Tramadol Side Effects
Written by: THE BALANCE
Medically reviewed by Dr. med. Sarah Boss
Last updated: November 5, 2025
Fact checked
Quick Summary
  • Although weaker than oxycodone or morphine, tramadol presents similar risks when used as a pain medication.
  • Doctors advise tramadol to patients who need pain relief from persistent pain from arthritis or fibromyalgia and after surgery, as well as pain related to nerve problems.
  • Tramadol comes in two formulations: immediate-release (IR) and extended-release (ER), so patients can choose between immediate relief and slow pain relief throughout the day [1].
Reading time: 17 min

Over the years, Tramadol has been used as a reliable painkiller. With the advent of safer alternatives, its use has somewhat declined. Although weaker than oxycodone or morphine, tramadol presents similar risks when used as a pain medication.

Doctors advise tramadol to patients who need pain relief from persistent pain from arthritis or fibromyalgia and after surgery, as well as pain related to nerve problems. Tramadol comes in two formulations: immediate-release (IR) and extended-release (ER), so patients can choose between immediate relief and slow pain relief throughout the day [1].

Tramadol stands out among painkillers because it works on opioid receptors and modifies norepinephrine and serotonin levels in the brain in a distinct way that stronger opioids do not. The added effect can make it more dangerous when combined with antidepressants or anxiety drugs.

Tramadol Has Well Known Side Effects

Tramadol produces side effects that vary between severe and mild reactions like all medical treatments. The impact of tramadol side effects varies from person to person, with some experiencing mild effects and others facing major health challenges.

Mild To Moderate Side Effects

Tramadol impacts the central nervous system to make users feel light-headed and sleepy, which reduces their ability to perform regular tasks.

  • Many patients feel stomach upset when they begin taking tramadol because it affects their digestive system.
  • Some users feel light headaches, especially when they start taking tramadol.
  • Tramadol reduces the movements of the bowel, which leads to constipation.
  • The decrease in saliva makes your mouth feel unpleasant or dry [2].

Serious Side Effects

  • Taking tramadol with drugs that boost serotonin levels can trigger serotonin syndrome, which causes agitation, high fever, and muscle rigidity.
  • People with epilepsy or neurological problems should stay away from Tramadol because it weakens their ability to control seizures.
  • Taking large amounts of tramadol with alcohol or sedatives leads to breathing problems that heighten the risk of respiratory depression (slow breathing to the extent that causes organ damage).
  • Regular use in high doses can cause both physical and psychological dependence, which in turn causes withdrawal symptoms when Tramadol is stopped abruptly.

Tramadol’s Immediate Side Effects And Their Duration

Tramadol’s short-term side effects appear within 30 to 60 minutes of taking the drug and persist for several hours based on the drug formulation. IR tramadol reaches its peak effect in 2 to 3 hours yet ER formulations have their therapeutic levels for 12 to 24 hours.

Common short-term side effects include:

  • Shortly after starting the medication, some people report mental fogginess that affects clear thinking.
  • Taking tramadol makes users feel very tired and sleepy, which puts them at risk for accidents, especially while driving.
  • Your blood pressure drops quickly when you stand up, which makes you feel faint.
  • Taking tramadol without food can trigger nausea and stomach pain in addition to vomiting.
  • The body shows its response to the drug through warm flushing and increased sweating.

Patients normally recover from these temporary effects in 4 to 6 hours, but some need longer to feel well. Get professional medical care from your doctor if the drug’s problems do not go away.

Long-Term Tramadol Side Effects

Taking tramadol daily for several weeks or months creates serious health risks. Physical and mental health problems emerge as some of the permanent side effects of tramadol use.

1. Tolerance And Dependence

Repeated tramadol use makes the body accustomed to the presence of tramadol and more pills are needed to achieve the same pain control and even routine physiological functions over time. Tramadol withdrawal symptoms start right after you stop taking the drug and include feeling irritable and experiencing body aches, sweating, and chills.

2. Cognitive And Memory Issues

Tramadol abuse over time weakens your ability to focus and remember routine happenings. Some people taking tramadol experience mental confusion and face problems making decisions.

3. Hormonal Changes

Tramadol influences testosterone and estrogen hormones, which results in sexual dysfunction, extreme tiredness, and emotional instability. Long-term tramadol users experience stronger negative effects.

