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9 Tramadol side effects of important concern

by egpat         07-12-2017

Controlling pain in the patients with opioid is a painful task as therapy should manage the sensitive balance between analgesic and euphoric effects of these drugs where tramadol works as charm. But it is not completely devoid of euphoric effects and other tramadol side effects produce a stir in its liberal use for controlling pain.

Even though theoretically it has less addiction potential than other drugs in the class, still it produces some euphoria and addiction. It also shows significant and sometimes very serious side effects all should be took into the account before its use.

So here let’s discuss the clinically important tramadol side effects.

No object exists without its shadow in light, so the case with this drug.

Tramadol is an opioid of synthetic origin that acts on μ-opioid receptors and produce analgesia at central level.

So it’s not unnatural to see that this drug shows similar effects as seen with other opioids, but it picks few other extra side effects unique to this drug in this category.

Let’s explore one by one.

9 tramadol side effects

1. Dizziness

The first notable on among the tramadol side effects is dizziness.

Clearly, we can relate this side effect to its central inhibition on neuronal transmission.

Patients on treatment with tramadol may observe symptoms like light headedness, drowsiness and a feeling of sleepiness even during daytime.

Sometimes patients may also observe vertigo with reeling sensation of surroundings and a state of nausea.

Practically these tramadol side effects are not observed in all the patients and at most of the times it stands as safe at the recommended dose.

Then what about its significance? Why to mention here?

Yes, we are coming to the point.

Even dizziness is not significant at most of the times, it may be enhanced with other factors aggravating the situation.

Suppose a patient has taken tramadol with alcohol the degree of dizziness may significantly raise to abnormal levels leading to coma in severe conditions.

So, intake of alcohol along with tramadol should be avoided.

Is that enough?

No. We have more number of drugs with such add-on effect on dizziness.

Drugs like benzodiazepines, narcotic drugs and other opioids all fit into the same shell potentiating the side effects like dizziness and respiratory depression.

2. Constipation

One more important tramadol side effect is on gastrointestinal system.

Constipation is a common side effect observed with other opioids. It is for the same reason, opioids like loperamide can be used to treat diarrhea.

These drugs can reduce gastric motility and tramadol can cause constipation by the same mechanism.

But sometimes tramadol can produce diarrhea.

How it’s possible? Both are quite opposite effects by a single drug.

Yes, Its possible but not by same mechanism instead different mechanisms.

As we have seen above, constipation is due to action of tramadol on opioid receptors.

On the other hand, diarrhea is an affect produced by tramadol due to its effect on serotonin and norepinephrine uptake which produce a set of effects commonly called as serotonin syndrome.

We will see it in detail in the following sections.

3. Nausea

All opioids can induce nausea and vomiting due to stimulation of chemoreceptor trigger zone (CTZ) in the brain.

Tramadol is no exception and produces a feeling of nausea in the patients.

4. Itching

Even though it doesn’t seem more significant, skin rashes may decrease your compliance once they are developed.

You can’t sit comfortable if itching and skin irritation every time diverts your attention bringing

Tramadol can produce skin rashes in few of the patients which sometimes become troublesome.

5. Muscle weakness

Even though there is no direct relation of tramadol action with muscle, a general muscle weakness can be observed in few set of patients.

Muscle stiffness may alter normal functionality bringing difficulty in its control.

Tremors may also add to this situation making the muscle lack of energy.

6. Serotonin syndrome

Definitely this is a side effect of very important concern.

Normally tramadol itself can produce few symptoms like anxiety, agitation, increased heart beat, sweating, increased body temperature in the patients using it for longer periods.

It can also produce changes in the mental state resulting in hallucinations in the patients.

All these effects are not shown by other opioids

Why tramadol produces these side effects while opioids not?

That’s due to its addition actions.

Tramadol also inhibits uptake of serotonin and norepinephrine thereby increases their levels within the CNS. As norepinephrine levels raise sympathetic system is activated.

That’s why you can see effects like agitation and tachycardia.

Serotonin also plays its role bringing a marked change in the mental states like hallucinations.

One of the important things here is that the risk can be enhanced by other factors. Drug like SSRIs, SNRIs, TCAs and MAO inhibitors all can increase the risk of developing this syndrome.

So, whenever tramadol is to be given the patient should be checked for simultaneous use of following drugs.

  • Amitriptyline
  • Nortriptyline
  • Imipramine
  • Fluoxetine
  • Paroxetine
  • Venlafaxine
  • Isocarboxazid
  • Phenelzine

7. Risk of seizures

Can tramadol induce seizures? Is it a convulsant?

The answer can be partially ‘no’.

Tramadol normally may not produce seizures in the patients within the recommended dose but at a high dose and when other risk factors join, it can catch the fire.

So the use of tramadol in seizure risk patients or patients taking CNS stimulants like amphetamine, theophylline or any other drugs with seizure tendency should be avoided.

8. Loss of appetite

Tramadol also reduces the appetite in the patients when used for longer periods. Even it doesn’t produce significant weight loss in the patients, a decrease in appetite is of important concern in the patients who are under weight and poor eaters.

9. Runny nose

Among the tramadol side effects, this is again observed due to its class effect. Generally opioids increase the runny nose bringing difficulty with inhalation. This tramadol side effect is observed within few days of treatment and can be tolerated on continuation of the dose.


Tramadol side effects are of important concern as this drug is widely used opioid analgesic for the treatment of moderate to severe pain. It produces few side effects related to its class effects such as sedation, dizziness, nausea and runny nose. But few of the tramadol side effects like risk of seizures are clinically important should be closely monitored.

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