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Updated on February 2, 2023
6 min read

Tramadol and Alcohol Interactions

What is Tramadol?

Tramadol is an opioid analgesic or pain reliever. Like other opioids, tramadol is a central nervous system (CNS) depressant that inhibits pain signals and provides relief. This is why it's used to treat severe acute or chronic pain.

People who are considering taking tramadol should speak with a healthcare professional. A healthcare professional can discuss the risks and benefits of tramadol. To help the decision-making process:  

  • Outline pain treatment objectives
  • Discuss the length of treatment
  • Explore other pain management options 

Compared to other opioids like morphine, 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 substance misuse may not occur. 

Is Tramadol Addictive?

In 2014, the Drug Enforcement Agency (DEA) classified tramadol as a Schedule IV controlled substance. Tramadol falls within the less severe end of the spectrum and isn't like heroin.

Heroin is a Schedule I drug with high abuse potential and no legal medical use in the U.S. In certain countries, doctors are allowed to prescribe heroin under their supervision. In these cases, heroin treats long-term users of illicit opioids. 

However, as an opioid, tramadol can be habit-forming and produce physical dependence. After long periods of use, tramadol dependence may arise. This is true, especially with supra-therapeutic doses. 

The total number of tramadol prescriptions dispensed/sold in the U.S. was 36.5 million in 2018. 

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Tramadol and Alcohol Effects on the Body

Alcohol and tramadol are both CNS depressants. This means they slow down the activities of the CNS, resulting in decreased coordination, dizziness, and drowsiness. This impairs a person’s ability to think clearly and move purposely.

When taken separately, tramadol and alcohol have addictive effects like relaxation and euphoria. Both alcohol and tramadol interact with brain chemicals that regulate mood, pain, and stress. 

Drinking alcohol while taking tramadol is never a good idea. Mixing alcohol and tramadol intensifies each of their side effects. This may cause severe physical and mental impairment and an increased risk of overdose.

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 
  • Increased 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 coordination
  • Nausea or vomiting 
  • Fainting 
  • Difficulty having or maintaining an erection
  • Irregular menstruation

When a person consumes alcohol while taking tramadol, these side effects may worsen. Tramadol is an analgesic metabolized primarily in the liver. Alcohol is another substance metabolized in the liver. Someone who participates in heavy or binge drinking while taking tramadol increases their risk of overdose or death. 

Although a person may stop drinking after eight rounds of drinks, the liver can only metabolize a standard alcoholic beverage in at least 1 hour. They can still feel the effects of alcohol, especially in combination with tramadol.


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Dangers of Mixing Tramadol and Alcohol

Mixing tramadol and alcohol carries risks of severe side effects, intoxication, and even death. 

Drinking too much alcohol while taking tramadol may lead to tramadol intoxication. This is also called 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)

Dying from tramadol intoxication is uncommon. The risk of death, however, increases when alcohol and tramadol are mixed together.

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


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Alcohol Poisoning and Tramadol Overdose

If someone overdoses on tramadol, a rescue medication called naloxone can help counteract 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, family members or caregivers must understand how to identify an overdose and use naloxone, and know what to do until emergency medical personnel arrives. 

Tramadol addiction can result in physical dependence. In such cases, withdrawal symptoms follow when someone attempts to quit taking the drug. 

These symptoms may be so extreme that the person could feel the need to take the substance again to find relief. This can make abstinence challenging. There is also a high risk of accidental overdose.

Treatment for Tramadol and Alcohol Misuse

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:

History intake is the foundation of any excellent substance abuse treatment. A medical professional will conduct assessments to learn about the person’s medical history, history of drug abuse, and any co-occurring mental health disorder.

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 difficult to do because of the 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?

A person should only take tramadol as prescribed when prescribed by a physician. The daily dose should never exceed 400mg over a 24-hour period.

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.

How long after taking tramadol can you drink alcohol?

It is important for you to know which type of tramadol you’re taking. Short-acting and long-acting tramadol stay in the body for different amounts of time.

A dose of short-acting tramadol is out of your system within 32 hours. Long-acting tramadol takes 50 hours before all of it leaves your body. If you have taken tramadol, it is safe to wait until it is completely out of your system before drinking alcohol. 

When you wait for tramadol to clear itself from your body, it will help you avoid the unwanted side effects and significantly lower your risk of overdose.

Updated on February 2, 2023
6 sources cited
Updated on February 2, 2023
All Alcoholrehabhelp content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies.
  1. “TRAMADOL .” Drug Enforcement Administration Diversion Control Division, Mar. 2020.
  2. “Tramadol: MedlinePlus Drug Information.” MedlinePlus, U.S. National Library of Medicine,
  3. 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
  4. Vesna Jovanović-Čupić, et al. Seizures Associated with Intoxication and Abuse of Tramadol, Clinical Toxicology, 44:2, 143-146, 2006 DOI: 10.1080/1556365050014418
  5. 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
  6. Zacny, James P. “Profiling the Subjective, Psychomotor, and Physiological Effects of Tramadol in Recreational Drug Users.” Drug and Alcohol Dependence, Elsevier, 6 July 2005,
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All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice.
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