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What is Tramadol?

Tramadol acts as an opioid analgesic or pain reliever. 

Opioids are potent substances that can lessen the body’s perception of two types of severe pain: acute or chronic. And like other opioids, tramadol is a central nervous system depressant that inhibits pain signals to provide relief. 


Examples of other more commonly known opioids are hydrocodone, oxycodone, heroin, and morphine. 

When compared to morphine, specifically, tramadol has been claimed to be about one-tenth as powerful. This means that tramadol has a lower potential for dependence and abuse. However, this does not mean that substance misuse may not occur. 

Opioids like tramadol are habit-forming and can produce physical dependence. After long periods of use, and especially with supra-therapeutic doses, tramadol dependence may arise in individuals. 

In 2014, the Drug Enforcement Agency (DEA) classified tramadol as a Schedule IV controlled substance. Unlike heroin, a Schedule I drug with high abuse potential and no acceptable medical use, tramadol falls within the less severe end of the spectrum. 

According to IQVIA™ (formerly referred to as IMS Health™), the total number of tramadol prescriptions dispensed/sold in the United States was 36.5 million in 2018. 

Individuals who are considering taking tramadol should speak with a healthcare professional about the risks and benefits of this pain medication. It is just as important to outline pain treatment objectives, length of treatment, and other pain management options to help the decision-making process. 

Side Effects of Mixing Tramadol and Alcohol

Using tramadol may produce some side effects, such as:

  • Headaches
  • Insomnia
  • Nervousness
  • Muscle tightness
  • Mood changes 
  • Dry mouth 
  • Increase in blood pressure 
  • Heartburn 
  • Uncontrollable shaking of a body part

More severe side effects of tramadol may include:

  • Seizures
  • Hives
  • Rash
  • Trouble breathing or swallowing 
  • Decrease in sexual desire
  • Irritability 
  • Loss of coordinations
  • Nausea or vomiting 
  • Fainting 
  • Difficulting in having or maintaining an erection
  • Irregular menstruation

When individuals consume alcohol while taking tramadol, these side effects may worsen. Tramadol is an analgesic that is metabolized primarily in the liver. Alcohol is another substance metabolized in the liver. 

When the hepatic organ has to break down both drugs simultaneously, more time is necessary for complete elimination. This means that the two substances can interact for longer periods and affect a person’s physical and mental capacities more intensely. 

By the same token, if individuals participate in heavy drinking or binge drinking while taking tramadol, the risk of overdose or death increases. Although an individual may stop drinking after 8 rounds of drinks, for example, the liver is capable of only metabolizing a standard alcoholic beverage in at least one hour. Individuals can therefore still feel the effects of alcohol, especially in combination with tramadol. 

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Dangers of Mixing Tramadol and Alcohol

Like any other substance mixed with alcohol, there are the risks of severe side effects, intoxication, and even death. 

An individual who drinks too much alcohol while taking tramadol may suffer from tramadol intoxication (or tramadol poisoning). In these cases, symptoms will range from:

  • CNS depression and coma
  • Tachycardia (fast heart rate)
  • Cardiovascular failure
  • Seizures
  • Multiple organ dysfunction
  • Respiratory depression (slow, irregular breathing)
  • Respiratory arrest (when an individual stops breathing or is not breathing effectively)

While it is not common for individuals to die of tramadol intoxication, the risk of death appears to be higher in those who co-ingest other drugs (like alcohol) and overdose heavily on tramadol.  

The risk of seizure increases for individuals who have received more than 4 tramadol prescriptions, are between the ages of 25 and 54, and have a history of alcohol abuse, stroke, or head injury. 

Alcohol Poisoning and Tramadol Overdose

If individuals overdose on tramadol, a rescue medication called naloxone can help counteract the life-threatening effects. Naloxone helps to block opioid effects and mitigate symptoms caused by high amounts of tramadol in the blood. 

In cases like this, it is important that family members or caregivers understand how to identify an overdose and use naloxone and know what to do until emergency medical personnel arrives. 

