Tramadol

What it is

Tramadol is a centrally acting analgesic with two mechanisms: it is a weak agonist at opioid mu receptors and it also inhibits the reuptake of serotonin and noradrenaline in descending pain pathways. Together these dampen the transmission of pain signals in the spinal cord and brain. It is used for moderate pain that milder painkillers do not control.

A usual adult range, not a national label — the dose and the timing differ by country and by product.

Used for

• Pain

Approved uses differ by country — some of these may be off-label or unapproved where you live.

What to know while taking it

It can be taken with or without food, and drowsiness, dizziness and slowed reactions are common at the start and after any change, so driving and machinery are unsafe until the effect is known. Alcohol adds to that sedation and to the risk of depressed breathing and must be avoided. The serotonin component means that antidepressants such as sertraline, venlafaxine, duloxetine and amitriptyline raise the risk of serotonin toxicity and of seizures, since tramadol lowers the seizure threshold on its own. Tolerance and physical dependence develop with continued use, so length of treatment and how it ends are decisions for the prescriber.

When to see a doctor

A seizure, or agitation with fever, sweating, shivering and muscle jerks, is an emergency. Very slow or shallow breathing, extreme sleepiness or confusion needs urgent care, and craving, escalating use or withdrawal symptoms between doses are reasons to see a doctor.

Worth knowing

• Can cause dependence
• Causes drowsiness
• Care when driving
• Do not combine with alcohol
• Lowers the seizure threshold