Tramadol is a nontraditional centrally acting analgesic with a dual mechanism of action. It is a weak opioid and also a reuptake inhibitor for serotonin and norepinephrine.

It is assumed that tramadol is associated with a reduced risk for opioid related side effects such as respiratory depression or ileus. 

Tramadol is also considered to have a lower abuse potential than other opioids and is therefore not a scheduled drug in many countries. However, this view had been recently challenged. It has also been reported that patients who are prescribed tramadol for pain are more likely to become chronic opioid users.

Clinical Use: 
  • The FDA approved indication for tramadol is acute pain. 
  • At UCSF, tramadol is only available as immediate release tablets. 
  • The duration of analgesia is about six hours.
  • Most commonly prescribed as 50mg (25-100mg) every six hours as needed, or scheduled when used as part of a multimodal analgesic regimen.
Special Considerations: 

Important Side Effects

  • Serotonin syndrome, a potentially lethal complication
  • Seizures
  • Hypoglycemia


The concurrent use with other drugs that increase CNS serotonin concentrations is not advised. The combined use with antidepressants (TCAs, SNRIs) and CNS stimulants seems especially problematic.

Tramadol lowers the seizure threshold and should not be used in patients with seizure disorders.

Contraindications for use in children younger than 12 years

The FDA restricts use of tramadol in children due to serious risk of slowed or difficult breathing and death, which appear to be a greater risk in children <12 years.


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