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What is Tramadol?

Tramadol acts as an opioid analgesic or pain reliever. 

Opioids are potent substances. They lessen the body’s perception of two types of severe pain: acute or chronic. Like other opioids, tramadol is a central nervous system depressant. It 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, tramadol dependence may arise. This is true, especially with supra-therapeutic doses. 

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 acceptable medical use. 

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. 

People who are considering taking tramadol should speak with a healthcare professional. This is to talk about the risks and benefits of this pain medication.  To help the decision-making process, it is very important to:  

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

Tramadol and Alcohol Effects on the Body

Alcohol and tramadol are both central nervous system depressants (CNS). This means they slow down the activities of the CNS, resulting in decreased coordination, dizziness, and drowsiness. It 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.

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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 coordination
  • Nausea or vomiting 
  • Fainting 
  • Difficulting in having or maintaining an erection
  • Irregular menstruation

When a person consumes 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 leaves the two substances to interact for longer periods. They both affect a person’s physical and mental capacities more intensely. 

Someone who participates in heavy drinking or binge drinking while taking tramadol increases their risk of overdose or death. 

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

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 not common. 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 4 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 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, 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 be similar to alcohol addiction, being cyclical in nature. When someone attempts to quit taking the drug, withdrawal symptoms follow. 

These symptoms may be so extreme that the person could feel the need to take the substance once again to find relief. This aspect is what can make abstinence challenging. But when people consume the drug of choice, there is 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:

  • 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 — these 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. This may be done inside behavioral treatment facilities or in an outpatient facility.

The foundation of an excellent substance abuse treatment plan is history taking. A member of the mental health administration will conduct assessments to learn about the patient’s medical history, history of drug abuse, and presence of a 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 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?

A person 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.

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.

Resources

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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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