Tramadol: uses, dosing, side effects & brands
Tramadol is an opioid agonist sold in the U.S. under 5 brand and generic names, for pain. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.
Key facts
- Drug class
- Opioid Agonist
- Treats (across its forms)
- Pain
- Available as
- Tablet · Capsule, extended release · Solution · Tablet, extended release
- Sold as
- 5 products — Ultram, Conzip and Qdolo, and others
- Prescription?
- Prescription only
- Generic available?
- Yes
- Half-life
- about 6 hours (mean terminal elimination half-life of tramadol in healthy adults)
- What the pharmacy pays
- about $0.72 for a 30-count supply — not your price
- Boxed warning
- Boxed warning
How Conzip is dosed
From the FDA label for Conzip (application NDA022370). Other tramadol products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.
CONZIP should be prescribed only by healthcare professionals who are knowledgeable about the use of extended-release/long-acting opioids and how to mitigate the associated risks. ( 2.1 ) Use the lowest effective dosage for the shortest duration of time consistent with individual patient treatment goals. Reserve titration to higher doses of CONZIP for patients in whom lower doses are insufficiently effective and in whom the expected benefits of using a higher dose opioid clearly outweigh the substantial risks. ( 2 , 5 ) Initiate the dosing regimen for each patient individually, taking into account the patient's underlying cause and severity of pain, prior analgesic treatment and response, and risk factors for addiction, abuse, and misuse. ( 2.1 , 5.1 ) Respiratory depression can occur at any time during opioid therapy, especially when initiating and following dosage increases with CONZIP. Consider this risk when selecting an initial dose and when making dose adjustments. ( 2.1 , 5.2 ) CONZIP is administered orally once daily. ( 2.1 ) Discuss opioid overdose reversal agents and options for acquiring them with the patient and/or caregiver, both when initiating and renewing treatment with CONZIP, especially if the patient has additional risk factors for overdose, or close contacts at risk for exposure and overdose. ( 2.2 , 5.1 , 5.2 , 5.3 ) For patients currently on tramadol IR:…
Everything below is the FDA label for Conzip (capsule, extended release). Tramadol is also sold as tablet, solution and tablet, extended release, and those are different medicines to take — follow the label for the one you were prescribed.
Conzip side effects
The following serious or otherwise important adverse reactions are described in greater detail, in other sections: Addiction, Abuse, and Misuse [see Warnings and Precautions (5.1) ] Life-Threatening Respiratory Depression [see Warnings and Precautions (5.2) ] Interactions with Benzodiazepines and Other CNS Depressants [see Warnings and Precautions (5.3) ] Neonatal Opioid Withdrawal Syndrome [see Warnings and Precautions (5.4) ] Ultra-Rapid Metabolism of Tramadol and Other Risk Factors for Life-Threatening Respiratory Depression in Children [see Warnings and Precautions (5.6) ] Opioid-Induced Hyperalgesia and Allodynia [see Warnings and Precautions (5.8) ] Serotonin Syndrome [see Warnings and Precautions (5.9) ] Seizures [see Warnings and Precautions (5.10) ] Suicide [see Warnings and Precautions (5.11) ] Adrenal Insufficiency [see Warnings and Precautions (5.13) ] Severe Hypotension [see Warnings and Precautions (5.14) ] Gastrointestinal Adverse Reactions [see Warnings and Precautions (5.16) ] Hypersensitivity Reactions [see Warnings and Precautions (5.17) ] Withdrawal [see Warnings and Precautions (5.18) ] Most common adverse reactions (incidence ≥10% and twice placebo) are nausea, constipation, dry mouth, somnolence, dizziness, and vomiting. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Vertical Pharmaceuticals, LLC at 1-800-541-4802 or FDA at 1-800-FDA-1088 or…
Who shouldn’t take Conzip
