Categories: Side effects

Serious side effects of tramadol

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Discover the serious side effects of tramadol.

Tramadol is the most widely consumed opioid in France to relieve pain, but its side effects are numerous. How to take it without risk? Avoid overdose in children? What signs should alert? Advice and precautions.

Tramadol is the most widely consumed opioid in France, ahead of codeine. It can be administered to adults and children, but only on prescription. Shocking side effects of tramadol


According to figures published in 2019 by the ANSM, the consumption of tramadol alone has increased by 68% between 2006 and 2017 (the tramadol/paracetamol has decreased since 2011).

However, tramadol is the first opioid analgesic reported in the notifications of problematic use of the addictovigilance network, the first also involved in deaths. of the “Toxic Deaths by Analgesics (DTA)” survey.

Overdose of tramadol may present with vomiting, narrowing of the pupil (miosis), disturbance of consciousness which may lead to coma, seizures, serotonin syndrome, cardiovascular collapse, or respiratory depression which may cause arrest. respiratory.


Medicines containing Tramadol

Tramadol alone: Biodalgic®, Contramal®, Monoalgic®, Monocrixo®, Orozamudol®, Takadol®, Topalgic®, Zamudol®, Zumalgic® and Tramadol Generics.

In combination with paracetamol: Generic Ixprim®, Zaldiar®, Tramadol / Paracetamol.

In combination with dexketoprofen: Skudexum®.

Girls’ education in the Sahel has changed dramatically over recent years.

Side effects of tramadol

If opioids are consumed less than non-opioid analgesics (paracetamol, aspirin, NSAIDs) and have ” a major and unquestionable interest in the management of pain “, their misuse is increasing.

With the key to more poisonings and deaths. “The number of hospitalizations linked to the consumption of opioid analgesics obtained on medical prescription increased by 167% between 2000 and 2017, going from 15 to 40 hospitalizations per million inhabitants”, specifies the ANSM.


The number of deaths related to opioid use increased 146% between 2000 and 2015, with at least 4 deaths per week .” This problem mainly affects patients who consume an opioid analgesic to relieve pain, and who develop a primary dependence on their treatment, and sometimes divert it from its initial indication” notes the ANSM. Women are predominantly affected.

Among the side effects of tramadol:

•constipation, drowsiness (this is a level 2 analgesic so be careful driving!), nausea, vomiting, headache, confusion, dry mouth.

•In the event of overdose: central nervous system depression (drowsiness, coma ), respiratory depression with decreased respiratory rate and pupil contraction. Overdose can lead to death.

Even more so when the person is also taking alcohol, sedative drugs, antidepressants, or even anti-hypertensive drugs.

•risk of drug abuse and dependence.


•hepatic risk when taking tramadol + paracetamol in addition to paracetamol alone.

•A study ** published in August 2019 in the journal Scientific Reports showed that tramadol can promote hypoglycemia (abnormally low blood sugar levels).

The American authors recommended  “to monitor glucose levels during the initiation of tramadol or methadone in diabetic and non-diabetic patients” and to favor other opioid or non-opioid analgesics which are safer for patients at risk. hypoglycemia or complications associated with hypoglycemia.

Interactions to avoid

Tramadol should not be taken simultaneously with other medicines. For example : 

•With tranquilizers, sleeping pills, analgesics such as morphine or codeine (increased risk of drowsiness or feelings of fainting).

•With anticoagulants: the effects of anticoagulants derived from coumarin, which thin the blood may be increased (risk of bleeding).


•With serotonergic drugs such as SSRI antidepressants (selective serotonin reuptake inhibitors such as Prozac®) or MAO inhibitors taken during the depression.

•With carbamazepine, nalbuphine, buprenorphine, pentazocine, ondansetron, bupropion, or triptans (migraine).

•With other opioid drugs (analgesics, cough suppressants).

