Tramadol is commonly available by the trade name of Ultram. It is often prescribed as a narcotic painkiller. It is derived from opium poppy and used for the treatment of mild to moderate and severe pain. It is mainly related to morphine and codeine, and depends on the same mechanism of action to ensure pain relief.

Mechanism of Action

The main action of Tramadol is based on bringing about the absence of pain. The signals of pain are generated in the spinal cord and Tramadol interferes with the transmission of the pain signals to the brain. This action ultimately leads to the absence of pain, as the brain is unable to get the nervous signals needed to feel the pain.

Substances that should not be used with Tramadol

Tramadol should not be used with alcohol, antidepressants, tranquilizers or any other SSRIs (Selective serotonin re-uptake inhibitors). In case of gastric or intestinal blockage, asthma and seizures, the use of Tramadol is prohibited. This is because, in some patients, the occurrence of epilepsy and seizures may remarkably increase with the administration of Tramadol. The drug should also be avoided by breastfeeding mothers, as it can easily pass to the infant within the milk.

Adverse Effect

Several adverse effects are associated with the administration of Tramadol, some of which are provided below.
• Constipation
• Respiratory distress
• Compromised cognitive functioning
• Gastric pain
• Dry mouth
• Complication of digestion
• Headache
• Vertigo

Side Effects

Seizures and physical dependence can be regarded as the common adverse effects of Tramadol. These adverse effects are commonly exaggerated with the use of alcohol. Moreover, an overdose can lead to death due to sudden increase in heart rate, leading to cardiac arrest.

Physical dependence is also associated with the administration of a larger dose for an increased period of time. Dependence is mainly concerned with the feeling of craving for the medication. Withdrawal symptoms may appear in case of a sudden decline of the drug in the bloodstream. However, this problem can be overcome by reducing the quantity and intake of the drug gradually over time.

Recreational Use

Tramadol is often used for recreational purposes. This is because it boosts the metabolism as well as the functioning of the brain, leading to the feeling of euphoria (feeling of happiness). Increased administration of Tramadol for recreational use can lead to insomnia, loss of appetite, disruption in sleep pattern, dizziness and nausea.


Tramadol interacts with a variety of drugs including TCAs (antidepressants), analgesics (painkiller), anxiolytics (anti-seizures), amphetamines, antibiotics and antidepressants. It is important to ask the patient about their history of medication, as it can lead to severe consequences, including epilepsy, cardiac arrest and sudden death.


Adult Dose

Initial recommended dosage: 25mg OD (Morning)
Extended release drug: initial dose in 100mg OD. In case of severe pain, the dose is prescribed b.i.d (two times a day) but the total dose should not increase the limit of 300mg.

Geriatric Dose

Over 65 years: 300 mg per day, Consideration of renal and hepatic performance of the body is essential. The dose range should be calculated prior to the administration and prescription of Tramadol.
Over 75 years: Divided doses of 300mg
The prescription of Tramadol is acceptable in case of severe pain associated with tumors and related conditions. However, this practice should not be encouraged as it is associated with increased chances of physical dependence.