Tramadol ER, Tramadol Hydrochlorideer, Tramadol Hcl ER

Medically reviewed by Amber Watson, PharmD on May 30, 2023
Written by Sarah Lewis, PharmD

This article describes tramadol’s uses, side effects, and more. Below you’ll also find some coupon options to help save on the cost of tramadol.

This article doesn’t provide coupons for all forms of tramadol. To find coupons for tramadol oral tablet, see this article.

Boxed warnings

Tramadol oral tablet and extended-release (ER)* oral tablet have boxed warnings, which are the most serious warnings from the Food and Drug Administration (FDA). These include:

• risk of misuse and addiction
• risk of serious breathing problems
• risk of accidental ingestion
• risk of life threatening effects in children
• risk of neonatal opioid withdrawal syndrome
• risk of interactions with certain medications
• risk of interactions with benzodiazepines and other central nervous system depressants

* With extended-release tablets, the drug is released over time in your body after you take it.

For details, see the “Interactions and warnings for tramadol” section below.

Tramadol may cause mild or serious side effects. More common mild side effects of tramadol and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about tramadol’s side effects, see this article or ask your doctor or pharmacist. You can also read the prescribing information* for tramadol.

* To view tramadol’s prescribing information, see the “Article resources” section below.

Mild side effects

More common mild side effects reported with some forms of tramadol are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about tramadol’s side effects based on the form, see the prescribing information* for tramadol.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Tramadol oral tablet and extended-release† oral tablet’s mild side effects include:

• constipation
• dizziness
• headache
• nausea
• mild allergic reaction‡

* To view tramadol’s prescribing information, see the “Article resources” section below.
† With extended-release tablets, the drug is released over time in your body after you take it.
‡ For details about this side effect, see the “Interactions and warnings for tramadol” section below.

Serious side effects

Serious side effects of tramadol are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about tramadol’s side effects based on the form, see the prescribing information* for tramadol.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, tramadol’s serious side effects include:

• adrenal insufficiency (inability of the adrenal glands to make enough cortisol hormone)
• low sodium levels
• seizures
• serotonin syndrome (a condition of too much of the chemical serotonin in the body), which can be life threatening
• very low blood pressure, which can lead to fainting
• very low blood sugar
• boxed warning: risk of misuse and addiction†
• boxed warning: risk of serious breathing problems †
• boxed warning: risk of accidental ingestion†
• boxed warning: risk of life threatening effects in children†
• boxed warning: risk of neonatal opioid withdrawal syndrome†
• boxed warning: risk of interactions with certain medications†
• boxed warning: risk of interactions with benzodiazepines and other central nervous system depressants†
• severe allergic reaction†

* To view tramadol’s prescribing information, see the “Article resources” section below.
† For details about this side effect, see the “Interactions and warnings for tramadol” section below.

Below you’ll find answers to a few commonly asked questions about tramadol.

Is tramadol a ‘narcotic’? Can it cause withdrawal?

Yes, tramadol is a narcotic drug (also known as an opioid drug). Opioids are controlled substances that treat moderate to severe pain.

Tramadol can cause withdrawal in people who are dependent on it. Withdrawal can happen when people who are dependent on a drug stop taking it suddenly. Being dependent means your body needs the drug to function as usual.

If you have questions or concerns about taking tramadol, talk with your doctor or pharmacist. 

Can tramadol be used for dogs?

Yes, veterinarians can use tramadol for dogs and other animals. They sometimes use human medications to treat conditions in animals.

However, it’s important that you do not give a dog tramadol that’s been prescribed for human use. You’ll only give tramadol to a dog if it’s been prescribed by a veterinarian.

To learn more about the use of tramadol in animals, talk with your dog’s veterinarian.

How does tramadol compare with oxycodone or Toradol?

Similar to tramadol, oxycodone and Toradol are pain relievers.