Tramadol in children: respect the doses

Tramadol can be prescribed to children from 3 years old, with a dosage set according to weight. It is currently in the drinkable form in a dropper bottle (100 mg/ml).


In September 2021, the National Medicines Agency ( ANSM ) reported: “medication errors with tramadol in oral solution (…) the serious consequences of which put the patient’s vital prognosis at risk”.

Therefore, in agreement with the ANSM, the Sanofi and Grünenthal laboratories will modify the boxes of their Topalgic and Contramal 100 mg / mL specialties based on tramadol, in oral solution, by adding two boxes to avoid overdose : 


Boxes were added to boxes of Topalgic and Contramal to avoid the risk of overdose in children. © ANSM

Overdose of tramadol may present with vomiting, narrowing of the pupil (miosis), disturbance of consciousness which may lead to coma, seizures, serotonin syndrome, cardiovascular collapse, or respiratory depression which may cause arrest. respiratory.

It can also be prescribed from the age of 12 or 15 in oral form. The injectable form of tramadol is contraindicated before the age of 15.

To avoid any medication errors, the authorities remind parents:

•to respect the doctor’s prescription,

•to seek medical advice in case of doubt about the prescription or the operation of the drop bottle,


•keep the medicine out of the reach and sight of children,

•to immediately consult a doctor or emergency service in the event of the appearance of signs of overdose: vomiting, disturbances of consciousness, breathing difficulties, etc.

Because of the increase in the use of analgesic opioids in France and the complications that can be very serious, the health authorities are taking actions aimed at controlling the supervision of these drugs in terms of prescription and dispensing conditions, prohibiting advertising to the general public, information for healthcare professionals.

They carefully monitor their consumption and the associated risks. In France, tramadol is marketed alone in the specialties Topalgic ©, Tramadol Lavoisier ©, Contramal ©, and generics. In combination with paracetamol in Ixprim ©,  Zaldivar ©, and generics. And with dexketoprofen in Skudexum ©.

  • codeine, dextropropoxyphene, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, tapentadol, tramadol.

Prescribing Tramadol

Since  April 15, 2020, tramadol-based drugs taken by mouth can no longer be prescribed for more than 3 months, without a  new prescription.

This decision taken by the director of the French Medicines Agency (ANSM) aims to limit the misuse of these medicines as well as the risk of dependence.


Tips when taking Tramadol

For the safe use of tramadol-based medicines: 

Respect the dosage indicated on the prescription, as well as the duration of treatment.

If the pain is not relieved enough or quickly with your treatment, see your doctor again.

Do not suddenly stop your treatment: Your doctor or pharmacist will tell you how to gradually reduce the doses.

Tramadol in figures

According to health insurance data, nearly 10 million French people receive an opioid prescription each year. Between 2006 and 2017, they increased by around 150%.

That of tramadol *, the most prescribed analgesic since 2017, jumped 68% during the same period (especially in the city) according to a report from the National Medicines Agency (ANSM) published in 2019.


Developed in the 1970s, this drug dethroned codeine after the withdrawal of dextropropoxyphene ( Di-Antalvic® ) in 2011. Today, it is:

•1 st  analgesic opioid cited in a 2018 survey of problem use in both drug users but also the general population for the treatment of pain. 

•1 st analgesic involved in deaths associated with taking painkillers before morphine (DTA survey *).

•2 nd analgesic most frequently found on forged orders presented in pharmacies behind codeine (** OSIAP investigation.

The reasons for taking tramadol are in this order: to relieve pain, headache, and opioid dependence. According to the French Observatory for Analgesic Drugs, tramadol is taken by 46% of men and 54% of women.

The average age of the patients is 53 years. The number of people taking tramadol for more than 2 years has doubled since 2013 (38% in 2013, 50% in 2014 and 2015, 77% in 2016).


In 2016, in 49% of cases (for which the information is known), the quantity consumed is greater than that recommended in the marketing authorization, which directly increases the risk of dependence. 


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