Tramadol for pain
Published in Medicine Update
Date published: About this date
Health and medicines information in this article may have changed since the date published. This information does not replace advice from a health professional.
This Medicine Update is for people who are taking tramadol or are thinking about starting it.
Tramadol is a painkiller prescribed by your doctor. In general, it should not be taken instead of paracetamol or aspirin without good reason, as it has more side effects.
There are many forms of tramadol. Some are newer than others. It is important that people taking tramadol know how often to take it. Some forms need to be taken every 4 to 8 hours, some are taken twice a day, and one form is taken only once a day. It is also important to take only one form of tramadol at a time — so check the active ingredient of all your pain medicines.
- What tramadol is
- What tramadol is for
- Who can take tramadol
- What does tramadol do?
- Important side effects of tramadol to consider
- How to reduce your risk of side effects from tramadol
- Important interactions to consider
- What else you should know about tramadol
- How to decide between tramadol and other medicines
- What does tramadol cost?
- Other ways to help control pain
- Where to find more information
The active ingredient of this medicine is tramadol (pronounced tram-a-dol).
Tramadol is available as tablets, capsules and liquid drops that are swallowed. This update talks about tablets and capsules. The liquid drops work in the same way and have the same side effects.
Several different forms of tramadol tablets and capsules are available (see table 1). Some forms are taken every 4 to 8 hours, some are taken twice a day, and one form is taken only once a day.
How long tramadol works for depends on the way the tablets or capsules release the medicine in the body (see table 1). Some brand names of tramadol will have an ‘SR’ or ‘XR’ after them. The SR stands for ‘sustained release’ and the XR stands for ‘extended release’. The SR form of tramadol is long acting and the XR form is very long acting.
Table 1: Different forms of tramadol*
|How often you take it||How long it lasts||Brand names|
|Every 4 to 8 hours||Short acting|
Every 12 hours (twice a day)
Every 24 hours (once a day)
|Very long acting||Durotram XR|
* Make sure you take only one form of tramadol at a time.
Tramadol is taken to help relieve pain. It can be taken on its own, but is more commonly taken in addition to paracetamol. Tramadol must be prescribed by your doctor.
You can take tramadol if your pain is not effectively treated by paracetamol or aspirin, or if these medicines are unsuitable for you.
You can take tramadol while continuing to take paracetamol or aspirin.
You should not take tramadol if you:
- have epilepsy (fits or seizures) that are not well controlled by your epilepsy medicine
- are breastfeeding
- have severe liver or kidney disease
- are taking a type of antidepressant known as an MAOI or MAO inhibitor, e.g. moclobemide (Aurorix), phenelzine (Nardil) or tranylcypromine (Parnate).
If you take any other medicine for depression, check with your doctor before taking any form of tramadol.
Tramadol works in two ways to relieve pain.
It works on the brain in a similar way to codeine and morphine.
It also affects some other chemicals in the brain called noradrenaline and serotonin. These have many functions, some of which include easing pain.
Ask your health professional about the possible side effects of this medicine before you take it. Always tell them about any changes to your condition if you're taking a new medicine.
To report possible side effects call the NPS Adverse Medicine Events (AME) Line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST).
People with questions about their medicines or seeking general information about side effects can call the NPS Medicines Line on 1300 633 424 (Monday–Friday, 9am–5pm AEST).
Common side effects of tramadol include dizziness, nausea, constipation and drowsiness.
Dizziness and drowsiness may affect your ability to drive a car safely, so see how tramadol affects you before drive.
Tramadol can slightly increase your chances of having a fit or seizure. This is particularly true for people who are at risk of having a fit because they have epilepsy, have had a head injury or have had an infection of the brain such as meningitis. Talk to your doctor if you think this might affect you.
For a more complete list of possible side effects for tramadol, see the consumer medicine information (CMI) leaflet available on our Medicines Finder page.
It is very important to know how often and how many of your tramadol capsules or tablets to take. With so many different forms and strengths of tramadol, it is easy to take the wrong form of the medicine, or to take two different forms without realising they are both tramadol.
Check the active ingredients of all your pain medicines to make sure you are not doubling up on any.
It is also important to follow the instructions about how to take tramadol. Some forms of tramadol must be swallowed whole to reduce the risk of side effects.
Tramadol can cause constipation. Drinking plenty of water, being more active and increasing the amount of fibre in your diet can help reduce the chances of being constipated.
Tramadol interacts with several other medicines. In particular, it interacts with many antidepressants, and with St John’s wort and warfarin.
Tell your doctor about all the medicines you take, including any natural and herbal medicines.
You should not drink alcohol if you are taking tramadol, as it can make you very drowsy.
Remember that benefits and side effects differ between medicines and from person to person.
The painkiller you use will depend on the type of pain you have, the cause of the pain and the severity of the pain, among other things.
It will also depend to some extent on the side effects of different painkillers.
Paracetamol (e.g. Panadol, Dymadon) is the most appropriate painkiller for many people. It relieves pain with few side effects when it is used at the right dose. If you can manage your pain with paracetamol, there is no need to try other painkillers.
