Tramadol: Uses, Dosage, Side Effects & Precautions

Tramadol is the generic name of a prescription painkiller from the opioid group. It is used for pain that is moderate to severe.

In India it is sold under several brand names, on its own and combined with paracetamol. Forms and strengths differ between products, and its sale is controlled by narcotics law.

What Is Tramadol?

Tramadol is an opioid painkiller. MedlinePlus[1] places it among the opiate, or narcotic, analgesics and explains that it changes the way the brain and nervous system respond to pain.

The NHS[2] describes it as a strong painkiller that reduces how much pain is felt rather than removing it completely.

MedlinePlus lists tablets, an oral solution and extended-release forms. The NHS adds that injections are mostly given in hospital.

What Are the Main Tramadol Uses?

It is prescribed for moderate to severe pain. The NHS states that doctors usually choose it when weaker painkillers have not worked.

Among tramadol uses, MedlinePlus lists certain kinds of pain and notes that it is sometimes prescribed for other purposes.

The US prescribing information for the brand Ultram[3] describes its use in adults. That is a United States label, and it does not describe the approved indications of any Indian product.

Popular Brands Containing Tramadol

Several brands are listed on Medkart, some with tramadol alone and some combined with paracetamol. Company names are those shown on each listing.

Brand Name	Active Ingredient	Available Strengths / Forms*	Manufacturer / Company
Contramal DT	Tramadol	50 mg tablets	Abbott Health Care Private Limited
Tramazac	Tramadol	50 mg capsules	Zydus Lifesciences Limited
Moredol	Tramadol	50 mg tablets	Morepen Laboratories Limited
Centra DT	Tramadol	50 mg tablets	Medimarck Biotech Pvt Ltd
Tramadin Plus	Tramadol and paracetamol	37.5 mg tramadol with 325 mg paracetamol tablets	Mankind Pharma Limited
Tramacad P	Tramadol and paracetamol	37.5 mg tramadol with 325 mg paracetamol tablets	Cadila Pharmaceuticals Private Limited

Examples of listed strengths and forms, not a complete catalogue. Product ranges can change.

Medkart lists tablets, capsules and injections under tramadol 50 mg, injections under tramadol 100 mg, and combination tablets under paracetamol 325 mg with tramadol 37.5 mg.

A strength such as tramadol 50 mg describes the amount of active ingredient in that product. It is product information, not a dosing instruction.

How Is Tramadol Dosage Decided?

There is no single tramadol dosage for every prescription. NHS guidance on how and when to take tramadol[4] says the doctor weighs pain sensitivity, how bad the pain is, the response to earlier painkillers and any side effects.

Standard tablets, capsules and drops are usually taken three or four times a day for short-term pain. Slow-release forms work over 12 to 24 hours and are taken once or twice a day for severe long-term pain.

The US Ultram label gives a maximum of 400 mg a day, or 300 mg for patients over 75. It sets a 200 mg daily limit for severe kidney impairment and does not recommend Ultram in severe liver impairment. These limits are written for prescribers, not for any individual.

What Are the Common Tramadol Side Effects?

Headaches, drowsiness, dizziness, nausea or vomiting, constipation, a dry mouth, sweating and low energy are the common tramadol side effects. NHS guidance on tramadol side effects[5] reports them in more than 1 in 100 people.

MedlinePlus also lists nervousness, shaking, mood changes and heartburn.

The NHS lists rarer serious effects, including low blood pressure, hallucinations, confusion, extreme sleepiness and difficulty passing urine. It advises emergency help for:

A seizure or fit
Breathing difficulties or short, shallow breathing
Swelling of the lips, mouth, throat or tongue
Skin, lips or tongue that look blue, grey or pale
Severe confusion or loss of consciousness

Does Tramadol Make You Sleepy?

Yes, it can. MedlinePlus warns that it may cause drowsiness and affect coordination.

NHS guidance on common questions about tramadol[6] says alcohol can add to the sleepiness and raise the risk of serious side effects. Cannabis can also increase sleepiness and dizziness.

Why Do Dependence and Withdrawal Matter?

Tramadol can be habit-forming. MedlinePlus warns about dependence, and the NHS says addiction is possible, so doctors monitor the dose.

The NHS lists tolerance and increased sensitivity to pain as possible results of long-term use. It says anyone who has taken the medicine for more than a few weeks should speak to a doctor before stopping.

Withdrawal symptoms listed by the NHS include agitation, anxiety, panic attacks, palpitations, poor sleep, shaking and sweating.

In India it is covered by narcotics law. A notice from Goa’s Directorate of Food and Drugs Administration[7] records notification S.O. 1761, dated 26 April 2018, adding tramadol to the psychotropic substances listed under the Narcotic Drugs and Psychotropic Substances Act, 1985.

What Are the Main Tramadol Interactions?

Several groups of medicines interact with tramadol. NHS guidance on taking it with other medicines[8] lists antidepressants, other painkillers, sleeping tablets, anxiety medicines, allergy medicines, warfarin and medicines for infections.

The NHS warns against monoamine oxidase inhibitors, or MAOIs. The US Ultram label rules out use with an MAOI or within 14 days of stopping one.

Carbamazepine, buprenorphine, ondansetron and rifampicin can make it less effective, according to the NHS.

The US label warns of serotonin syndrome with other serotonergic medicines, and of serious effects with benzodiazepines or other central nervous system depressants.

Tramadol interactions can involve supplements too. MedlinePlus names St John’s wort and tryptophan, and the NHS says there is very little information on herbal remedies.

Who Should Not Take Tramadol, and What Precautions Apply?

