These effects cause the functions of the body to slow down, especially breathing patterns. If a person takes too much Ultram, they can suffer a potentially lethal overdose.
The main cause of overdose is slowed or stopped breathing. People who struggle with taking too much tramadol may need help to stop taking the drug. Vertava Health provide medical detoxification and addiction treatment for people who suffer from opioid addiction, including tramadol. Like other opioids, tramadol can result in a feeling of relaxation and well-being. This may lead some people to take too much of the drug. It is not common to overdose on tramadol when the drug is taken as prescribed.
People who overdose on tramadol are often abusing the drug, or taking it more frequently than directed. We are here to help you through every aspect of recovery. Let us call you to learn more about our treatment options.
Tramadol comes in an extended-release tablet, which means the medication has a potent amount in each dose. If a person abuses tramadol by crushing and snorting the pill , they are at a heightened chance of overdose.
Large amounts of opioids like tramadol can decrease the amount of oxygen available to the brain. This can result in coma, permanent brain damage, or death. The least tramadol amount that has resulted in seizure is mg. Tramadol neurotoxicity generally occurs within the first 24 hours postingestion mainly in the first 6 hours and seizures are usually tonic-clinic [ 3 , 6 - 8 , 11 , 21 , 23 , 50 , 75 - 78 ].
Status epilepticus has also been reported [ 6 , 11 , 59 , 76 ]. This shows that tramadol can cause seizure at both therapeutic and toxic levels [ 43 , 52 , 77 , 79 ]. Brain computed tomography CT of the tramadol-intoxicated patients has often been reported to be normal [ 43 , 77 ]. In a study performed to evaluate the risk of idiopathic seizure in tramadol users, only 17 cases of idiopathic seizure were found among patients, all of whom, used tramadol in combination with some other medication; it, therefore, is difficult to relate their seizure to tramadol use [ 71 ].
Seizure is less frequent in the patients who use tramadol with benzodiazepines. Psychological and somatic complications hepatitis C and liver injury were detected in those who had seized. Ethanol can reduce the seizure threshold in tramadol use. Seizure is also more common in younger patients who have abused tramadol for a long period of time [ 23 ].
Background seizing disorders, medications causing seizure, ethanol withdrawal, CNS depressants, or head injury can affect seizure occurrence in tramadol overdose, as well [ 45 ]. Mydriasis and tachycardia can accompany with a higher risk of seizure [ 44 ].
Risk of seizure was 2-to 6-fold in the patients who had background diseases or consumed other medications. The risk was also higher in those between 25 and 54 years of age, those who use tramadol for more than 4 times, or those with the history of alcohol abuse, infarction, or head injury [ 74 ].
In another study on 97 patients with seizure, electroencephalographic EEG evaluations were normal in seven and isolated sharp slow-wave feature of EEG was seen in one patients. Tramadol-induced seizure can cause trauma, intra-articular dislocation, and tongue laceration [ 67 , 81 , 82 ]. In a study on 70 rats, it was revealed that tramadol could inhibit electron transfer cycle ETC , cause ATP depletion, and disrupt the mitochondrial integrity.
Apoptosis may also happen due to tramadol use [ 83 ]. In the neonates, tramadol can trigger pentylenetetrazole-induced seizure in an age-dependant manner causing fewer seizures in the neonatal period and more seizures after the lactating period [ 84 ].
Administration of tramadol hydrochloride to a zebrafish caused abnormal behaviors, reduced activity, and reduced brain and body weight. In the zebrafish brain, functional cytoskeletal proteins engaged in the energy metabolism had changed due to tramadol.
Lower levels of ATP synthetase, creatine kinase, pyruvate dehydrogenase, kinase, and aldolase C could be due to the impaired production of energy because of tramadol. Weak regulation of the proteins engaged in the oxidative stress, mitochondrial functional abnormalities, and impaired production and destruction of the proteins represented the neurotoxicity of tramadol Table 1 [ 85 ]. Acute pulmonary hypertension and right heart failure are the uncommon presentations reported in a young tramadol-overdosed patient [ 86 ].