CONZIP is contraindicated for: All children younger than 12 years of age [see Warnings and Precautions (5.6) ] Postoperative management in children younger than 18 years of age following tonsillectomy and/or adenoidectomy [see Warnings and Precautions (5.6) ] CONZIP is also contraindicated in patients with: Significant respiratory depression [see Warnings and Precautions (5.12) ] Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment [see Warnings and Precautions (5.12) ] Known or suspected gastrointestinal obstruction, including paralytic ileus [see Warnings and Precautions (5.16) ] Hypersensitivity to tramadol (e.g., anaphylaxis) [see Warnings and Precautions (5.17) , Adverse Reactions (6) ] Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days [see Drug Interactions (7) ] Children younger than 12 years of age. ( 4 ) Postoperative management in children younger than 18 years of age following tonsillectomy and/or adenoidectomy. ( 4 ) Significant respiratory depression. ( 4 ) Acute or severe bronchial asthma in an unmonitored setting or in absence of resuscitative equipment. ( 4 ) Known or suspected gastrointestinal obstruction, including paralytic ileus. ( 4 ) Hypersensitivity to tramadol. ( 4 ) Concurrent use of monoamine oxidase inhibitors (MAOIs) or use within the last 14 days. ( 4 )
Conzip drug interactions
Table 2 includes clinically significant drug interactions with CONZIP. Table 2: Clinically Significant Drug Interactions with CONZIP Inhibitors of CYP2D6 Clinical Impact: The concomitant use of CONZIP and CYP2D6 inhibitors may result in an increase in the plasma concentration of tramadol and a decrease in the plasma concentration of M1, particularly when an inhibitor is added after a stable dose of CONZIP is achieved. Since M1 is a more potent mu-opioid agonist, decreased M1 exposure could result in decreased therapeutic effects, and may result in signs and symptoms of opioid withdrawal in patients who had developed physical dependence to tramadol. Increased tramadol exposure can result in increased or prolonged therapeutic effects and increased risk for serious adverse events including seizures and serotonin syndrome. After stopping a CYP2D6 inhibitor, as the effects of the inhibitor decline, the tramadol plasma concentration will decrease and the M1 plasma concentration will increase which could increase or prolong therapeutic effects but also increase adverse reactions related to opioid toxicity, and may cause potentially fatal respiratory depression [see Clinical Pharmacology (12.3) ] . Intervention: If concomitant use of a CYP2D6 inhibitor is necessary, evaluate patients at frequent intervals for adverse reactions including opioid withdrawal, seizures, and serotonin syndrome. If a CYP2D6 inhibitor is discontinued, consider lowering CONZIP dosage until stable drug effects are achieved. Evaluate patients at frequent intervals for adverse events including respiratory depression and sedation. Examples: Quinidine, fluoxetine, paroxetine, and bupropion Inhibitors of CYP3A4 Clinical Impact: The concomitant use of CONZIP and CYP3A4 inhibitors can increase the plasma concentration of tramadol and may result in a greater amount of metabolism via CYP2D6 and greater levels of M1. Follow patients closely for increased risk of serious adverse events including seizures and serotonin syndrome, and adverse reactions related to opioid toxicity including potentially fatal respiratory depression, particularly when an inhibitor is added after a stable dose of CONZIP is achieved. After stopping a CYP3A4 inhibitor, as the effects of the inhibitor decline, the tramadol plasma concentration will decrease [see Clinical Pharmacology (12.3) ] , resulting in decreased opioid efficacy and possibly signs and symptoms of opioid withdrawal in patients who had developed physical dependence to tramadol. Intervention: If concomitant use is necessary, consider dosage reduction of CONZIP until stable drug effects are achieved. Evaluate patients at frequent intervals for seizures and serotonin syndrome, and signs of respiratory depression and sedation. If a CYP3A4 inhibitor is discontinued, consider increasing the CONZIP dosage until stable drug effects are achieved and evaluate patients for signs and symptoms of opioid withdrawal. Examples: Macrolide antibiotics (e.g., erythromycin), azole-antifungal agents (e.g., ketoconazole), protease inhibitors (e.g., ritonavir) CYP3A4 Inducers Clinical Impact: The concomitant use of CONZIP and CYP3A4 inducers can decrease the plasma concentration of tramadol [see Clinical Pharmacology (12.3) ] , resulting in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence to tramadol [see Warnings and Precautions (5.7) ] . After stopping a CYP3A4 inducer, as the effects of the inducer decline, the tramadol plasma concentration will increase [ see Clinical Pharmacology (12.3) ] , which could increase or prolong both the therapeutic effects and adverse reactions and may cause seizures and serotonin syndrome, and potentially fatal respiratory depression. Intervention: If concomitant use is necessary, consider