Tramadol lowers your ability to feel pain. It is a type of opioid painkiller. Opioids are made to mimic the effects of chemicals that come from the opium poppy.
Tramadol comes as tablets or capsules. In medical settings, it also comes as drops or injections.
Doctors only prescribe tramadol to treat pain if the benefits of tramadol outweigh the risks.
Drugs sold as tramadol in the illegal drug market have more risks. You cannot know what is in a tablet, even if it is packaged like a medicine.
The information on this page is about non-medical use of tramadol. To learn more about a medicine prescribed to you, ask your GP or pharmacist. You can also check the leaflet that comes with the medicine.
What we mean by non-medical use of a medicine
Non-medical use is when someone uses a medicine in a way that does not follow medical guidelines.
This can include when someone uses a medicine:
- they bought in the illegal drug market - this can be online or in person
- that was not prescribed to them
- in a different way or quantity than their doctor prescribed
Drug category: opioid
Opioids are drugs that are made:
- from chemicals in the opium poppy (opiates) - such as heroin
- to mimic the effects of opiates (synthetic opioids) - such as fentanyl or nitazenes
Opioids relieve pain but have a high risk of physical dependency or overdose.
Effects of tramadol
The effects of tramadol can vary depending on:
- your size, weight and sex
- if you have any health conditions or mental health difficulties
- how you take the drug
- the strength of the drug
- how much you take
- if you take alcohol, medicines or other drugs at the same time
- where you take the drug and how you feel before you take it
- if you have taken the drug before and how often
The effects of tramadol can start after 30 to 60 minutes. How long the effects last depends on the dose.
How you may feel or behave
You may feel:
- calm or relaxed
- happy
- tired
- irritable
Effects on your brain and body
Tramadol can cause:
- slow heart rate or breathing rate
- nausea (feeling sick)
- vomiting (getting sick)
- dizziness, fainting or loss of consciousness
- reduced appetite
- drowsiness
- increased sweating
- low blood pressure
- muscle weakness
- problems sleeping
- hallucinations - you see, hear or feel things that are not there
Serotonin syndrome
Serotonin is a chemical that carries messages from your brain to your body. It helps with many body functions. For example, mood, sleep and digestion.
Serotonin syndrome is when your serotonin levels get too high. It is a medical emergency.
In rare cases, tramadol can cause serotonin syndrome. The risk is higher if you use tramadol with other substances that affect serotonin levels. For example, MDMA or antidepressants.
Signs of serotonin syndrome include:
- confusion
- agitation
- muscle twitches
- pain in your arms or legs
- sweating
- shivering or trembling
- a very high temperature (fever)
- seizures (fits)
- irregular heartbeat
- unconsciousness
Tramadol and mental health
Tramadol can cause mental health difficulties or make existing difficulties worse.
For example:
- mood swings
- low mood or depression
- thoughts of suicide
The risk may be higher if you or someone in your family has a history of mental health difficulties. For example, bipolar disorder.
Some people may take tramadol without medical advice to cope with pain. Pain can cause mental health difficulties such as stress or anxiety. Talk therapy can help.
If you use drugs and have problems with pain, you can get help for both.
Tramadol and dependency
Regular use of tramadol can cause:
- tolerance - when you need to take more of the drug to get the same effects
- dependency
Signs of dependency can include:
- cravings for a drug
- withdrawal symptoms
- continuing to use a drug even when it causes you harm
Withdrawal symptoms
If you stop taking tramadol after regular use, you may get withdrawal symptoms.
These include:
- tremors
- anxiety
- problems sleeping
- nausea
- diarrhoea
- restlessness
It is not safe to suddenly stop taking tramadol after regular use.
If you want to stop taking tramadol, you can get support from:
- your GP or practice nurse
- a pharmacist
- a drug service
How long does tramadol stay in your system?
It can be hard to know how long tramadol stays in your system.
There are tests to detect tramadol. But different types of tests have different detection times.
Things that affect how long a drug stays in your system
The time it takes for a drug to leave your system depends on many things.
For example:
- how much you took
- how often you take the drug
- how strong the drug was
- your age, sex and metabolism
- your general health
Reducing risks from tramadol
It’s always safest not to take drugs or medicines that are not prescribed to you. The strength and contents of tramadol tablets sold in the illegal drug market can vary. This can happen even if they are packaged like a medicine.
There are ways to reduce the risk of harm if you take tramadol without medical advice. Select a piece of advice to find out more.
Consider if there is extra risk for you - such as health conditions or how you feel.
There are always risks if you use drugs. But some people may be more at risk than others.
If you or someone in your family has any health conditions or mental health difficulties, you may be more at risk of a drug emergency.
It can be hard to know your level of risk. Some people have health conditions and do not know it.
If you feel low, anxious or stressed, you are more at risk of a negative or challenging experience.
Be with people you trust and look out for each other - do not use alone.
Pick a meeting point and know what to do in case of an emergency.
Start with a small amount and wait 2 hours before you take more.
This is to reduce the risk of an overdose or drug emergency.
The contents or strength of drugs can vary, even in the same batch.
If you start with a small amount, you can:
- see how you react
- stop if you get an effect you did not expect or do not want
It can take up to 2 hours for some effects to happen. If you take too much too soon, it increases your risk.
Plan a safe way to get home.
It is dangerous to drive if drugs are in your system. You could harm yourself or other people. A drug can still be in your system even if you do not feel the effects.
Get and carry naloxone.
Naloxone is a prescription medicine that can temporarily reverse the effects of opioids. It can help prevent death from an overdose.
If you are at risk of an opioid overdose, you can get a naloxone kit through your GP or other services.
Give a naloxone kit to another person - this could be a family member, friend or someone who is around you when you use.
Know what to do in case of a drug emergency.
If you take any kind of drug, it is important to know:
- signs of a drug emergency, including signs related to mental health
- what to do in case of overdose or other emergencies
An overdose can be a life-threatening condition. It happens when someone has too much of a drug or another substance in their system.
Getting help can prevent serious damage or death. Your wellbeing is the main priority.
Mixing tramadol with alcohol or other drugs
Using tramadol with alcohol, medicines or other drugs can have unpredictable and negative effects.
The risk of overdose or negative effects is higher if you mix tramadol with substances that:
- slow down messages between the brain and the body - such as alcohol or benzos
- affect your serotonin levels - such as MDMA, antidepressants or amphetamines
Emergency action required: Call 112 or 999 if
you or someone else has taken tramadol and has:
- severe drowsiness or problems staying awake
- cold and clammy skin - white skin may turn blue, black or brown skin may turn grey
- problems breathing
- pinpoint pupils
- a seizure (fit)
- slow or irregular heartbeat
- signs of serotonin syndrome
Stay with the person until help arrives.
Tell the medics everything you know about the drug and give them any leftover drug if possible. It will help them decide the right treatment.
If you are worried about tramadol use
If you are worried about your own or someone else’s use, you can get support. This can be when tramadol use affects your health, relationships, work or other areas of your life.
Non-urgent advice: Drugs and alcohol helpline
You can contact the helpline for support, information or advice on treatment and support options.
Freephone: 1800 459 459
Monday to Friday, 9.30am to 5.30pm
Email: helpline@hse.ie