NHS guidance on who can and cannot take tramadol[9] says most adults and children aged 12 and over can take it, and lists situations to raise first.

Situation	What to do
A previous allergic reaction	The NHS says to mention any earlier allergic reaction to tramadol or another medicine, or a bad reaction to a strong painkiller.
Fits or a head injury	The NHS lists both among the reasons for advice before starting. The US Ultram label warns of a seizure risk with tramadol.
Breathing problems	The NHS lists breathing problems among the conditions to raise. The US label rules out use in acute breathing depression and severe asthma.
Kidney or liver problems	The NHS lists both conditions. The US label sets lower limits for severe kidney impairment and does not recommend use in severe liver impairment.
Past alcohol or drug problems	The NHS lists problems with alcohol, strong painkillers or illegal drugs as reasons to speak to a doctor first.
Children	The US label rules out use under 12, and under 18 after removal of the tonsils or adenoids.

The NHS also lists pregnancy and breastfeeding. Its guidance on pregnancy and breastfeeding[10] says tramadol during pregnancy is not known to harm the baby’s development, though more research is needed and short-term use is preferred.

The NHS says only small amounts pass into breast milk. The US Ultram label and MedlinePlus advise against breastfeeding during treatment, so this decision should be made with a doctor.

Generic Tramadol Vs Brand-Name Tramadol

Generic and branded versions contain the same active ingredient. The US FDA[11] states that a generic matches the brand on active ingredient, strength, dosage form and route, and is bioequivalent to it.

The FDA adds that approved generics give the same clinical benefit and risks. That is the U.S. FDA standard, and an India-specific regulatory source is needed before making the same claim about an Indian product.

A tramadol alternative from another company can still differ in manufacturer, inactive ingredients, appearance and price. The same ingredient and strength alone do not prove two products are interchangeable, so a doctor or pharmacist should confirm any switch.

Buy or Compare These Medicines on Medkart

Medkart lists tramadol tablets, capsules, injections and paracetamol combinations, all marked as prescription items and not for online sale. They are bought at a Medkart store. Medkart states that its medicines are sourced from WHO-GMP certified manufacturers.

The medicines index shows what is listed. Details a reader can compare on Medkart’s medicine comparison tool include:

Active ingredient
Strength
Dosage form
Manufacturer
Pack size
Current price

Availability and pack size differ between products. Any suggested alternative should be discussed with a doctor or pharmacist before changing a prescribed medicine.

Key takeaways

Tramadol is an opioid painkiller that changes how the brain and nervous system respond to pain.
Doctors prescribe tramadol for pain that is moderate to severe, usually when weaker painkillers have not worked.
A strength such as tramadol 50 mg is product information, not an instruction about how much to take.
Common tramadol side effects include drowsiness, dizziness, nausea, constipation, headaches and sweating.
Tramadol can be habit-forming, and in India it is listed as a psychotropic substance under the NDPS Act, 1985.
MAOIs should not be taken with tramadol, and antidepressants, sleeping tablets and other painkillers need checking first.
Pregnancy, breastfeeding, fits, breathing problems and kidney or liver disease are reasons to seek advice before starting.
Generic and branded tramadol share the same active ingredient, but two individual products are not automatically interchangeable.

FAQs: Common Questions About Tramadol

Q. How quickly does tramadol for pain start to work?

Usually within an hour. The NHS says standard tramadol starts to relieve pain within 30 to 60 minutes, and the effect lasts about four to six hours. Slow-release products can take up to 24 hours to work fully, but their relief lasts longer.

Q. What happens if a dose of tramadol is missed?

It depends on how near the next dose is. MedlinePlus says a missed dose is taken once remembered, unless the next one is almost due, when it is skipped. The NHS says a double dose should never be taken to make up for a forgotten one.

Q. Can slow-release tramadol tablets be crushed or chewed?

No. The NHS says slow-release tablets should not be broken, crushed, chewed or sucked, and warns this could lead to a dangerous overdose. Standard tablets and capsules are swallowed whole with water, and drops are mixed with water first.

Q. Does tramadol make you sleepy enough to affect driving?

Yes, it can. The NHS says a person should not drive, cycle or use machinery if the medicine causes sleepiness, blurred vision, dizziness or poor concentration, at any point in treatment rather than only at the start. MedlinePlus advises against driving until the effect is known.

Q. Can tramadol be taken with paracetamol or ibuprofen?

Yes, in most cases. The NHS says it can be taken with paracetamol, ibuprofen or aspirin, with aspirin limited to people aged 16 and over, but not with codeine painkillers such as co-codamol. Combination tablets already contain paracetamol, so a pharmacist should check before any extra is added.

Q. Can tramadol during pregnancy affect a newborn baby?

Yes, if it is taken close to the birth. The NHS says use near delivery may cause feeding or breathing difficulties in the newborn, which may need hospital monitoring. The US Ultram label also warns of neonatal opioid withdrawal syndrome after exposure in the womb.

Q. Is there a tramadol alternative if it does not control the pain?

It depends on the pain. The NHS says the right painkiller depends on the type of pain and its cause, and advises talking to a doctor if tramadol is not working. Any change of painkiller should be arranged with the prescriber.

References

Medical disclaimer: This article provides general information and does not replace advice from a doctor or pharmacist. Tramadol is a prescription opioid painkiller, and in India it is listed as a psychotropic substance under the Narcotic Drugs and Psychotropic Substances Act, 1985. Brands with the same composition should only be substituted under the guidance of a healthcare professional or pharmacist because product details and approved indications can differ.

Tramadol: Uses, Dosage, Side Effects, Precautions & Interactions