Other painkillers include non-steroidal anti-inflammatory drugs (NSAIDs) and medicines like codeine and morphine.
Non-steroidal anti-inflammatory drugs
NSAIDs such as ibuprofen (e.g. Nurofen) and diclofenac (e.g. Voltaren) are available from your pharmacist without a prescription. Some NSAIDs are only available with a prescription.
In general, NSAIDs are more likely than paracetamol to cause side effects, especially if they are taken for more than a few days. This is especially true for older people. NSAIDs can sometimes cause serious side effects like stomach bleeding, and can increase the risk of heart conditions in some people. NSAIDs are more likely to cause side effects when they are taken at higher doses for more than a few days.
Codeine, morphine and oxycodone
Medicines like codeine, morphine and oxycodone all belong to the same family as tramadol. They are more likely to cause side effects than paracetamol, but are necessary for some kinds of pain.
These medicines all work in a similar way, but morphine and oxycodone are stronger than codeine and tramadol. They share many side effects, such as drowsiness, constipation and nausea.
Tramadol has some side effects and interactions that most other members of this family of pain relievers don’t have. For example, it should be avoided by people taking certain types of antidepressants.
Tramadol often isn’t suitable for people because it makes them feel sick, because they have other conditions, or because are taking other medicines that mean they can’t take tramadol.
Some people find that tramadol relieves their pain and that its side effects are acceptable.
There are other choices of painkillers that work as well as, or better than, tramadol. It may be that you have to try several different painkillers to see which one is best for you. The decision might involve balancing the pain relief against the side effects of the medicine.
It is possible to combine some painkillers — but you should discuss this with your doctor or pharmacist before doing so.
Most forms of tramadol are available through the Pharmaceutical Benefits Scheme (PBS), but only under certain conditions. Your doctor must certify that paracetamol and/or aspirin have not eased your pain or are not appropriate for you. For some forms of tramadol, your doctor may need to make a phone call before they can prescribe more than 10 days supply.
If you have a concession card, you will pay $5.00 for a prescription through the PBS.
If you don’t have a concession card, you will pay between $10.00 and $30.00 per prescription, depending on what form and brand of tramadol you are prescribed.
Dealing with pain involves several steps.
Understanding the cause of the pain
Sometimes, the cause of the pain (such as an abscess) can be treated, and sometimes it is clear that the pain, such as pain caused by a bee sting, will settle down with time and care.
Recognising the difference between short and long-term pain
Short-term pain might be caused by something like a sprained ankle or having a tooth removed at the dentist.
Long-term pain, which lasts for more than a few months, might be caused by things like arthritis or back pain.
If you have pain for more than a couple of days, you should speak to your doctor.
Relieving pain in other ways
Whether the pain is short-term or long-term, there are other things you can do to help ease the pain.
For example, in short-term pain, resting the affected part and putting an ice pack on it can often help.
In long-term pain, it is particularly important to look at other ways to help ease the pain and to avoid the things that can make it worse, so the pain does not stop you doing the things you enjoy. Being active, eating healthily and managing stress are some of the things that can help. If you have long-term pain, your doctor can help you to find ways to help manage your pain and the effect it has on your life. It’s also important that you try to look after the pain yourself — you will know, more than anyone, what helps and what doesn’t.
For example, research is gradually showing the importance of sleep for people with chronic pain. In general, people who sleep well have less pain than those who don’t sleep so well. Getting a good night’s sleep is a vital part of dealing with long-term pain.
So, too, are diet and exercise. Long-term pain is generally less of a problem for people who can exercise regularly, in a manageable way, and who can maintain a healthy body weight.
Other techniques that have been shown to reduce long-term pain in certain circumstances include:
- creams and gels
- heat and cold
- psychological techniques such as stress management training, cognitive behaviour therapy and others
Specialist pain management clinics are also available in some parts of Australia for people whose chronic pain is not controlled by the usual methods. You would need to be referred by your doctor.
You can find more information in the consumer medicine information (CMI). This will tell you:
- who should not use the medicine
- which other medicines should be avoided
- how to take the medicine
- most of the possible side effects
- the ingredients.
You can get the CMI leaflet for tramadol from:
- your doctor or pharmacist
- our Medicines Finder page.
Information over the phone
NPS works with healthdirect Australia to provide the NPS Medicines Line phone service for consumers.
To get more information about any medicine call 1300 MEDICINE (1300 633 424). This service is available from anywhere in Australia, Monday to Friday, 9am to 5pm AEST excluding NSW public holidays.
To report a side effect
Call the NPS Adverse Medicine Events (AME) Line on 1300 134 237, Monday to Friday, 9am to 5pm AEST excluding public holidays.
The AME Line is a service where you can report possible side effects of your medicine and contribute to national medicine safety efforts. Information on medicine-related side effects is passed on to the Therapeutic Goods Administration (TGA) for assessment, but your personal details will remain confidential and your privacy maintained.