increasing the CONZIP dosage until stable drug effects are achieved. Evaluate patients for signs of opioid withdrawal. If a CYP3A4 inducer is discontinued, consider CONZIP dosage reduction and evaluate patients at frequent intervals for seizures and serotonin syndrome, and signs of respiratory depression and sedation. Patients taking carbamazepine, a CYP3A4 inducer, may have a significantly reduced analgesic effect of tramadol. Because carbamazepine increases tramadol metabolism and because of the seizure risk associated with tramadol, concomitant administration of CONZIP and carbamazepine is not recommended. Examples: Rifampin, carbamazepine, phenytoin Benzodiazepines and Other Central Nervous System (CNS) Depressants Clinical Impact: Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death [see Warnings and Precautions (5.3) ] . Intervention: Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Inform patients and caregivers of this potential interaction and educate them on the signs and symptoms of respiratory depression (including sedation). If concomitant use is warranted, consider recommending or prescribing an opioid overdose reversal agent [see Dosage and Administration (2.2) , Warnings and Precautions (5.1 , 5.2 , 5.3) ] . Examples: Benzodiazepines and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids (gabapentin or pregabalin), other opioids, alcohol Serotonergic Drugs Clinical Impact: The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome [see Warnings and Precautions (5.9) ]. Intervention: If concomitant use is warranted, frequently evaluate the patient, particularly during treatment initiation and dose adjustment. Discontinue CONZIP if serotonin syndrome is suspected. Examples: Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonin neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), certain muscle relaxants (i.e., cyclobenzaprine, metaxalone), monoamine oxidase inhibitors (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue) Monoamine Oxidase Inhibitors (MAOIs) Clinical Impact: MAOI interactions with opioids may manifest as serotonin syndrome [see Warnings and Precautions (5.9) ] or opioid toxicity (e.g., respiratory depression, coma) [see Warnings and Precautions (5.2) ] . Intervention: Do not use CONZIP in patients taking MAOIs or within 14 days of stopping such treatment. Examples: Phenelzine, tranylcypromine, linezolid Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics Clinical Impact: May reduce the analgesic effect of CONZIP and/or precipitate withdrawal symptoms. Intervention: Avoid concomitant use. Examples: Butorphanol, nalbuphine, pentazocine, buprenorphine Muscle Relaxants Clinical Impact: Tramadol may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression. Intervention: Because respiratory depression may be greater than otherwise expected, decrease the dosage of CONZIP and/or the muscle relaxant as necessary. Due to the risk of respiratory depression with concomitant use of skeletal muscle relaxants and opioids, consider recommending or prescribing an opioid overdose reversal agent [see Dosage and Administration (2.2) , Warnings and Precautions (5.2) ] . Examples: Cyclobenzaprine, metaxalone. Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. Intervention: Evaluate patients for signs of diminished diuresis and/or effects on blood pressure and increase the dosage of the diuretic as needed. Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. Intervention: Evaluate patients for signs of urinary retention or reduced gastric motility when CONZIP is used concomitantly with anticholinergic drugs. Digoxin Clinical Impact: Post-marketing surveillance of tramadol has revealed rare reports of digoxin toxicity. Intervention: Evaluate patients at frequent intervals for signs of digoxin toxicity and adjust dosage of digoxin as needed. Warfarin Clinical Impact: Post-marketing surveillance of tramadol has revealed rare reports of alteration of warfarin effect, including elevation of prothrombin times. Intervention: Frequently reevaluate the prothrombin time of patients on warfarin for signs of an interaction and adjust the dosage of warfarin as needed. Mixed Agonist/Antagonist and Partial Agonist Opioid Analgesics : Avoid use with CONZIP because they may reduce analgesic effect of CONZIP or precipitate withdrawal symptoms. ( 5.18 , 7 )
Can you take tramadol with…?
Source-cited answers for the combinations people actually ask about — each with a verdict and what to watch for.
