18 Things You Need to Know About Tramadol (Ultram)

By Efosa Airuehia | 2196 Comments | Addiction Treatment,Drugs and Alcohol,

18 Things You Need to Know About Tramadol (Ultram)

18 Things You Need to Know About Tramadol (Ultram)

Have you heard of Tramadol? You likely have. Tramadol is an opioid medication used to treat moderate to severe pain. The benefits of this medication are well known. Perhaps, you are also aware of the adverse effects of this drug.

Most people know Ultram is a pain medication. Several people have had to consume this drug at one time or another. Did you know it has the potential for abuse? Or that it can be addictive? Indeed, Tramadol is one of the most commonly abused drugs in the world.

It is thus essential to educate yourself on this medication. Informing ourselves will help with avoiding potential dangers. It also puts us in a position to educate and keep others safe.

So, here are 18 things you need to know about tramadol.


1. What is Tramadol?

Tramadol is a synthetic opioid pain medication. This prescription drug is similar to others like hydrocodone, codeine, and oxycodone. Ultram works for moderate to severe pain. This medication has made headlines more recently with the substantial opioid addiction problem in the United States. For this reason, it is essential only to use tramadol as prescribed.

When is Ultram prescribed? It is given after surgery and also for other painful conditions like fibromyalgia. Because tramadol is an opioid, it acts on areas of the brain known as opioid receptors. As a result of binding on these receptors, it decreases pain.

Although tramadol acts like other opioids, it is not as potent as morphine, oxycodone, or hydrocodone. Ultram works on different brain chemicals. These include dopamine, norepinephrine, and serotonin. Even though Ultram is a milder opioid, addiction can still be an issue.

Natural opiates come from processing the dried milk of the opium poppy plant. On the other hand, synthetic opiates, like tramadol, are made in labs. Tramadol is a synthetic opiate that acts similarly to the natural opiates.

The FDA approved this drug for pain treatment in 1995. It was, however, non-controlled at the time. Since then, there have been reports of drug misuse, abuse, and diversion. As a result of this, tramadol is now a controlled substance.


2. Brand Names and Street Names of Tramadol

Tramadol is the generic or chemical name for this substance. It was approved for marketing in the U.S. in 1995 under the trade name of Ultram. There are a few trade (brand) names for tramadol. These include:

  • Ultram
  • ConZip
  • Rybix ODT
  • Ryzolt
  • Ultram ER
  • Ultracet (contains acetaminophen)

Because of the abuse of tramadol, there are also various street names for this drug. Some of these are:

  • Chill Pills
  • Ultra
  • Trammies


3. What is the Dose for Tramadol?

Depending on the brand, tramadol tablets can come in 50 mg, 100 mg, 200 mg, and 300 mg tablets. The recommendation is to take 50 – 100 mg by mouth, every four to six hours. Sometimes, individuals start on just 25 mg and increase slowly.

tramadolThe maximum dose of tramadol per day is 400 mg. However, it is best to use the smallest effective treatment. It is also essential to use it for the shortest possible time. In older people, the preference is lower doses and a slower increase.

According to the DEA, there were 43.6 million tramadol prescriptions in the U.S. in 2016. And then 41 million in 2017. 16 million prescriptions were dispensed for the first half of 2018. I am sure you agree with me that this is a lot of medications!

Most people take their tramadol as prescribed. On the other hand, some misuse their prescriptions. Some other people even outrightly abuse this drug, taking much higher doses than they should. Taking tramadol in the wrong way can ultimately lead to many problems.


4. How does Tramadol Work?

The way a drug works is known as its mechanism of action. For Ultram, the exact mechanism of action is unknown. We do, however, know that tramadol binds to specific areas of the brain. These areas are called opioid receptors. Tramadol also acts on some brain chemicals – norepinephrine and serotonin.

The liver plays a significant role when tramadol gets in the body. This medication passes through the liver, which makes some changes to it. These changes occur through a process called metabolism. Consequently, tramadol gets out of the body in the urine. About 30% of the tramadol taken is passed in the urine unchanged. For this reason, urine tests can detect tramadol.


5. Some Shocking Statistics

Below are some worrying facts from the National Institute on Drug Abuse:

  • More than 40 Americans die from overdosing on opioid pain prescriptions every day.
  • 52 million individuals in America over the age of 12 years have abused prescription pills in their lifetime.
  • In 2010, there were enough prescriptions for painkillers handed out by physicians to medicate every adult in the U.S. every 4 hours for a whole month.
  • In 2010, there were 5.1 million prescription painkiller abusers in America.