4. Chronic Digestive Problems

Tramadol use over time induces long-term constipation that damages the rectal area and causes bloating and stomach pain. Disorders like GERD are common in people who stay on the medicine for more than a couple of weeks.

5. Mood And Emotional Changes

Using tramadol for a long period creates depression symptoms along with anxiety and changes in mood. When long-term tramadol users stop the medication, it affects their serotonin levels, which makes their emotional state unpredictable.

6. Liver And Kidney Strain

Tramadol use overloads the liver and kidneys, which raises the risk of organ damage. It is particularly seen in people with underlying kidney and liver problems.

7. Increased Risk Of Seizures

Tramadol builds up seizure risk in anyone who takes it over a long period. People using high amounts of tramadol and antidepressants or stimulants face a higher risk of side effects.

By disrupting the hormone levels, tramadol affects men’s sexual performance and heart health. The main side effects people experience when using this drug are:

1. Reduced Testosterone Levels

Repeated tramadol use leads to reduced testosterone production in people. Lower testosterone can cause:

Men who take tramadol for long periods develop chronic fatigue, lack of energy, and emotional instability because of hormone changes.

2. Increased Risk Of Erectile Dysfunction (ED)

Research indicates that tramadol and other opioid medications may harm sexual performance because they also affect how nerves send signals and control blood flow [3]. Men who take tramadol for pain often develop sexual problems with their erections.

3. Impact On Fertility

Some reports suggest that tramadol decreases sperm production and movement which damages male fertility [3]. Men who want to create a family need to pay attention to these findings.

4. Higher Risk Of Cardiovascular Issues

Extended opioid use can increase the risk of heart damage. It can manifest in various health issues, including:

  • Increased blood pressure
  • Irregular heart rhythms
  • A higher risk of chronic heart disease

So, Tramadol, which is known as a mild opioid, can harm the heart if taken over a long time.

Women taking tramadol may develop distinct side effects due to their peculiar hormones, reproductive structure, and metabolic changes.

1. Menstrual Irregularities

The drug tramadol affects hormone levels, which causes changes in menstrual cycles such as unpredictable bleeding patterns.

  • Irregular or missed periods
  • Heavier or lighter bleeding
  • Increased menstrual cramps

The drug effects will likely stand out more in women who take tramadol for many months.

2. Increased Sensitivity To Side Effects

Because of biological and hormonal changes, women metabolize opioids differently from men, leading to these side effects:

  • Stronger pain relief
  • Higher risks of nausea and dizziness
  • A greater likelihood of developing dependence

In clinical practice, Tramadol doses for women are usually reduced to decrease their potential side effects.

3. Risks During Pregnancy

Tramadol use during pregnancy puts both mother and baby at risk of health complications. Research shows that taking Tramadol while pregnant can lead to specific health problems [4].

  • After birth, some newborns develop Neonatal opioid withdrawal syndrome.
  • Regular tramadol use during pregnancy can lead to abnormal fetal growth and premature early birth.

Doctors recommend avoiding tramadol use in pregnancy except when there are no other suitable treatment options.

4. Breastfeeding Considerations

Tramadol moves from breast milk to the baby where it creates breathing problems and strong sleepiness that can lead to withdrawal reactions in the baby. Mothers who breastfeed need to talk with their doctor about tramadol use.

Tramadol affects more than just pain control in the brain; It alters the way the brain processes mood, memory, and thinking.

Tramadol eases pain by changing how brain cells communicate and modifying both serotonin and norepinephrine levels while interacting with opioid receptors. Tramadol helps treat pain through brain changes, but continued use damages brain health, which affects mental abilities and triggers emotional and neurological problems.

Dependence And Brain Adaptation

Repetitive tramadol use makes the brain depend on the drug to control neurotransmitter activity. Tramadol use over time causes the brain to change in a way that affects its ability to manage pain naturally.  

  • The body loses its natural pain resistance because of the tramadol treatment. 
  • The brain finds it hard to work properly when the drug is no longer present. 
  • When tramadol users stop taking the drug, they commonly develop mood changes such as anxiety, depression, and increased irritability.

Cognitive Decline And Memory Issues

Evidence shows that long-term tramadol users often have less effective thought processing and poor memory function. 

People who use tramadol for long periods develop these effects.  

  • Difficulty concentrating or focusing 
  • Forgetfulness and short-term memory issues 
  • Slower reaction times and problem-solving difficulties 

The mental clouding from tramadol stays with users even after they stop taking the drug, especially when they take heavy doses for a longer time.