Every tramadol product we track (5)
Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.
| # | Drug | Rating | Type | Form | Generic? | Pharmacy pays | |
|---|---|---|---|---|---|---|---|
| 1 | 70/100 | Prescription | Tablet | Generic | $1 | View → | |
| 2 | Not yet rated | Prescription | Capsule | Generic | $1 | View → | |
| 3 | Not yet rated | Prescription | Solution | Generic | $1 | View → | |
| 4 | Not yet rated | Prescription | Tablet | Generic | $1 | View → | |
| 5 | Not yet rated | Prescription | Tablet | Generic | $1 | View → |
What tramadol pills look like
Imprint codes, colour and shape from the FDA’s labelling data. Match the imprint on your pill — or search any imprint.
| Imprint | Strength | Colour | Shape | Maker |
|---|---|---|---|---|
| AN;627 | 50 mg | white | round | — |
| 7;2 | 50 mg | white | round | — |
| 018 | 50 mg | white | capsule | — |
| AN;627 | 50 mg | white | round | — |
| 334 | 325 mg / 37.5 mg | white | capsule | — |
| L010 | 100 mg | white | round | — |
| 7;2 | 50 mg | white | round | — |
| L011 | 200 mg | white | round | — |
| 7;2 | 50 mg | white | round | — |
| L | 100 mg | white | round | — |
| 7;2 | 50 mg | white | round | — |
| T;5 | 50 mg | white | capsule | — |
Combination products containing tramadol
A combination is a different drug — different dosing, different warnings. It is listed here so you can find it, not so you can substitute it.
Tramadol recalls
From the FDA Enforcement database. A recall covers specific lots — not the drug as a whole.
traMADol Hydrochloride Tablets
Failed Impurities/Degradation Specifications: N-nitroso-desmethyl-tramadol impurity (NDSRI) was found out of the specification at 24-month stability interval during Long term stability (25¿C/60%RH).
Amneal Pharmaceuticals, LLC · Mar 19, 2026
TraMADol HCl 50 mg Tablet
Presence of Foreign Tablets: Manufacturer received a report from a Pharmacist who reported finding a tablet of baclofen in a bottle of 1000-count tramadol
RemedyRepack Inc. · May 2, 2024
traMADol Hydrochloride Tablets
Presence of Foreign Tablets: Pharmacist reported a tablet of baclofen in a bottle of 1000-count tramadol
Rubicon Research Private Limited · Apr 26, 2024
Can you crush or split tramadol?
At least one tramadolproduct is labelled to be swallowed whole — crushing an extended-release tablet releases the whole day’s dose at once. Which applies depends on the form you were given.
What each tramadol label says about crushing, splitting and chewingHow long tramadol keeps
No tramadol label we read sets a separate limit for after opening, but they do specify how it must be stored — and the stability behind any date assumes those conditions.
Does tramadol expire? The in-use limits and storage rules from its labelsTramadol and breastfeeding
From LactMed, the US National Library of Medicine’s Drugs and Lactation Database — quoted, not rewritten.
Full LactMed record for tramadol: levels in milk, effects in breastfed infants, and the drugs it would consider insteadThe excretion of tramadol into milk is low and even lower amounts of the active metabolite, O-desmethyltramadol, are excreted. With usual maternal dosage, the amount excreted into breastmilk is much less than the dose that has been given to newborn infants for analgesia and is unlikely to adversely affect nursing infants. Maternal use of oral opioids during breastfeeding can cause infant drowsiness, which may progress to rare but severe central nervous system depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. The US Food and Drug Administration and the manufacturer recommend against the use of tramadol during breastfeeding. If the mother of a newborn requires tramadol, it is not a reason to discontinue breastfeeding; however, once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral tramadol to 2 to 3 days at a low dosage with close infant monitoring. If tramadol is used, monitor infants for increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties or limpness, and contact a physician immediately if any of these occur. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped.
National Institute of Child Health and Human Development, record revised April 15, 2026. LactMed states its information is not a substitute for professional judgement.
What people report to the FDA about tramadol
The FDA Adverse Event Reporting System (FAERS) collects reports from patients and clinicians. It holds 42,896 reports naming tramadol, and the FDA flagged 90% of those reports as serious. The effects reported most often — leaving out reports about overdose, misuse or the condition being treated, which dominate the raw list for common medicines:
- vomiting3,773 reports
- nausea3,398 reports
- headache2,742 reports
- dyspnoea2,695 reports
- fatigue2,678 reports
- drug hypersensitivity2,379 reports
- dizziness2,366 reports
- arthralgia2,312 reports
Read these as a signal, not a rate. A report does not mean tramadol caused the effect — anyone can file one, and many describe people taking several medicines for several conditions. Crucially there is no denominator: FAERS does not record how many people took the drug, so these counts cannot be turned into “X% of patients” — a bigger number often just means a more widely used or more talked-about drug. Duplicates exist, and publicity drives reporting. For what is actually established, read the FDA label section above.
