This medicine is an opioid painkiller. There is a serious risk of addiction when taking this medicine, especially if used long-term. The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new guidance for people prescribed an opioid painkiller. If you have any questions or concerns about taking opioids safely please speak with your doctor or a pharmacist.
Tramadol is prescribed to treat moderate to severe pain.
You may be prescribed tramadol to take regularly, or only when it is needed for pain relief. Make sure you know which is right for you.
The most common side-effects are feeling sick (nausea) and feeling dizzy.
|Type of medicine
|Strong opioid painkiller
|Pain relief in adults and in children over 12 years of age
|Brimisol®; Marol®; Maxitram®; Tilodol®; Tradorec®; Tramquel®; Tramulief®; Zamadol®; Zydol®;
In combination with paracetamol: Tramacet®
In combination with dexketoprofen: Skudexa®
|Capsule, soluble tablet, orodispersible tablet (dissolves in the mouth), modified-release tablets and capsules, oral drops and injection
Strong opioids (sometimes called opiates) are medicines used to treat severe pain. Tramadol is a type of strong opioid. It works on your nervous system and brain to reduce the amount of pain you feel.
There are many different forms, strengths and brands of tramadol. Some forms and brands of tramadol start working quickly to ease pain. Others release the tramadol they contain more slowly over several hours to provide a constant and more even pain control - these are called 'modified-release' and often have 'XL', 'SR' or '24hr' after their brand name.
Before taking tramadol
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking tramadol, it is important that your doctor knows:
- If you are pregnant, trying for a baby or breastfeeding.
- If you have liver or kidney problems.
- If you have prostate problems or any difficulties passing urine.
- If you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD), or a sleep-related breathing problem.
- If you have been told you have low blood pressure (hypotension).
- If you have any problems with your thyroid or adrenal glands.
- If you have epilepsy.
- If you have a problem with your bile duct.
- If you have been constipated for more than a week or have an inflammatory bowel problem.
- If you have a condition causing muscle weakness, called myasthenia gravis.
- If you have recently had a severe head injury.
- If you have ever been dependent on drugs or alcohol.
- If you have ever had an allergic reaction to a medicine.
- If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
How to take tramadol
- Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The manufacturer's leaflet will give you more information about the specific brand of tramadol you have been prescribed, and a full list of the side-effects which you may experience from taking it.
- Take tramadol exactly as your doctor tells you to. Depending on the reason you are taking it, your doctor may advise that you take regular doses or only when you need it for pain relief. Make sure you know which is right for you.
- If you have been prescribed quick-acting tablets or capsules, you will be asked to take a dose every 4-6 hours. If you have been given modified-release tablets or capsules, you will be asked to take either two doses a day (taken 12 hours apart) or just one dose daily (at the same time of day each day). Your dose will be printed on the label of the pack to remind you, but if you are still unsure about what to do, ask your pharmacist for further advice. Do not take more than a total of 400 mg of tramadol in any 24-hour period.
- If you have been given modified-release tablets or capsules, it is important that you do not break the tablets or chew the contents of the capsules; otherwise they may release the medicine too quickly and cause side-effects. Swallow the tablets/capsules whole with a drink of water, unless the label says you may do otherwise.
- You can take tramadol before or after food.
- If you forget to take a dose, check the manufactuer's information leaflet for advice about what to do. Depending upon when your next dose is due, you will either be recommended to take a dose when you remember or wait for your next dose. Never take two doses together to make up for a missed dose.
Getting the most from your treatment
- Ask your doctor for advice before drinking alcohol while you are on this medicine. Your doctor may recommend you do not drink alcohol while you are on tramadol because it increases the possibility of side-effects such as feeling dizzy and sleepy.
- If you are a driver, please be aware that tramadol is likely to affect your reactions and ability to drive. It is an offence to drive while your reactions are impaired. Even if your driving ability is not impaired, should you drive, you are advised to carry with you some evidence that the medicine has been prescribed for you - a repeat prescription form or a patient information leaflet from the pack is generally considered suitable.
- As there are several different brands and strengths of tramadol, each time you collect a prescription, check to make sure it contains what you are expecting. Ask your pharmacist to check for you if you are unsure about anything.
- If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking tramadol as a painkiller.
- If you buy any medicines, check with a pharmacist that they are suitable for you to take with tramadol. Many other medicines have similar side-effects to tramadol, and taking them together will increase the risk of unwanted effects.
- If you are planning a trip abroad, you are advised to carry a letter with you from your doctor to explain that you have been prescribed tramadol. This is because tramadol is classed as a 'controlled drug' and is subject to certain restrictions.
- Do not take tramadol for longer than you have been advised by your doctor. This is because repeatedly using tramadol may lead to your body becoming dependent on it. When you then stop taking it, it will cause withdrawal symptoms such as restlessness and irritability. If you are concerned about this, discuss it with your doctor or pharmacist.
Can tramadol cause side-effects?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with tramadol. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Common tramadol side-effects - these affect around 1 in 10 people who take this medicine
|What can I do if I experience this?
|Feeling dizzy, tired or sleepy
|If this happens, do not drive and do not use tools or machines. Do not drink alcohol
|Feeling sick (nausea) or being sick (vomiting)
|Stick to simple meals - avoid rich or spicy foods
|Eat a well-balanced diet and drink plenty of water each day. If this continues to be a problem, speak with your doctor
|Try chewing sugar-free gum or sucking sugar-free sweets
|Less common side-effects include: headache, diarrhoea, itchy rash, and sweating
|If any of these become troublesome, speak with your doctor
Important: people taking opioid medicines, and their family and friends, should be aware of the risk of accidental overdose and know when to seek medical help. The risk is higher if you also take other medicines that make you feel drowsy. Signs you have taken too much medicine include:
- Feeling very sleepy or dizzy.
- Feeling sick (nausea) or being sick (vomiting).
- Breathing difficulties.
- Loss of consciousness.
If you have taken more tramadol than you should or someone else accidentally swallows your medication, call for an ambulance and tell them the name of your medicine.
If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.
How to store tramadol
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading and references
Manufacturer's PIL, Zydol® 50 mg capsules; Grunenthal Ltd. The electronic Medicines Compendium. Dated December 2021.
Manufacturer's PIL, Zydol® SR 100 mg, 150 mg and 200 mg prolonged-release tablets; Grunenthal Ltd, The electronic Medicines Compendium. Dated December 2021.
Manufacturer's PIL, Zamadol® SR 50 mg, 100 mg, 150 mg and 200 mg prolonged-release capsules; Mylan Products Ltd, The electronic Medicines Compendium. Dated November 2022.
Medicines Complete BNF 86th Edition; British Medical Association and Royal Pharmaceutical Society of Great Britain, London.