These staggering statistics shed light on the severity of the opioid problem in America.


6. Is Tramadol Addictive?

Yes! Tramadol is addictive. Moreso, when taken in higher doses, or for long periods. The recreational use of Ultram is not only dangerous but also a criminal offense.

Ultram is not as strong as some other opioid medications. For this reason, it was generally thought not to be addictive. Recently, however, more and more people have been misusing and abusing this medication. This illegal use has ultimately led to dependence on the drug with accompanying withdrawal symptoms.

Some people describe a sense of relaxation and euphoria when they take tramadol. Because of this, there is a potential for some individuals to become addicted to this medication. Pain from different conditions can make people very miserable. For this reason, they may take more tramadol than prescribed.

Tramadol is not as addictive as some other pain medications like fentanyl and oxycodone. It is, however, still dangerous, and you should only take it as prescribed. Physiological and psychological dependence can occur with this drug. Consequently, stopping the medication manifests in withdrawal symptoms. So, it is advisable never to stop tramadol abruptly. Moreso, if you have been taking high doses for a long time.

People who abuse this drug mostly take more than the recommended dose of 400 mg by mouth. But some others crush the pills and snort them. This technique gets the drug to the brain very quickly, causing a quick euphoric high.


7. How do you know you are Addicted to Tramadol?

Below are several pointers to possibly having tramadol use disorder:

  1. Taking more significant amounts of tramadol over extended periods than intended.
  2. A persistent desire or unsuccessful efforts to cut down or control use.
  3. Spending a great deal of time in activities necessary to get, use, or recover from it.
  4. Craving for tramadol. Or also a strong desire or urge to use it.
  5. The recurrent use of tramadol causing a failure to fulfill role obligations. This failure may be at work, school, or home, for instance.
  6. Continued use despite having persistent or recurrent social or interpersonal problems.
  7. Important social, occupational, or recreational activities stopped or reduced because of it.
  8. Recurrent tramadol use in situations in which it is physically hazardous
  9. Continued use even with having a physical or psychological problem due to or made worse by tramadol.
  10. Tolerance to tramadol. Tolerance may be a need for increased amounts to achieve intoxication or the desired effect. It may also present as a decreased effect with continued use of the same amount of tramadol.
  11. Withdrawal symptoms.


8. Who Abuses Ultram?

More than 100 million adults in the United States experience severe pain. This condition affects their quality of life, ability to work, and performance of daily tasks. Chronic pain management remains a challenge. This dilemma is not just for the patients, but also for the health care providers.

Ultram is most commonly abused by:

  1. people who use recreationally
  2. chronic pain patients
  3. health professionals

Other risk groups for tramadol abuse are military personnel/veterans, teenagers/college students, and construction workers.

According to the American Association of Poison Control Centers, there were 12,108 tramadol exposures in 2016. Out of this number, there were 5,712 single substance exposures and three associated deaths. The National Survey on Drug Use and Health also made a report in 2016. This report showed that 1.6 million people in the U.S. aged 12 or older misused tramadol products in the past year.

9. What are the Side Effects of Tramadol?

Ultram is generally well-tolerated by most people. However, it can also lead to some side effects, some of which may be life-threatening. Even as far back as 2011, there were an estimated 54,397 emergency room visits involving tramadol. Out of this number, 27,421 (50%) was due to side effects.

There are many possible side effects of Ultram. These side effects can occur even when used in regular doses. Some examples are:

  • Dizziness
  • Nausea
  • Constipation
  • Headache
  • Vomiting
  • Fever
  • Sore throat
  • Skin itching
  • Excessive sweating
  • Stomach discomfort
  • Diarrhea
  • Flushed skin
  • Loss of appetite
  • Difficulty sleeping

The above are common problems with this medication. There are, however, some more severe side effects with this medication. These include:

  • Seizures
  • Breathing problems
  • Severe rash
  • Low blood pressure
  • Fainting spells
  • Confusion
  • Issues with body organs, eg adrenal gland, intestines, eyes
  • Heart problems
  • Thoughts of suicide
  • Serotonin syndrome

Even though seizures can occur in people taking recommended doses of tramadol, this is more likely at higher than average dosages. Again, another reason to avoid abusing this medication! Also, it is crucial to prevent children from taking Ultram. The reason for this is because difficulty breathing and death can occur.


