How does this medication work? What will it do for me?

Tramadol belongs to a group of medications called opioid analgesics. It is used to manage severe pain for people who need several days or more of pain control. It decreases pain by acting on the central nervous system.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

100 mg
Each white, bevelled-edge, round, biconvex tablet, plain on one side and printed "LP 100" in black ink on the other, contains tramadol hydrochloride 100 mg. Nonmedicinal ingredients: ammonium hydroxide, colloidal silicon dioxide, Contramid (modified starch), hydrogenated vegetable oil, iron oxide black, isopropyl alcohol, magnesium stearate, n-butyl alcohol, polyvinyl acetate, povidone, propylene glycol, shellac glaze, sodium lauryl sulfate, and xanthan gum.

200 mg
Each white, bevelled-edge, round, biconvex tablet, plain on one side and printed "LP 200" in black ink on the other, contains tramadol hydrochloride 200 mg. Nonmedicinal ingredients: ammonium hydroxide, colloidal silicon dioxide, Contramid (modified starch), hydrogenated vegetable oil, iron oxide black, isopropyl alcohol, magnesium stearate, n-butyl alcohol, polyvinyl acetate, povidone, propylene glycol, shellac glaze, sodium lauryl sulfate, and xanthan gum.

300 mg
Each white, bevelled-edge, round, biconvex tablet, plain on one side and printed "LP 300" in black ink on the other, contains tramadol hydrochloride 300 mg. Nonmedicinal ingredients: ammonium hydroxide, colloidal silicon dioxide, Contramid (modified starch), hydrogenated vegetable oil, iron oxide black, isopropyl alcohol, magnesium stearate, n-butyl alcohol, polyvinyl acetate, povidone, propylene glycol, shellac glaze, sodium lauryl sulfate, and xanthan gum.

How should I use this medication?

The usual starting dose of tramadol extended release is 100 mg once every 24 hours. Your doctor may gradually increase the dose by 100 mg every 2 to 5 days, up to a maximum of 300 mg every 24 hours.

The medication may be taken with or without food, but it should be taken consistently (i.e., either always with food or always without food) and with a glass of water. The tablets should be swallowed whole and must not be broken, chewed, or crushed. Breaking the tablets may cause too much medication to be absorbed into the body at one time and may be fatal.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Do not stop taking this medication without talking with your doctor. If this medication is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shakiness, nausea, tremors, diarrhea, or hallucinations.

It is important to that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take tramadol if you:

  • are allergic to tramadol or any ingredients of the medication
  • are allergic to other opioid medications (e.g., codeine, morphine)
  • are intoxicated with alcohol or other medications that can depress breathing and consciousness - such as hypnotics, other opioids (e.g., codeine or morphine), or psychotropic medications (certain medications for mental health conditions)
  • are breast-feeding or pregnant
  • are treating pain caused by surgery
  • are experiencing acute asthma or other obstructive airway disease
  • are experiencing acute respiratory depression
  • have a blockage or narrowing of the gastrointestinal tract
  • have a head injury, brain tumour, or increased pressure inside the head or spinal cord
  • have any condition that reduces the movement of masses through the digestive tract, such as ileus
  • have mild pain, pain that comes and goes, or pain which can be treated with other pain medications
  • have severe kidney function impairment
  • have severe liver function impairment
  • have taken monoamine oxidase (MAO) inhibitor medications (e.g., phenelzine, tranylcypromine) within the last 14 days

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • constipation
  • dizziness
  • drowsiness
  • headache
  • nausea
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abnormal, fast, or pounding heartbeat
  • confusion
  • difficulty breathing
  • difficulty urinating
  • joint pain
  • symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heart beat, weakness)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a severe allergic reaction (e.g., hives; difficulty breathing; or swelling of the lips, mouth, throat, or tongue)
  • signs of serotonin syndrome (e.g., agitation, confusion, diarrhea, fever, overactive reflexes, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, twitching)
  • symptoms of a severe skin reaction (e.g., high fever; rash; sores; painful blisters on the skin, mouth, or eyes; or skin peeling off)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Asthma and other respiratory conditions: Tramadol extended release may cause increased breathing difficulty for people having an acute asthma attack or for those with chronic obstructive pulmonary disease (chronic bronchitis, emphysema) or other conditions that affect breathing. If you have asthma or other breathing disorders, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Breathing: Tramadol extended release can suppress breathing. People at risk for breathing suppression (e.g., people with head trauma) should be closely monitored by their doctor while taking this medication.

Dependence and withdrawal: This medication may become habit-forming if taken for long periods of time. Drug abuse is not a problem for people who require this medication for pain relief. If this medication is stopped suddenly, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shaking, pain, nausea, tremors, diarrhea, and hallucinations. Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms when this medication is no longer required for pain control.

