Moderate opioid
Tramadol
Tramadol hydrochloride
Tramadol is a prescription-only painkiller used for moderate to severe pain. It works partly like an opioid and partly like an antidepressant, which explains both its benefits and its particular risks.
How this medicine is supplied
Prescription only in the UK. Dispensed by us only against a valid prescription from a UK prescriber.
How prescriptions workCall 999 for a seizure or for signs of serotonin syndrome: high temperature, agitation, fast heartbeat, muscle stiffness or confusion.
What it is used for
- Moderate to severe pain, including after injury or surgery
- Long-term musculoskeletal or nerve-related pain when other options have not worked
How it works
Tramadol relieves pain in two ways: it weakly activates opioid receptors, and it increases levels of serotonin and noradrenaline in the nervous system. The second action is why it can interact with antidepressants and why it lowers the seizure threshold.
Forms available in the UK
- Immediate-release capsules and tablets
- Modified-release tablets (once or twice daily)
- Oral drops and solution
- Injection
Safety information you must know
- Tramadol lowers the seizure threshold. Avoid it if you have uncontrolled epilepsy, and tell your prescriber about any history of seizures or head injury.
- It can cause serotonin syndrome when combined with SSRIs, SNRIs, triptans or St John's wort. Seek urgent help for agitation, sweating, tremor, fast heartbeat or muscle rigidity.
- It can cause low blood sugar — monitor for shakiness, sweating and confusion if you have diabetes.
- Do not use with alcohol, and do not drive until you know how it affects you.
- Tramadol can cause dependence. Do not stop suddenly after long-term use without advice.
Common side effects
- Nausea and vomiting
- Dizziness and drowsiness
- Constipation
- Dry mouth
- Headache
- Sweating
- Sleep disturbance
Interactions to be aware of
- SSRI and SNRI antidepressants
- Triptans (migraine medicines)
- St John's wort
- Warfarin (altered INR)
- Carbamazepine and other anti-seizure medicines
- Alcohol
UK legal position
Tramadol has been a Class C controlled drug since 2014 and is a Schedule 3 prescription-only medicine. It is not available over the counter in the UK, and prescriptions are valid for 28 days.
Brand names you may see
Brand names are listed for identification only. We do not endorse or supply them.
This page provides general information only and does not constitute medical advice, a prescription or an offer to supply. Doses are decided by your prescriber. If you think you may need this medicine, speak to your GP, an NHS 111 clinician or a specialist pain service. In an emergency, call 999.