Source: openFDA drug/event (FAERS), retrieved August 26, 2026.
How long tramadol stays in your system
The elimination half-life of tramadol is about 6 hours (mean terminal elimination half-life of tramadol in healthy adults). Tramadol's main active metabolite, M1 (O-desmethyltramadol), has a slightly longer half-life (about 7.4 hours) and drives much of the opioid effect. The half-life is markedly prolonged in liver cirrhosis (about 13 hours for tramadol and 19 hours for M1) and is somewhat longer in adults over 75, so effects can last longer in these groups.
Tramadol Hydrochloride Tablet — DailyMed ↗Half-life is how long the body takes to clear half a dose. It is not the same as how long a drug test can detect it, and it varies with age, kidney and liver function.
Can you drink alcohol on tramadol?
The label says avoid it
Tramadol is an opioid, and its FDA label names alcohol explicitly as a CNS depressant. The boxed warning states that concomitant use of opioids with benzodiazepines or other central nervous system depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death — an additive effect. The label directs that such combinations be reserved for patients with no adequate alternative, and tells patients not to exceed the recommended dose and to limit their intake of alcohol. Abuse or overdose risk is likewise increased when tramadol is taken with alcohol.
Stopping tramadol: withdrawal & how to come off
The label describes physical dependence and an opioid withdrawal syndrome. Physical dependence can develop after several days to weeks of use, and abrupt discontinuation or a significant dose reduction in a physically dependent patient can produce serious withdrawal symptoms, uncontrolled pain, and even suicide. The label instructs that the drug not be rapidly reduced or abruptly discontinued; instead, the prescriber gradually tapers the dose using a patient-specific plan based on the dose taken, duration of treatment, and the patient's characteristics, with the tapering schedule agreed upon with the patient. (Separately, the boxed warning notes that prolonged use in pregnancy can cause neonatal opioid withdrawal syndrome in the newborn.)
This describes what the label says about stopping — not a schedule to follow on your own. Any change to tramadolis your prescriber’s decision; stopping some medicines abruptly is dangerous.
Tramadol Hydrochloride Extended-Release Tablets — DailyMed FDA Label ↗Related guides
Related calculators
Frequently asked questions
What is Conzip?
Conzip (Tramadol Hydrochloride) is an opioid agonist used to treat Pain.
What kind of drug is tramadol?
The FDA classifies tramadol as an opioid agonist. Opioid agonists bind opioid receptors (mainly mu receptors) on nerves in the brain and spinal cord, dampening the release of pain-signaling chemicals so fewer pain messages reach the brain, which relieves moderate to severe pain. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.
Can you drink alcohol while taking tramadol?
Tramadol is an opioid, and its FDA label names alcohol explicitly as a CNS depressant. The boxed warning states that concomitant use of opioids with benzodiazepines or other central nervous system depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death — an additive effect. The label directs that such combinations be reserved for patients with no adequate alternative, and tells patients not to exceed the recommended dose and to limit their intake of alcohol. Abuse or overdose risk is likewise increased when tramadol is taken with alcohol. This is what tramadol's FDA label says; alcohol advice depends on your dose and health, so confirm with your pharmacist.
What happens if you stop taking tramadol?
The label describes physical dependence and an opioid withdrawal syndrome. Physical dependence can develop after several days to weeks of use, and abrupt discontinuation or a significant dose reduction in a physically dependent patient can produce serious withdrawal symptoms, uncontrolled pain, and even suicide. The label instructs that the drug not be rapidly reduced or abruptly discontinued; instead, the prescriber gradually tapers the dose using a patient-specific plan based on the dose taken, duration of treatment, and the patient's characteristics, with the tapering schedule agreed upon with the patient. (Separately, the boxed warning notes that prolonged use in pregnancy can cause neonatal opioid withdrawal syndrome in the newborn.) Do not stop tramadol on your own — any change is a prescriber-managed decision.
How long does tramadol stay in your system?
The elimination half-life of tramadol is about 6 hours (mean terminal elimination half-life of tramadol in healthy adults) — that is how long the body takes to clear half of a dose. Tramadol's main active metabolite, M1 (O-desmethyltramadol), has a slightly longer half-life (about 7.4 hours) and drives much of the opioid effect. The half-life is markedly prolonged in liver cirrhosis (about 13 hours for tramadol and 19 hours for M1) and is somewhat longer in adults over 75, so effects can last longer in these groups. Half-life is not the same as how long a drug test can detect the drug, and it varies with age, kidney and liver function.
