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Tramadol (TRA-ma-dole) is used to relieve pain, including pain after surgery. The long-acting tablets are used for chronic ongoing pain. The effects of tramadol are similar to those of narcotic analgesics. Although tramadol is not classified as a narcotic, it may become habit-forming, causing mental or physical dependence.
Tramadol is an analgesic. It works in certain areas of the brain and nervous system to decrease pain.
This may not be a complete list of all interactions that may occur. Ask your health care provider if Tramadol may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Use Tramadol as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Tramadol may cause drowsiness and dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Tramadol with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
 Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Tramadol ; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
Tramadol may cause dizziness; alcohol, hot weather, exercise, or fever may increase this effect. To prevent it, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of this effect.
Tell your doctor or dentist that you take Tramadol before you receive any medical or dental care, emergency care, or surgery.
Use Tramadol with caution in the ELDERLY; they may be more sensitive to its effects.
Tramadol should not be used in CHILDREN younger than 16 years old; safety and effectiveness in these children have not been confirmed.
PREGNANCY and BREAST-FEEDING: Tramadol has been shown to cause harm to the fetus. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Tramadol while you are pregnant. Tramadol is found in breast milk. Do not breast-feed while taking Tramadol .
When used for long periods of time or at high doses, Tramadol may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Tramadol stops working well. Do not take more than prescribed.
Some people who use Tramadol for a long time without a break may develop a physical need to continue taking it. This is known as physical DEPENDENCE. If you suddenly stop taking Tramadol , you may experience WITHDRAWAL symptoms including anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For tramadol, the following should be considered:
The suitability of tramadol suppositories for inclusion in our hospital formulary for the treatment of mild to moderate post-operative pain was evaluated. In an open randomized trial, rectal tramadol was compared with our standard treatment acetaminophen/codeine suppositories. We expected tramadol to be equally effective as our current standard but with fewer side effects. Forty patients were treated with either tramadol suppositories 100 mg 6 hourly (qds) or acetaminophen/codeine suppositories 1000/20 mg qds. Patients were comparable with regard to demographic data and type of surgery and anaesthesia. Post-operative pain was scored with the aid of a Visual Analogue Scale before each drug administration, at rest and during movement. Side effects, notably nausea and vomiting, were recorded by interviewing the patients and by inspecting the nursing report. There was no difference in pain scores between the two groups. The incidence of nausea and vomiting was significantly higher in the tramadol-treated (84%) than in the acetaminophen/codeine treated group (31%). The relative risk of experiencing an episode of nausea under treatment with tramadol was 2.7 (95% confidence interval: 1.3–5.3; P=0.0001) as compared with acetaminophen/codeine. We conclude that for acute treatment of mild to moderate post-operative pain frequent nausea and vomiting makes tramadol suppositories less suitable than acetaminophen/codeine.
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to tramadol or narcotic analgesics. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Although tramadol is known to exhibit a local anaesthetic effect, how tramadol exerts this effect is not understood fully.
The only thing missing from the well-intentioned tramadol piece in JFP (McDiarmid T, Mackler L, Schneider DM, "Clinical inquiries. What is the addiction risk associated with tramadol?" J Fam Pract 2005; 54[1]:72-73) was a little common sense. The low numbers they quoted on tramadol addiction and detoxification seem paltry in comparison with illicit opiates (such as heroin) and diverted opiates (such as OxyContin), but the numbers can be deceptive--reporting agencies rarely know what's going on in the real world. In the treatment arena we see staggering amounts of Ultracet and tramadol addiction, with patients popping up to 30 or 40 pills daily to fill an ever-expanding mureceptor void. Many of these fall into the addiction innocently because, and I quote, "My doctor told me that these were safe!" Far from it. The tramadol mu activity is considerable in the opiate-naive patient, and even more so in the recovering opiate addict. The phenomenon of "reinstatement," where any activity at the receptor level triggers old drug-seeking behavior, is well documented, and should be avoided at all costs, especially given the broad nonopiate choices available to our patients in need, including the highly effective neural modulators (such as Neurontin, Depakote, and Trazodone) and NSAID/ COX-2 families. While any primary doc can step into the waters of addiction medicine, some formal training may help avoid potential disasters.

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