Increased Risk Of Mood Disorders

Tramadol changes the amount of serotonin and norepinephrine in the brain, which affects how you feel emotionally. 

People who take tramadol for a long period may develop these problems [2]:

  • Higher risks of depression and anxiety
  • Emotional numbness or lack of motivation
  • Increased likelihood of mood swings
  • People with past mental health disorders tend to experience stronger effects from tramadol.
  • Regular Tramadol use at high levels may damage your brain permanently

Although tramadol has lower opioid strength than other painkillers, it poses potential long-lasting brain damage when used in the long term or at high doses.

Seizure Risk And Neurological Damage

  • Tramadol weakens the brain’s resistance to seizures and raises the chance of seizures even in people who do not have a history of epilepsy.
  • Repetitive seizure activity over time harms the brain’s health.
  • Recurrent seizures can make you lose consciousness and confuse you while creating permanent mental problems.
  • People with past seizures or brain trauma need to take tramadol with special precautions.

Reduced Oxygen To The Brain (Hypoxia Risk)

  • When someone takes too much tramadol or misuses it, their breathing rate can slow down, reducing oxygen flow to the brain.
  • Hypoxia affects brain cells and leads to brain damage.
  • Hypoxia from tramadol overdose can put someone into a coma or harm their brain permanently.

Reversible Vs. Irreversible Effects

The brain returns to normal function when tramadol is stopped, especially when users take the drug for a limited period. The brain experiences permanent changes when someone uses tramadol for an extended period and becomes dependent on it. 

The factors listed below determine the chance of recovering from tramadol’s effects on the brain:

  • The duration of use
  • The dosage and frequency
  • The presence of underlying conditions (e.g., pre-existing neurological conditions or mental health disorders)

The way Tramadol affects sleep depends on how much you take, your biological tolerance to the drug, and the total duration for which the medicine is taken. Some users feel sleepy under tramadol while others have trouble sleeping and experience night-time restlessness. 

Understanding how tramadol affects sleep will help patients manage side effects and sleep better.

Tramadol As A Sedative

Tramadol produces sedation in certain people because of the symptoms listed here [1]:

  • Drowsiness
  • Increased fatigue
  • Slower reaction times
  • Inability to focus or concentrate on routine tasks

Tramadol induces sleepiness mainly when people use large doses or take it with other drugs that slow down brain activity such as benzodiazepines and alcohol.

Tramadol As A Stimulant

Some users report the opposite effects such as:

  • Restlessness or jitteriness
  • Increased energy or alertness
  • Difficulty falling or staying asleep

Tramadol produces opposite effects because it affects serotonin and norepinephrine levels similarly to antidepressant medications.

Time Of Administration Matters

People who take tramadol during daytime hours have a lower chance of sleep disruptions at night.

Using tramadol within a short period before bedtime raises your level of alertness and makes it harder to fall asleep.

Tramadol affects the sleep patterns of most users, which can develop into insomnia and poor sleep quality over extended periods.

Tramadol And Sleep Cycle Disruptions

Research shows that tramadol affects your sleep by decreasing your deep sleep periods and reducing the time spent in REM sleep [5].

A person may wake up tired despite having a complete night of sleep when deep sleep decreases.

When REM sleep decreases, people experience more vivid dreams combined with nightmares and excessive sweating at night.

Withdrawal And Sleep Disturbances

Regular tramadol users who stop taking it will develop sleep problems during withdrawal such as:

  • Severe insomnia
  • Restless legs syndrome (RLS): This produces painful sensations in the legs during nighttime sleep [2].
  • Increased anxiety or nightmares

The duration of tramadol withdrawal symptoms depends on how long someone took the drug before stopping.

Follow Specific Steps To Improve Their Sleep Quality.

If you have sleep problems from tramadol use, try these methods to improve your rest:

  • Taking tramadol near bedtime increases the chance of sleep problems so it should be avoided.
  • Follow regular sleep habits and limit screen time before bedtime to improve your sleep quality.
  • See your doctor about sleep problems because changing the dose or choosing different medications can improve your condition.

Safe Use Of Tramadol: Risks And Precautions

Tramadol provides good pain relief but you should modify your diet and lifestyle to prevent unwanted side effects and maintain its effectiveness. 

Older adults need to know the tramadol food interactions and precautionary steps because they have greater chances of getting side effects from the drug.

Tramadol interacts with specific foods and drinks that either worsen its side effects or affect how the body handles the medication.

