Tramadol is a synthetic weak opioid. “Weak”, because it has a slightly lower pain relieving effect on the classical effects of opioids than it does strong opioids.

Medicines containing tramadol are therefore prescribed on a regular prescription (not on a narcotic prescription). Tramadol is used in medicines as tramadol hydrochloride.

How does Tramadol help?

Tramadol takes pain

Tramadol is used for moderate to severe acute and chronic pain, and also helps with nerve and bone pain and intestinal pain. Tramadol reduces pain perception in the brain. On the one hand it has a pain-relieving effect like strong opioids, albeit weaker. On the other hand pain modulating as antidepressants: It ensures that the messengers serotonin and norepinephrine in the brain can work longer and so raise the pain threshold.

Pain and pain therapy

Further effects

Depending on the dose, Tramadol is antitussive (cough center in the brain). With its antispasmodic property (internal organs) tramadol throttles the intestinal activity, which often leads to constipation. Tramadol also makes you tired and sleepy. Although drowsiness subsides after some time, getting up quickly or sitting up can cause dizziness.

How to use Tramadol

The dose of tramadol must always be adjusted to the pain and gradually increased until optimal pain relief with acceptable side effects occurs.

Effervescent tablets, film-coated tablets, hard capsules, capsules, tablets, drops, orodispersible tablets (oral)

For effervescent tablets, (film) tablets, (hard) capsules and orodispersible tablets, the pain relief starts within 20-30 minutes and lasts for about 4 hours. Your doctor will adjust the dose so that you take tramadol 4-6 times daily. You can take Tramadol with your meal. For light swallowing problems, effervescent and orodispersible tablets and drops have advantages. Melted tablets put on the tongue, dissolve by active sucking and swallow the dissolved active ingredient. It is then taken through the gastrointestinal tract as with normal tablets. In case of dry mouth you should moisten the mouth beforehand or better switch to drops or effervescent tablets.

Prolonged-release tablets (oral)

For chronic pain is changed from the above forms to prolonged-release tablets. “Retard” means delayed. They are usually taken twice a day at intervals of 12 hours. After first taking they work within one hour. Some manufacturers also offer divisible prolonged-release tablets. Without swallowing problems, the tablet should generally be taken as a whole.

Syringe / drip into the subcutaneous fat tissue (subcutaneously), into the vein (intravenously) or into the muscle (intramuscularly), uvula (rectally)

If you can not swallow Tramadol, a kind of “tissue drip” is often applied. Tramadol, alone or in combination with other important medications, is continuously released as a solution into the fat depot below the skin and from there gradually into the blood. It works after 10-20 minutes. As a syringe directly into the vein it works after 5-10 minutes. Tramadol works for 4-6 hours.

Continuous intravenous administration is possible with a pain pump (PCA).

If swallowing is more severe, suppositories may be used instead of oral. Here the effect begins after 20-30 minutes.

Critical questions about Tramadol

What to do if the dosage is too high?

The risk is extremely low because the dose setting is closely monitored by the doctor.

An overdose causes muscle spasms, seizures, cardiovascular problems, shallow breathing, very tight pupils or vomiting. You should then immediately inform the attending physician. In case of overdose, an antidote (naloxone) is injected which maintains the pain-inhibiting effect of tramadol but stabilizes respiration.

What to do if a dose has been missed?

You can take an accidentally missed dose – but not if it is already time for the next dose. A double dose should be avoided.

You may notice in your pain that you have forgotten a dose. Usually, however, your doctor has written down an additional required dose of the medication so that you can then take this required dose as a substitute.

Driving during the treatment?

Tramadol can make you dizzy and tired. Do not drive a car or operate machinery until you know how the drug affects you. We advise you to drive in the first few weeks only after consultation with the attending physician.

What side effects are common with tramadol?

Side effects What helps against it?

Tiredness, dizziness, drowsiness.

Usually only during the dose adjustment at the beginning of the therapy.

Some patients get used to these effects.

If the weakness is too debilitating, talk to your doctor. He may adjust the dose again and / or additionally prescribe a non-opioid analgesic.

Nausea and vomiting

Nausea is a common side effect with tramadol, but usually only during dose adjustment at the beginning of therapy

Often, medications for nausea and vomiting are used as a precautionary measure.

Constipation as a result of the effect in the stomach-dar area

As a precaution, a mild laxative is prescribed.

  • Dry mouth
  • Chewing chewing gum.
  • Sweets or ice cubes suck.
  • Mundbefeuchtungsmittel.

Can Tramadol be addictive?

When a life-threatening cancer is present, the risk of dependency on the benefit of relieving pain is negligible. The low risk of dependence of strong opioids when used as intended is even lower with a weak opioid such as tramadol.

The body can get used to tramadol, which means that after prolonged use the same dose will not work as well.

If you no longer need Tramadol as a painkiller, your doctor can easily stop the remedy for several days.

What can happen when using other medicines at the same time?

Tell your doctor about all medications you use. The leaflet describes possible interactions in detail.

Many medications increase the side effects of tramadol, e.g. sleep aids, antidepressants and muscle tension remedies also make you tired and sleepy.

Anticonvulsants such as butylscopolamine cause dry mouth, urinary retention and constipation.

Certain antidepressants must not be combined with tramadol.

Alcohol should be avoided

Alcohol enhances the effects and side effects of tramadol, especially in slow-release drugs, alcohol consumption can release significantly more active than desired.

If you can not swallow any more pills

In cases of massive dysphagia or vomiting, subcutaneous administration of tramadol becomes important. This type of application can easily take place over a longer period of time.

If tramadol does not help

If tramadol does not help or no longer in combination with metamizole or paracetamol, must be switched to more potent opioids: morphine, fentanyl, hydromorphone, buprenorphine or levomethadone. Your palliative care physician or pain therapist will advise you in such situations.

Metamizole Paracetamol

Morphine Fentanyl Hydromorphone Buprenorphine Levomethadone

Also, additional analgesics like some antidepressants can relieve pain. Because of possible interactions Tramadol is only combined with certain antidepressants. Talk to your doctor!

Additional painkillers (co-analgesics)

Pain can be intensified by anxiety and restlessness. Lorazepam can help here, but it also makes you tired.


The information about Tramadol was created by the authors with the greatest possible care and written in such a way that it can be understood by laymen and implemented accordingly. This necessarily means that the information had to be significantly simplified and shortened without distorting it.

Of course, this information can not replace the package leaflet, which always accompanies the prescribed medication. This informs comprehensively about the drug used in each case and should be read carefully in each case.

Likewise, this information can not replace the conversation with the attending physician. This has thought about why he wants to use exactly this preparation and can justify this well. The variety of palliative care situations and individual needs always means individual treatment, while this information has been deliberately kept general. Please always ask your doctor if you have any questions.