Oxycodone (Oxycontin, Roxicodone, Roxybond, and Xtampza ER) is an opioid pain reliever. It has many of the same side effects and warnings as tramadol. But it’s more potent than tramadol, so it has a higher risk of misuse and addiction.* (With misuse, you take a drug in a way other than how a doctor prescribes it. With addiction, a drug is taken even if doing so causes harm.)

Toradol was the brand-name version of ketorolac, but brand-name Toradol is no longer available in the United States. Ketorolac is prescribed for moderate to severe pain, similar to tramadol. But it’s a nonsteroidal anti-inflammatory (NSAID) drug. So it has different side effects and warnings than tramadol. Since it isn’t an opioid drug, Toradol doesn’t have a risk of misuse or addiction.

Talk with your doctor if you think tramadol isn’t relieving your pain. They can prescribe a different pain reliever that might work better.

* Tramadol has a boxed warning for misuse and addiction. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Interactions and warnings of tramadol” section below.

Is it safe to take tramadol with ibuprofen or Tylenol?

Yes, it’s safe to take tramadol with ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol). In fact, doctors often recommend this combination.

Taking tramadol with either of these two drugs can relieve pain more effectively. This usually means people don’t need to take as much tramadol, which lowers the risk of misuse and addiction.* (With misuse, you take a drug in a way other than how a doctor prescribes it. With addiction, a drug is taken even if doing so causes harm.)

Talk with your doctor about taking ibuprofen or Tylenol with tramadol. They’ll advise whether it’s safe for you to take these medications.

* Tramadol has a boxed warning for misuse and addiction. A boxed warning is the most serious warning from the FDA. For details, see the “Interactions and warnings of tramadol” section below.

How does tramadol work? And how long does it take to start working?

Tramadol is an opioid medication. So it attaches to opioid receptors in the brain and spinal cord. (Receptors are binding sites on cells.) This causes tramadol’s pain-relieving effects.

Tramadol oral tablet will start to work within an hour. It’ll reach its peak pain relief in about 3 hours. Due to its half-life, you’ll take your dose every 4 to 6 hours. (A drug’s half-life is about how long it takes your body to get rid of half of a dose.)

Tramadol extended-release oral tablet will last longer. (With extended-release tablets, the drug is released over time in your body after you take it.) You’ll take a dose once every 24 hours.

To find out more about what you can expect with tramadol, ask your doctor or pharmacist.

Does tramadol increase the risk of side effects in older adults?

Yes, certain older adults (ages 75 and older) may have a higher risk of side effects from tramadol compared with younger adults (under 65 years of age).

In studies* of the drug, adults 75 years and older were more likely to have treatment-limiting side effects. This means the side effects were serious enough to limit the dose or length of their treatment. In some cases, they had to stop treatment.

The most common treatment-limiting side effects were digestive problems, including constipation. Slowed breathing is also a serious risk for older adults. (Tramadol has a boxed warning for serious breathing problems. A boxed warning is the most serious warning from the FDA. For details, see the “Interactions and warnings of tramadol” section below.)

If you’re an older adult and concerned about taking tramadol, talk with your doctor or pharmacist.

* For details about tramadol’s studies, see its prescribing information in the “Article resources” section below.

The dosage of tramadol your doctor prescribes may vary based on your condition and certain other factors. Talk with your doctor about the dosage you should take.

Taking tramadol

Tramadol oral tablet is swallowed, with or without food.

Tramadol extended-release (ER)* oral tablet is swallowed, with or without food. Your doctor will likely recommend taking the drug in the same way each day, either always with food or always without food. This is because food can affect how quickly the drug works. And taking it the same way each day helps the drug provide steady pain relief over time.

Be sure to swallow the ER oral tablet whole. Do not crush, chew, break, or dissolve it. Doing so could result in a fatal overdose.

Your doctor will talk with you about how to take tramadol. They’ll explain how much to take and how often. Always follow your doctor’s recommendation.