Alcohol And Tramadol: A Dangerous Combination

Alcohol and tramadol together create serious risks of extreme sleepiness and dizziness along with breathing problems that put your life in danger.

Tramadol’s side effects worsen when you consume any alcohol because it raises the risk of nausea, mental confusion, and movement problems.

Eating A High-Fat Meal Can Slow Down Tramadol Metabolism

High-fat meals eaten before tramadol intake reduce their absorption and make pain relief take longer.

When you need fast pain relief but can handle taking tramadol on an empty stomach, it will work better.

Grapefruit And Grapefruit Juice

The liver enzymes that break down tramadol are blocked by grapefruit, which raises the amount of drug in your bloodstream.

Grapefruit affects tramadol metabolism, which raises the chances of experiencing drowsiness and digestive problems.

Caffeine And Highly Processed Sugars

Caffeine from coffee, tea, and energy drinks raises insomnia risk and restlessness, especially when tramadol activates stimulant-like effects in certain users as discussed above.

Users who take tramadol and eat high amounts of sugar may experience more severe mood swings and energy instability that make their tramadol side effects worse.

Herbal Supplements That May Interact With Tramadol

Tramadol’s effects on the body can change when you use herbal remedies and dietary supplements.

  • St. John’s Wort reduces tramadol’s effectiveness while making withdrawal symptoms more intense.
  • Using valerian root and kava together with tramadol can lead to dangerous levels of sleepiness.
  • The combination of turmeric and ginger with tramadol raises bleeding risks, especially in patients who take blood thinners.

People aged 65 and above are more likely to develop tramadol side effects because their bodies process medications slowly, and they might have more health problems and increased pain medication sensitivity.

  • As people age, the liver and kidneys process drugs slowly, leaving more tramadol in the bloodstream.
  • The aging nervous system of older adults reacts strongly to painkillers, which makes side effects such as mental confusion and dizziness appear more frequently.
  • Tramadol makes users more sleepy and vision is impaired, which raises their danger of falling and breaking bones.

Common Tramadol Side Effects In Older Adults

Old people tend to have these reactions to tramadol more often.

  • Confusion or memory problems
  • Drowsiness and fatigue
  • Dizziness and unsteadiness
  • Constipation or digestive issues

Tramadol can lead patients to experience hallucinations and paranoia as well as enhanced agitation which may be mistaken for dementia.

Safety Tips For Elderly Tramadol Users

Elderly patients and their caregivers need to take these safety steps during tramadol treatment.

  • If your loved one experiences a change in mental health, they must see a doctor straight away.
  • Beginning with small medication amounts helps lower the chance of serious side effects developing.
  • Older adults should drink enough water and eat fiber-rich foods to avoid constipation caused by tramadol.
  • Due to its hypotension-causing effect, getting up too quickly from a sitting position may make dizziness worse and increase the chances of falling in the elderly.
  • Regularly check all your medications because tramadol interacts strongly with blood thinners, antidepressants, and sedatives.

1. Vazzana M, Andreani T, Fangueiro J, Faggio C, Silva C, Santini A, Garcia ML, Silva AM, Souto EB. Tramadol hydrochloride: pharmacokinetics, pharmacodynamics, adverse side effects, co-administration of drugs and new drug delivery systems. Biomedicine & Pharmacotherapy. 2015 Mar 1;70:234-8. https://www.sciencedirect.com/science/article/pii/S0753332215000396

2. Beakley BD, Kaye AM, Kaye AD. Tramadol, pharmacology, side effects, and serotonin syndrome: a review. Pain physician. 2015;18(4):395. https://scholarlycommons.pacific.edu/phs-facarticles/534/

3. Azari O, Emadi L, Kheirandish R, Shafiei Bafti H, Esmaili Nejad MR, Faroghi F. The effects of long-term administration of tramadol on epididymal sperm quality and testicular tissue in mice. Iranian Journal of Veterinary Surgery. 2014 Jun 1;9(1):23-30.

4. NHS. Pregnancy, breastfeeding, and fertility while taking tramadol. https://www.nhs.uk/medicines/tramadol/pregnancy-breastfeeding-and-fertility-while-taking-tramadol/

5. Dimsdale JE, Norman D, DeJardin 1 D, Wallace MS. The effect of opioids on sleep architecture. Journal of Clinical Sleep Medicine. 2007 Feb;3(01):33-6. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.26742

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