What is Tramadol?

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Tramadol is a prescription medication used to treat severe pain. It works alone or in combination with other drugs to treat chronic pain. Originally, 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.

tramadol overdose

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

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?

Some tramadol users have a higher risk of overdose. For example:

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.

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. 

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. Mixing this drug with alcohol or other drugs also poses a risk of overdose.

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 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.

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. 

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 for Tramadol Addiction

Both outpatient and residential addiction treatment programs are available for people with a tramadol addiction. In most cases, overcoming an addiction to tramadol requires detox, ongoing treatment, and access to relapse support.

Tramadol detox removes the drug from the body. The reduction in toxicity is performed on an inpatient or outpatient basis. 

In most cases, doctors encourage tramadol users to slowly wean off the drug under medical supervision. This reduces the intensity of withdrawal symptoms and the risk of relapse. Medically supervised tapering off of a drug is almost always more effective than going “cold turkey.”

In addition to detox, tramadol-addicted individuals also focus on eliminating their psychological dependence on the drug. A variety of therapies help with this process, including one-on-one counseling, group therapy, and 12-step program participation.

People with co-occurring disorders must receive treatment for both tramadol addiction and the other issue. 

For example, someone diagnosed with depression or anxiety must treat those conditions along with the addiction to the drug. If their co-occurring issue is an additional addiction, that should be treated as well.

Specific treatment options used to deal with tramadol addiction include: 

  • Group therapy
  • One-on-one counseling
  • 12-step programs
  • Support groups
  • Cognitive-behavioral therapy (CBT)
  • Biofeedback
  • Motivational enhancement therapy (MET)
  • Dialectical behavior therapy (DBT)
  • Medication-assisted treatment (MAT)
  • Art, yoga, animal, and other holistic therapies

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Resources +

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, https://www.pubmed.ncbi.nlm.nih.gov/12842359/, 10.1016/s0379-0738(03)00100-2.

Treat Opioid Use Disorder. 2019, https://www.cdc.gov/drugoverdose/prevention/treatment.html.

“Tramadol: MedlinePlus Drug Information.” Medlineplus.gov, Oct. 2019, https://www.medlineplus.gov/druginfo/meds/a695011.html.

Center for Drug Evaluation and Research. “Tramadol Information.” FDA, 3 Nov. 2018, www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/tramadol-information.

Shermling, Robert H. M.D. “Is Tramadol a Risky Pain Medication?” Harvard Health Blog, 14 June 2019, https://www.health.harvard.edu/blog/is-tramadol-a-risky-pain-medication-2019061416844.

Dhesi, Manraj, et al. “Tramadol.” PubMed, StatPearls Publishing, 2021, https://www.pubmed.ncbi.nlm.nih.gov/30725745/.

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