A tramadol addiction can be similar to an alcohol addiction, being cyclical in nature. When individuals attempt to quit taking the drug, withdrawal symptoms follow. These symptoms may be so extreme that individuals could feel the need to take the substance once again to find relief. This aspect is what can make abstinence challenging. But when individuals consume the drug of choice, there is the high risk of accidental overdose.  

Treatment for Tramadol and Alcohol

If you or a loved one are misusing tramadol and alcohol simultaneously, addiction treatment programs are available to guide you to recovery. Choices for substance abuse rehab include:

  • Detoxification treatment — when you stop taking these substances, severe withdrawal symptoms may occur. A detox program lets a medical professional assess physical and mental health and provide you with the most suitable actions. 
  • Inpatient treatment — this approach can give you the necessary support for overcoming your addiction. Inpatient treatment centers offer a wide range of activities for a more pleasant recovery journey. 
  • Support groups — support groups can help encourage you in your fight against cravings and addiction. Support groups could also serve as a way to connect with other people who have gone through similar experiences.

Is it safe to quit tramadol and alcohol cold turkey?

No. Withdrawal symptoms may arise and lead to a possible overdose or death. If you’re thinking about quitting tramadol and alcohol, seek medical advice first. Your healthcare provider can discuss treatment options with you and determine the most suitable route to recovery.

You can quit tramadol cold turkey but it is not advisable due to withdrawal symptoms.

What else should you not mix with tramadol?

You should not mix tramadol with the following prescription drugs, including monoamine oxidase (MAO) inhibitors, isocarboxazid (Marplan®), linezolid (Zyvox®), methylene blue, phenelzine (Nardil®), selegiline (Eldepryl®, Emsam®, and Zelapar®), or tranylcypromine (Parnate®).

How long does tramadol last?

Individuals should not exceed 400mg of tramadol per day. This means that you can take the pain relief tablets approximately every 4 to 6 hours.

Can tramadol harm your liver?

Tramadol abuse may result in liver damage. Tramadol is primarily metabolized in the hepatic organ. There was a case of a 67-year-old man who took very high doses of tramadol, developed acute liver failure, and died of cardiorespiratory arrest.

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“TRAMADOL .” Drug Enforcement Administration Diversion Control Division, Mar. 2020. https://www.deadiversion.usdoj.gov/drug_chem_info/tramadol.pdf

“Tramadol Update Review Report Agenda Item 6.1.” World Health Organization, 20 June 2014. https://www.who.int/medicines/areas/quality_safety/6_1_Update.pdf

“Tramadol: MedlinePlus Drug Information.” MedlinePlus, U.S. National Library of Medicine, www.medlineplus.gov/druginfo/meds/a695011.html.

M. J. Traynor,et al. Influence of Alcohol on the Release of Tramadol from 24-h Controlled-Release Formulations During In Vitro Dissolution Experiments, Drug Development and Industrial Pharmacy, 2008 34:8, 885-889, DOI: 10.1080/03639040801929240 https://www.tandfonline.com/action/showCitFormats?doi=10.1080%2F03639040801929240

Vesna Jovanović-Čupić, et al. Seizures Associated with Intoxication and Abuse of Tramadol, Clinical Toxicology, 44:2, 143-146, 2006 DOI: 10.1080/1556365050014418 https://www.tandfonline.com/action/showCitFormats?doi=10.1080%2F1556365050014418

Ripple, Mary G. M.D; et al. "Lethal Combination of Tramadol and Multiple Drugs Affecting Serotonin," The American Journal of Forensic Medicine and Pathology: December 2000 - Volume 21 - Issue 4 - p 370-374 https://journals.lww.com/amjforensicmedicine/Abstract/2000/12000/Lethal_Combination_of_Tramadol_and_Multiple_Drugs.15.aspx

Zacny, James P. “Profiling the Subjective, Psychomotor, and Physiological Effects of Tramadol in Recreational Drug Users.” Drug and Alcohol Dependence, Elsevier, 6 July 2005, www.sciencedirect.com/science/article/pii/S0376871605001808.

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