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Tramadol is an opioid analgesic that has a mild anesthetic effect. Tramadol helps to alleviate pain by affecting the receptors in the patient’s brain.

The effectiveness of Tramadol in relieving pain of varying intensity is associated with its mixed mechanism of action. Tramadol slows the transmission of nerve impulses, and helps increase the levels of norepinephrine and serotonin hormones.

Tramadol is available in various dosage forms (solid or liquid), which makes it convenient for most patients with pain syndrome. To relieve pain, you can use one of the following Tramadol forms:

  • sublingual tablets or drops
  • oral tablets or capsules
  • rectal or intranasal suppositories
  • solutions for intramuscular, subcutaneous or intravenous injection

Prescribing Information

Tramadol is prescribed for adjunctive analgesic therapy of chronic or acute pain syndrome. Tramadol promotes a rapid and effective relief of moderate or severe pain of various etiologies, including:

  • cancer pain
  • postoperative pain
  • post-traumatic pain syndrome


The initial effective dose of Tramadol for pain management is 25 mg per day. If this Tramadol dose is not sufficient to relieve the pain, you can increase it to obtain an adequate analgesic effect:

  • maximum up to 400 mg of Tramadol/day – for patients under 75 years of age;
  • not more than 300 mg per day – for patients of the older age group.

The daily dose of Tramadol should be increased gradually, by no more than 25 mg once every 3 days. Single Tramadol doses of 50-100 mg are recommended for emergency pain relief.

Tramadol tablets and capsules have a different action duration and release rate. Depending on the used dosage form of Tramadol, the minimum interval between its two doses may be different:

  • extended or immediate release Tramadol tablets should not be taken more than twice in 24 hours;
  • dosage forms of Tramadol with normal release rate should not be used more than once in 4 hours.


Tramadol interacts with drugs that contribute to changes in the concentration of CYP2D6 or CYP3A4 enzymes, including:

  • Anti-migraine drugs (such as Sumatriptan or Eletriptan).
  • Antidepressants (for example, Phenelzine or Nortriptyline).
  • Some other opioid analgesics (Tapentadol).
  • Some antitussives (in particular Dextromethorphan).

Use of Tramadol together with one or more drugs from the listed medicinal groups, increases the risk of agitation, tremor, hyperreflexia or fever.

Such painkillers, like Hydrocodone or Codeine, can potentiate the action of Tramadol. One of these drugs can be used in conjunction with Tramadol to accelerate the relief of moderate or severe pain.

Side effects

In large doses, Tramadol can cause such adverse reactions,as hyperhidrosis, nausea, dizziness, itching, or severe drowsiness. At the beginning of the analgesic therapy, Tramadol can cause vomiting.

Tramadol has minimal effect on the cardiovascular system, and very rarely can cause:

  • tachycardia
  • hypertension
  • vasodilation


Geriatric patients or patients with kidney or liver disease may need to adjust the dose of Tramadol.

In head trauma, epilepsy or convulsive syndrome, care should be taken when using Tramadol.

Patients with a high risk of respiratory depression are recommended to use alternative methods of the pain syndrome treatment,instead of Tramadol.