* With extended-release tablets, the drug is released over time in your body after you take it.

Overdose of tramadol

You should not take more tramadol than your doctor prescribes. For some drugs, doing so may lead to serious side effects or overdose.

If you think you’ve taken too much tramadol, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

The Food and Drug Administration (FDA) approves prescription drugs such as tramadol for certain conditions. Approved uses for tramadol are described below.

Use for pain

Doctors may prescribe tramadol oral tablet and extended-release (ER)* oral tablet for treating moderate to severe pain. It’s used for this purpose in adults. Tramadol oral tablet can be prescribed as a long-term or short-term treatment. Tramadol extended-release oral tablet is a long-term treatment for chronic pain.

With moderate to severe pain, you may have pain that’s hard to ignore. And it may affect your daily activities. Doctors prescribe tramadol for pain caused by various conditions, such as injury or surgery. In these cases, an opioid pain reliever is needed.

Doctors may not prescribe tramadol oral tablet and ER oral tablet in certain situations, such as if:

• you have a high risk of serious breathing problems
• you have severe asthma
• you have depression or suicidal thoughts
• you have or might have a blockage in your digestive system
• non-opioid pain relievers are likely to work for you instead
• you’ve had problems with substance misuse or addiction†

* With extended-release tablets, the drug is released over time in your body after you take it.
† Tramadol has a boxed warning for misuse and addiction. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Interactions and warnings of tramadol” section below.

Below, you’ll find information about tramadol’s possible interactions and warnings.

Interactions of tramadol

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.*

Before you take tramadol, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription medications
• over-the-counter medications
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for tramadol” section below.

* Tramadol has a boxed warning for the risk of interactions with certain medications. It also has a boxed warning about the risk of interactions with benzodiazepines and other central nervous system depressants. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see “Warnings for tramadol” below.

Warnings for tramadol

Some people should not take tramadol, and others should take it cautiously.

Boxed warnings

Tramadol has boxed warnings about the following risks. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

To learn more about these warnings, read below. You can also talk with your doctor or pharmacist.

Risk of misuse and addiction. With misuse, you take tramadol in a way other than how a doctor prescribes it. An example is taking it when you aren’t in pain or taking it more often than you should.

Misuse can lead to addiction, which is continuing to take a drug even though it may be causing harm.

Symptoms of addiction may include craving the drug and taking the drug to cope with problems.

If you experience misuse or addiction, tell your doctor. They’ll likely recommend ways to get help.

Risk of serious breathing problems. With serious breathing problems, such as respiratory depression, you have slowed or stopped breathing. It can be fatal.

The risk is highest when you first start tramadol treatment and after a dosage increase. The risk is also higher in older adults (ages 65 and older).

If you experience serious breathing problems, seek immediate medical care or call 911 or a local emergency number.

Risk of accidental ingestion. With accidental ingestion, you accidentally take tramadol. This can lead to an overdose, which can be fatal. Accidentally taking tramadol can be especially dangerous in children. (For details about overdose with tramadol, see the “Dosage of tramadol” section above.)

Symptoms may include slowed breathing, small pupils, cold and clammy skin, extreme sleepiness, and coma.

If you experience an accidental ingestion, seek immediate medical care or call 911 or a local emergency number.

Note: Tramadol is not approved for use in children.

Risk of life threatening side effects in children. If your child takes tramadol, they may have a high risk of life threatening side effects, including slowed or stopped breathing. The risk is even higher with certain factors, including if your child:

• metabolizes (breaks down) the drug faster than usual, leading to high levels of a more active form of the drug in the body
• has lung disease, obesity, sleep apnea (a serious sleep disorder), or a nervous system disease that affects breathing
• has surgery to remove the tonsils or adenoids (glands in the roof of your mouth)
• taking other medications that can slow breathing

If your child is experiencing life threatening side effects, seek emergency help by calling 911 or a local emergency number.