10. Withdrawal from Tramadol

Abruptly stopping Ultram leads to two types of withdrawal syndromes – typical and atypical withdrawal syndromes.

Typical Withdrawal Syndrome

This withdrawal is typical of opioid medications. Also, it occurs in about 90% of cases. Such symptoms include:

  • Nausea
  • Restlessness
  • Difficulty sleeping
  • Sweating
  • Anxiety
  • Flu-like symptoms
  • Diarrhea
  • Body pains
  • Cravings

Atypical Withdrawal Syndrome

The second type of withdrawal syndrome is atypical of opioids and occurs in about 10% of cases. Atypical withdrawal may require intensive medical treatment. Symptoms include:

  • hearing or seeing things that are not there (hallucinations)
  • paranoia
  • panic attacks
  • extreme anxiety
  • confusion
  • tingling in the arms and legs
  • numbness


11. Black Box Warning

opioidA black box warning is the strictest warning put in the labeling of prescription medications by the FDA. This warning is put in place when there is a concern of a serious hazard with the drug. Tramadol has several such warnings.

The warning for “Addiction, Abuse, and Misuse” reads as follows:

Opioid agonist Schedule IV controlled substance with a risk of addiction, abuse and misuse, which can lead to overdose and death; reserve opioid analgesics for patients with inadequate treatment alternatives; assess opioid abuse or addiction risk prior to prescribing; regularly monitor all patients for misuse, abuse, and addiction. 


12. Is Tramadol safe for people with kidney and liver disease?

The recommendation is to decrease the dose of Ultram in kidney disease. The kidneys remove about 30% of tramadol without any change to the drug. Hence, people with kidney problems can have very high levels of tramadol in their blood. This toxic level is lethal to the body.

Also, people with liver disease need a change in dose and frequency of Ultram. The reason for this is because this medication goes through the liver, which makes changes to it as it passes through.

In very severe cases of kidney or liver disease, however, tramadol may need to be avoided. For those prescribed this medication, it is imperative to take it as prescribed. Also, it may be necessary to monitor the function of the kidney closely.


13. Does Tramadol show up in Urine Drug Tests?

Tramadol will show up in specific tests for prescription drugs. It will, however, not show up on standard drug tests.

Tramadol can stay in your body for several months if you have been using high doses for a long time. There are also several other factors that play a role in how long it remains in the body.

It is present in your blood for up to 24 hours after the last dose. In urine, it is detectable up to five days following the previous intake. Hair samples may test positive for this drug even up to 90 days from the last use.


14. Reasons to Avoid using Tramadol

There are a few reasons why you should not use tramadol. Below are some such reasons:

  • Hypersensitivity to opioids
  • Use of a Monoamine Oxidase Inhibitor (MAOI –  a type of medication for depression) in the last 14 days
  • People less than 12 years old
  • Severe breathing problems
  • Asthma
  • Children who had surgery to remove their adenoids or tonsils
  • Blockage and other issues with the intestines
  • Intoxication from alcohol or drugs
  • Suicidal ideation
  • People whose liver breaks down tramadol very quickly (ultra-rapid metabolizers)
  • Struggles with addiction to other drugs
  • Coma
  • Severe liver disease
  • Severe kidney disease
  • Pregnancy
  • Breastfeeding

Tramadol should also be used with caution if there is:

  • History of seizures
  • Head injury
  • Sleep apnea
  • Use of alcohol
  • History of mental illness
  • Low blood volume
  • Pancreatitis
  • Heart disease
  • Decreased heart rate
  • Driving or operating machinery


15. How to use Ultram

The best way to avoid an addiction to this medication is to avoid using it altogether. However, it may well be that you need this medication. This may be due to surgery or pain from other conditions. To stay safe, here a few tips you should bear in mind:

  • Take tramadol only under the close supervision of a health professional
  • Do not take more than recommended
  • Only take enough to relieve your pain
  • Use tramadol for only short amounts of time
  • Do not mix tramadol with alcohol, benzodiazepines, and other depressants

Tramadol has a chance of dependency. For this reason, it is classified as a Schedule IV substance. Even though Ultram has a place in the treatment of pain, there is a risk for addiction. Your best bet is to avoid this drug when possible. When available, explore alternative means of treating pain. For example, biofeedback, dietary supplements, physical therapy, nutrition, and massage can be helpful.


16. Drug Interactions

You need to be aware that tramadol has several drug interactions. Also, the way you break down and get rid of this drug from your body (metabolism) is vital to know. Some people break down tramadol very quickly. When this happens too fast, it can lead to problems. People who metabolize tramadol very quickly are known as ultra-rapid metabolizers.

