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Tramadol Facts

Self medication is not recommended. Always discuss medication changes with your physician and pharmacist.

Name: tramadol (TRA-ma-dol), Tramacet® (with acetaminophen), Ralivia®, Tridural®, Zytram XL®


Tramadol is an analgesic to treat moderate to severe pain. It is available in a form for immediate pain relief (combined with acetaminophen).  It is also available in long-acting forms that release the drug slowly over 24hr for patients who need around-the-clock pain relief for an extended period of time.

How tramadol works:

Tramadol is an analgesic that works in two ways. First it is a weak opioid (much less active than morphine). Second it works by increasing the chemicals in the brain (norepinephrine and serotonin) that help decrease pain felt by the patient.

Place in treatment:

Tramadol may be used for acute pain (eg. Post-operative pain, acute injury).Or may be used as an alternative to acetaminophen or anti-inflammatories if these are inadequate for pain control or are contra-indicated.


Tramadol has the potential to increase the risk of seizures especially in those with a history of seizures or patients taking antidepressants, or opioids.

Use tramadol with caution if you have kidney or liver dysfunction as the drug dose may need to be decreased or not used.

Side effects have been highest in patients over 75 years of age.

Talk to your physician and pharmacist about other prescribed medications, non-prescription medications including natural products you are taking to make sure there are no interactions with tramadol.

Do not drink alcohol while taking tramadol.


Take tramadol with or without food (best taken consistently with regards to food). If taking a long-acting 24h form take it at the same time each day.

If you forget to take a dose, take it as soon as you remember. If it is close to your next dose then skip the missed dose (do NOT take double the dose).

Doses of Tramacet® range from 2-8 tablets per day (in divided doses). Each Tramacet® tablet contains 325mg acetaminophen. Caution monitor other drugs you are taking that contain acetaminophen (Tylenol, cold medicines, muscle and joint pain relievers) to ensure you are not taking more than a total of 4000mg acetaminophen per day on a short term basis or no more than 2000mg on a regular dosing schedule. 

Doses of the long-acting tramadol range from 100-400mg once daily.

Do not chew, crush or split the long-acting form (Tridural®, Xytrem®, Ralivia®.

If stopping tramadol do not stop it suddenly to avoid withdrawal reactions. Always discuss this with your physician.

Side Effects:

All medications that have positive effects (usefulness) also have negative effects (side effects). A balance between the two is necessary. Starting at a low dose and increasing the dose gradually decreases the chance of side effects.

Most common side effects with tramadol are nausea, vomiting, sedation, dizziness, headache, and constipation.

Long-acting forms generally cause fewer side effects because they provide a continuous supply of drug to the body.


Tramadol has a unique action to provide pain relief. It may be beneficial for acute pain or breakthrough pain as the Tramacet® form, and in several long-acting forms for chronic moderate pain on a continuous basis. Tramadol has shown very low abuse potential. Each patient’s pain is unique, and therefore the individual response to different treatments varies.

Always discuss medication with your physician and pharmacist to see if this medication is appropriate for you.

Janice Sumpton RPh, BScPhm.   July 21,2009