Due to the above risks, doctors will likely not prescribe tramadol in children younger than 12 years. And they may not prescribe tramadol for children ages 12–17 years who have the risk factors listed above.

Note: Tramadol is not approved for use in children. But doctors may prescribe the drug off-label for children. This means they can prescribe the drug for children even though it’s not approved for this use.

Risk of neonatal withdrawal syndrome. With neonatal opioid withdrawal syndrome, a newborn experiences withdrawal symptoms after birth. This is because they were exposed to the drug in the womb before birth. And they were dependent on it. With dependence, your body needs a drug to function as usual.

Symptoms in newborns may include tremor (shaking), a high-pitched cry, diarrhea, or vomiting. These and other symptoms of withdrawal can be fatal.

If you become pregnant while taking tramadol, tell your doctor. They’ll help you decide if you should continue taking tramadol.

Risk of interactions with certain medications. If you take tramadol with certain medications, dangerous drug interactions can occur. This includes drugs that affect how your body processes and gets rid of tramadol.

Symptoms may include serious side effects, such as slowed breathing or seizures. Withdrawal symptoms, such as anxiety, nausea, vomiting, or diarrhea, may also occur.

If you have concerns about interactions with certain medications, tell your doctor. They’ll likely adjust your treatment.

Risk of interactions with benzodiazepines and other central nervous system depressants. If you take tramadol with benzodiazepines and other central nervous system (CNS) depressants, coma and death may occur. CNS depressants slow brain activity. Benzodiazepines, alcohol, and many other substances are CNS depressants. Taking them with tramadol can slow brain activity too much, which can be fatal.

Symptoms may include slowed or stopped breathing, loss of consciousness, and coma. Death can also occur.

If you have concerns about interactions with benzodiazepines and other CNS depressants, tell your doctor. They’ll likely recommend that you stop taking your other CNS depressants while taking tramadol.

Other warnings

Tramadol could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether tramadol is a safe option for you. These warnings may differ based on the form of tramadol you take.

Ask your doctor about specific warnings for tramadol, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Tramadol can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to tramadol or any of its ingredients, your doctor will likely not prescribe tramadol. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• severe skin rashes that may blister and peel
• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to tramadol, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Pregnancy or breastfeeding and tramadol

Information about tramadol and pregnancy and breastfeeding is described below.

Tramadol and pregnancy

There are risks to taking tramadol during pregnancy. There’s a boxed warning for risk of neonatal withdrawal syndrome. A boxed warning is the most serious warning from the FDA. (For more details, see the “Warnings for tramadol” section just above.) There are also risks with having untreated moderate to severe pain while pregnant. (Keep in mind that tramadol is prescribed for treating moderate to severe pain.)

If you’re planning a pregnancy or can become pregnant, talk with your doctor about moderate to severe pain treatment options during pregnancy. Together, you can discuss the risks and benefits of your treatment options and decide whether you should take tramadol during pregnancy.

Tramadol and breastfeeding

Tramadol should not be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication. Your doctor may recommend other ways to feed your child during treatment with tramadol.

You may be able to save money on your prescription for tramadol by using our Perks discount coupons. They can be found at the end of this article.

If you have questions about how to pay for tramadol, talk with your doctor or pharmacist. You can also learn more about the cost of tramadol in this article.

Note: Optum Perks coupons cannot be used with insurance copays or benefits.

This article describes tramadol’s uses and dosage, ways to save on cost, and more. Let your doctor know if you have questions about tramadol or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Is tramadol available as a brand name?
• Does tramadol make you sleepy?
• Is there a best time of day to take tramadol extended-release oral tablet?

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Tramadol hydrochloride extended-release tablets for oral use, C IV. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/68484531-f908-473f-a422-f37234de9691/spl-doc
• Tramadol hydrochloride tablets, for oral use, C-IV. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/c2bde858-47a3-4b4b-a153-42409ea5f4dc/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.