Can you take tramadol with other medicines?
It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run tramadol against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.
What brand names is tramadol sold under?
We track 5 tramadol-containing products in the U.S.: Ultram, Conzip, Qdolo, Ryzolt and Tramadol Hydrochloride. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.
What forms does tramadol come in?
Across the brands we track, tramadol is currently marketed as tablet, capsule, extended release, solution and tablet, extended release, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.
Is there a generic tramadol?
Yes. Our catalog lists 1 generic tramadol product alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.
Has tramadol been recalled?
The FDA's Enforcement database lists 3 recall records whose product description mentions tramadol. The most recent: traMADol Hydrochloride Tablets (Mar 19, 2026). A recall applies to specific lots, not to the drug as a whole — check the record for the affected lot numbers.
How long does it take for tramadol to work?
Tramadol works fairly quickly for pain. With the immediate-release tablets or capsules, relief typically begins within about 30 to 60 minutes of a dose and peaks a couple of hours later. Extended-release forms are designed for steady, around-the-clock pain rather than fast relief. Take only as prescribed — do not repeat a dose early if it feels slow, and talk to your prescriber if pain is not controlled.
What should I avoid while taking tramadol?
Alcohol: the FDA label says to avoid alcohol — see the alcohol section above for what it actually says. Other medicines: we hold source-cited interaction answers for Can you take tramadol with Tylenol?, Can you drink alcohol while taking tramadol? and Can you take ibuprofen and tramadol together?. This is what the FDA label and our cited sources say — it is not a complete list. Your pharmacist can check your own combination.
Is tramadol a narcotic (or controlled substance)?
Yes to both, in effect. Tramadol is an opioid analgesic and a federal DEA Schedule IV controlled substance. It is weaker than opioids like oxycodone, but it acts on opioid receptors (and on serotonin and norepinephrine), carries dependence and withdrawal risk, and can lower the seizure threshold — so it is treated as a controlled drug.
What are the common side effects of Ultram (tramadol)?
The most common side effects of Ultram (tramadol) are dizziness, nausea, constipation, drowsiness/sleepiness, headache, dry mouth, and sweating. MedlinePlus also lists nervousness, mood changes, uncontrollable shaking of a part of the body, and heartburn as effects to mention to your doctor if they persist or bother you. Constipation can be ongoing rather than fading, so ask your prescriber about prevention. Tell your doctor if any of these are severe or don't go away.
What serious side effects of Ultram (tramadol) mean I should call a doctor or go to the ER?
Ultram (tramadol) carries an FDA boxed warning — the most serious kind. The label states its use "exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death." It can also cause "serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased" (MedlinePlus). Combining tramadol with alcohol, benzodiazepines, or other sedatives sharply raises the risk of "serious, life-threatening side effects," including sedation, coma, and death. Get emergency help (call 911) for slow or difficult breathing, extreme drowsiness or trouble waking, blue lips, seizures, loss of consciousness, chest pain, or swelling of the face or throat. The boxed warning also covers deaths in children who are ultra-rapid metabolizers and life-threatening neonatal opioid withdrawal syndrome in babies exposed during pregnancy. This is not a complete list — read the full label and ask your pharmacist.
Can Ultram (tramadol) cause seizures or serotonin syndrome?
Yes to both. The FDA label states "Seizures have been reported in patients receiving tramadol hydrochloride within the recommended dosage range," and that "seizure risk is increased with doses of tramadol hydrochloride above the recommended range." Risk is higher when tramadol is combined with SSRI or SNRI antidepressants, tricyclic antidepressants (TCAs), other opioids, MAO inhibitors, or neuroleptics. The label also warns that "concomitant use of tramadol hydrochloride with MAO inhibitors or SSRI's increases the risk of adverse events, including seizure and serotonin syndrome." Serotonin syndrome is a medical emergency — signs include agitation, hallucinations, fast heartbeat, fever, sweating, shivering, and severe muscle stiffness or twitching. Give your doctor a full list of your medications and antidepressants before starting tramadol.
Is Ultram (tramadol) addictive, and what happens if I stop it suddenly?