Drowsiness/reduced alertness: This medication may cause drowsiness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.

Kidney function: The kidneys are partially responsible for removing tramadol from the body. Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severely decreased kidney function should not use tramadol.

Liver function: The liver is partially responsible for removing tramadol from the body. Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver disease or reduced liver function, discuss with your doctor how this medication may affect your  medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severely decreased liver function should not use tramadol.

Seizures: This medication may cause seizures, especially when higher doses are used or when taken with other medications that may increase the risk of seizures such as:

  • cyclobenzaprine
  • monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine)
  • neuroleptics (e.g., haloperidol, quetiapine, olanzapine, risperidone)
  • opioids (e.g., morphine, codeine, oxycodone)
  • promethazine
  • selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine, fluoxetine, citalopram)
  • tricyclic antidepressants (TCAs; e.g., amitriptyline, imipramine)

The risk of seizures is also higher for people with epilepsy, a history of seizures, or who are at risk of seizures (e.g., people with head trauma).

Serotonin syndrome: Severe reactions are possible when tramadol is combined with medications used to treat depression. The combination of tramadol and MAO inhibitors must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are also possible.

Surgery: Tramadol may interact with medications used during surgery. If you are scheduled for surgery, let your doctor know that you are taking this medication.

Pregnancy: The safety for both the mother and baby if this medication is used during pregnancy has not been determined. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking tramadol extended-release, it may affect your baby. You should avoid taking tramadol if you are breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children. This medication should not be used in people under 18 years of age.

Seniors: Seniors may be more likely to experience side effects from this medication, especially seniors over 75 years of age.

What other drugs could interact with this medication?

There may be an interaction between tramadol extended release and any of the following:

  • abiraterone
  • alcohol
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, haloperidol, quetiapine, olanzapine, risperidone)
  • aprepitant
  • azelastine
  • "azole" antifungal medications (e.g., fluconazole, itraconazole, ketoconazole)
  • baclofen
  • barbiturates (e.g., phenobarbital)
  • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
  • bosentan
  • boceprevir
  • brimonidine
  • bromocriptine
  • bupropion
  • buspirone
  • cabergoline
  • calcium channel blockers (e.g., diltiazem, nifedipine, verapamil)
  • carbamazepine
  • celecoxib
  • chloral hydrate
  • chloroquine
  • cinacalcet
  • cocaine
  • conivaptan
  • cyclosporine
  • deferasirox
  • desmopressin
  • desvenlafaxine
  • dexamethasone
  • dextromethorphan
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • dronabinol
  • droperidol
  • ergot derivatives (e.g., dihydroergotamine, ergoloid mesylates, ergonovine, ergotamine, methylergonovine)
  • fusidic acid
  • gabapentin
  • grapefruit juice
  • HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine, nevirapine)
  • HIV protease inhibitors (e.g., daraunavir, indinavir, lopinavir, ritonavir saquinavir)
  • isoniazid
  • lidocaine
  • lithium
  • macrolide antibiotics (e.g., clarithromycin, erythromycin, telithromycin)
  • magnesium sulfate
  • methotrimeprazine
  • metoclopramide
  • metronidazole
  • metyrosine
  • mifepristone
  • mitotane
  • mirtazapine
  • mixed agonists/antagonist opioids (e.g., butorphanol, buprenorphine, pentazocine)
  • monoamine oxidase (MAO) inhibitors (e.g., phenelzine, tranylcypromine, moclobemide)
  • muscle relaxants (e.g., cyclobenzaprine, methocarbamol, orphenadrine)
  • nabilone
  • naltrexone
  • norfloxacin
  • octreotide
  • olopatadine
  • opioids (e.g., morphine, codeine, oxycodone)
  • perampanel
  • pramipexole
  • promethazine
  • quinidine
  • quinine
  • rifabutin
  • rifampin
  • ropinirole
  • St. John's wort
  • scopolamine
  • seizure medications (e.g., carbamazepine, gabapentin, levetiracetam, phenytoin, topiramate)
  • selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine, fluoxetine, citalopram)
  • serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
  • sibutramine
  • simeprevir
  • stiripentol
  • tapentadol
  • telaprevir
  • terbinafine
  • tetracycline
  • thalidomide
  • ticlopidine
  • tocilizumab
  • tricyclic antidepressants (TCAs; e.g., amitriptyline, imipramine)
  • "triptan" migraine medications (e.g., sumatriptan, naratriptan)
  • tryptophan
  • tyrosine kinase inhibitors (e.g., dasatinib, imatinib, nilotinib, sunitinib)
  • venlafaxine
  • warfarin
  • zolpidem
  • zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.