Pain Medication?” Harvard Health Blog, 14 June 2019.

Dhesi, Manraj, et al. “Tramadol.” PubMed, StatPearls Publishing, 2021.

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