Ultram (tramadol) is a Schedule IV (CIV) controlled substance and an opioid, so it can cause physical dependence and addiction even when taken as prescribed. Do not stop it abruptly. MedlinePlus advises: "Do not stop taking tramadol without talking to your doctor. Your doctor will probably decrease your dose gradually." Stopping suddenly after regular use can trigger withdrawal — nervousness, panic, sweating, trouble sleeping, runny nose, chills, nausea, muscle pain, and (rarely) hallucinations. If you want to stop, ask your prescriber to set up a gradual taper rather than quitting on your own.
When do Ultram (tramadol) side effects start and how long do they last?
Dizziness, nausea, and drowsiness often appear soon after the first doses and may ease over days as your body adjusts. The most dangerous breathing risk is early: MedlinePlus notes life-threatening breathing problems can occur "especially during the first 24 to 72 hours of your treatment and any time your dose is increased," so use extra caution then and avoid alcohol and other sedatives. Constipation can persist for as long as you take the drug. Because tramadol impairs alertness, don't drive or operate machinery until you know how it affects you. Report side effects that are severe, worsening, or not improving to your prescriber.
How long does Ultram (tramadol) stay in your system?
"In your system" means two different things. First is clearance: tramadol's elimination half-life is about 5–7 hours for immediate-release tablets and about 6–10 hours for extended-release, per Mayo Clinic Laboratories. A drug is largely cleared after roughly 4–5 half-lives, so immediate-release tramadol is mostly gone in about 1 to 1.5 days (≈5 × 6 hrs ≈ 30 hrs), and extended-release in roughly 2 days — though its active metabolite O-desmethyltramadol clears a little slower. Second is detectability: a drug test can find tramadol or its metabolites for longer than it stays active, and how long depends entirely on the test type (see below). These are approximate laboratory-reference ranges, not guarantees — individual results vary, and only a clinician or testing lab can interpret a specific case.
How long is Ultram (tramadol) detectable in a urine drug test?
Urine is the most common test. ARUP Laboratories' plasma half-life and urine detection-window reference gives roughly 1–4 days for tramadol and 1–3 days for its metabolite O-desmethyltramadol; other clinical references cite a similar 24–72 hour window. One honest and practical point: tramadol is not included on standard 5-panel or 10-panel opioid immunoassay screens and does not reliably trigger a generic opiate screen, so detecting it usually requires a test that specifically targets tramadol (for example LC-MS/MS confirmation). The actual window depends on dose, how long and how often it was used, individual metabolism (CYP2D6 activity), kidney function, hydration, and the specific assay cutoff. Ranges are approximate — only the testing lab can interpret a given result.
How long does Ultram (tramadol) show up in blood, saliva, or hair?
Blood and saliva have the shortest windows: tramadol is typically detectable for up to about 48 hours in each, which fits its short half-life (blood levels track the drug closely and fall as it is eliminated). Hair has the longest window — roughly 30 to 90 days, because drug incorporated into the hair shaft grows out over time (hair grows about 1 cm per month, so a longer sample can reflect a longer history). These are typical ranges reported in laboratory references and are approximate, not exact cutoffs; a testing lab is the only source that can interpret an individual sample.
What affects how long Ultram (tramadol) stays in your system?
Several factors shift the window. Dose and frequency matter most — a single dose clears faster than chronic daily use, which can extend detection. Metabolism plays a large role: tramadol is broken down by the liver enzymes CYP2D6 and CYP3A4, so genetic differences in CYP2D6 (ultra-rapid vs. poor metabolizers), age, and reduced liver or kidney function all change how quickly it and its metabolite are eliminated. Body composition, hydration, urine pH, and the specific test's cutoff sensitivity also affect the result. Because of all this variation, the figures above are approximate ranges from laboratory references, not guarantees. This information is factual and not advice about passing or altering a test, and you should not stop a prescribed medication without talking to your prescriber — only a clinician or testing laboratory can interpret a specific result.
Cite this page
- APA
- pharmaranks. (2026, July 24). Tramadol: uses, dosing, side effects & brands. https://pharmaranks.com/drugs/tramadol
- MLA
- “Tramadol: uses, dosing, side effects & brands.” pharmaranks, 24 July 2026, https://pharmaranks.com/drugs/tramadol.
We summarise public FDA and NIH sources — for a clinical claim, cite the primary source we link to as well.
Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.
Read the full FDA label for tramadol on DailyMed (NIH) ↗ — including its boxed warning in full.