There are many enzymes in the liver which help with breaking down drugs. Tramadol and several other medications act on these enzymes in the liver. Such interactions can increase or decrease the dose of tramadol in the blood. When blood levels of tramadol are abnormally high, side effects can occur, and also lead to toxicity. On the other hand, when blood levels are low, there may be opioid withdrawal and inadequate pain control.

Examples of some substances that can affect the blood levels of tramadol are rifampicin, carbamazepine, erythromycin, and St John’s Wort. There are, however, many other drugs that can change the blood concentration of tramadol.

Serotonin is a chemical produced in the body. It helps the brain cells and nervous system communicate with one another. Too much serotonin can, however, be dangerous. This is because it can cause excessive nerve cell stimulation. Such a presentation can lead to a potentially deadly combination of symptoms known as Serotonin Syndrome. This disorder can cause problems like seizures, extremely high body temperature, muscle stiffness, confusion, and pain.

Combining tramadol with some medications can cause serotonin syndrome. Examples are the different groups of antidepressants – SSRIs, SNRIs, TCAs, and MAOIs. “Triptans” used to treat migraines are also common culprits.

For this reason, it is crucial to always inform your health care professionals about the other medications you are taking.


17. Tramadol is a Controlled Substance in the U.S.

In August 2014, the Drug Enforcement Administration (DEA) stated that tramadol was now a Schedule IV Substance. This new scheduling applied to all forms of tramadol. Before this, tramadol was a controlled substance in only a handful of states.

The categorizing of tramadol as a Schedule IV substance was due to national concerns about this medication. Primarily, were reports of misuse, abuse, dependency, overdoses, and deaths.

Restrictions are in place to decrease the abuse and diversion of Ultram. At this time, tramadol prescriptions in the U.S. can only be refilled up to five times within six months. Also, after five refills or after six months, a new order is required. Indeed, it was necessary to implement this as the opioid scourge was getting out of hand.


18. Treatment for Tramadol Addiction

Firstly, it is essential to have a safe detoxification. This detox is better done under professional supervision. A prolonged decrease of the drug over time helps with withdrawals. Medications can help with a more rapid detox. For example, lofexidine, clonidine, and buprenorphine make detox more bearable. The most commonly used buprenorphine medications for detox are suboxone and subutex.

Secondly, rehabilitation and long-term treatment are necessary. Medication-Assisted Treatment is helpful for the treatment of this disorder. The medications most commonly used are buprenorphine, naltrexone tablets, and Vivitrol. Prescribed drugs combined with behavioral therapies work much better than medications alone.

Cognitive-behavioral therapy and contingency management are the most commonly used behavioral therapies. Support groups provide community encouragement to help in the recovery process. Examples of such groups are Narcotics Anonymous and Pills Anonymous.

It is vital to get proper treatment for many reasons. One reason is that withdrawals from tramadol can be very uncomfortable. Indeed, even life-threatening. Also, intense cravings can occur following withdrawal symptoms. These cravings may lead the individual to start retaking the drug. Furthermore, with Ultram dependence, there is a risk of overdose and possibly death.



Tramadol is a synthetic opioid used to treat moderate to severe pain. It decreases pain by binding to opioid receptors in the brain. It is a Schedule IV Substance first approved by the FDA in 1995.

Ultram is usually prescribed in doses less than 400mg daily. Despite taking it at recommended doses, addiction can still be a problem. As a result of this, people with chronic pain remain a high-risk group for the addictive potential of this medication.

There are many possible side effects of this substance. Severe side effects include seizures, problems with breathing, confusion, thoughts of suicide, and serotonin syndrome. Withdrawal symptoms can manifest as anxiety, diarrhea, body pains, cravings, and flu-like symptoms.

Tramadol has many drug interactions, and it is important always to let your health care providers know about your medications. For instance, antidepressants and migraine medications interact with tramadol and can cause lethal side effects.

There is treatment for addiction to tramadol. Get the help you need! Detoxification under medical supervision is safer. Lofexidine, buprenorphine, and clonidine help with quicker detox. Also, medications like buprenorphine, naltrexone tablets, and Vivitrol help with long term sobriety. Counseling and support are also vital to the recovery process.

What has your experience been with tramadol? Do you know of anyone who has struggled with this drug? Please leave your comments below and share this article with others who may benefit from this information. Addiction is real!

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