Cardiopulmonary arrest was reported in some cases that had ingested more than 5 g of tramadol [ 8 ]. Higher doses of tramadol can block sodium channels and cause Brugada pattern in the ECG [ 11 , 47 ] which can be accompanied by ventricular dysrhythmias including ventricular fibrillation [ 11 ]. Almost one-thirds of the patients had terminal 40 msec frontal plane axis deviation and one-fourth had QT prolongation more than 0. Some cases of right heart failure, resistant shock, asystole, hypotension especially systolic , and sinus tachycardia have also been recorded [ 6 , 35 , 44 , 49 ].
Hypertension has also been reported. The least tramadol dose that has resulted in hypertension and agitation is mg [ 49 ]. Eleven suspected cases of tramadol-related angioedema have been reported from Sweden. Tramadol causes respiratory depression with less frequency in comparison with other opioids [ 28 , 57 , 88 ].
Renal failure is a probable risk factor for respiratory depression [ 28 , 89 ]. Tramadol overdose can cause respiratory depression; but in therapeutic oral doses, it does not cause respiratory complications. In a study on IV administration of 50 to 75 mg of tramadol, no significant changes were detected in the respiratory rate, respiratory volume per minute, and arterial PaO2 [ 90 ]. Sixteen cases of non-fatal hepatobiliary dysfunction due to tramadol ingestion have been reported [ 74 ].
Tramadol has caused centrilobular congestion and focal necrosis of the liver cells and minimal vacuolization in the kidney tubular cells of the rats. No changes were detected in the lactate dehydrogenase, blood urea nitrogen BUN , aspartate aminotransferase AST , and malondialdehyde MDA ; however, alanine aminotransferase ALT increased significantly showing the possible hepatotoxicity of tramadol [ 91 ].
It was shown that acute or chronic toxicity did not affect liver weight or cause histopathological changes in its tissue [ 17 , 92 ]. In the rats, mu receptor activation increases glucose use or decreases the liver gluconeogenesis which results in the low levels of plasma glucose in diabetic rats [ 88 , 93 ]. It has been shown that tramadol improves the peripheral metabolism of glucose by central activation of the mu receptors.
Therefore, central and peripheral metabolisms of glucose unite and cause hypoglycemia. It has also been suggested that tramadol changes the liver glucose output regulated by other organs likely CNS [ 93 ]. Some patients discontinue tramadol consumption because of nausea and vomiting. It has been shown that slow titration decreases the frequency of tramadol discontinuation due to these complications [ 94 ]. In long-term studies on rats and mice, no tramadol-attributed carcinogenic changes were detected.
Histopathologic evaluations showed increased risk of hepatic adenoma in the males and non dose-related pulmonary adenoma in females. No specific mutations or chromosomal impairments were detected in rats, mice, or hamsters due to tramadol use. Oral administration of tramadol was reported to have no carcinogenic effects on the mice and rats.
No mutations or increased risk of gene toxicity were detected in human-beings, either [ 17 ]. Tramadol can cause urinary retention because of opioid agonistic effects that can increase the tonicity of the bladder sphincter [ 68 ].
Also, it was shown to have hazardous effects on the growth, survival, and reproduction system of Daphnia Magna with the most effects on the latter. Long-term exposures decreased expression of the vtg gene which is an important biomarker in the reproduction of the oviparous animals [ 64 , 95 ].
In a study by Matthiesen et al, low dose of tramadol had no effect on the fertility, giving birth, and lactation of the rats and had no teratogenic effects on the fetus [ 17 ].
These results are however in contrast to the results withdrawn by Bornas who mentioned that laboratory studies had confirmed the teratogenic effects of tramadol on the animals. Tramadol and M1 metabolite can cross the placenta easily because of their low molecular weights [ 55 ].
Bleeding time BT , clotting time CT , prothrombin time, partial thromboplastin time, and body temperature were not affected by tramadol [ 17 ]. But, leukocytosis has been reported [ 44 ]. Tramadol overdose may result in increased creatine phosphokinase CPK which may be seen with or without seizure and can be accompanied by acute renal failure Table 2 [ 13 ]. Serotonin syndrome SS is a potentially fatal syndrome due to increased synthesis, decreased metabolism, increased release, and reuptake inhibition of serotonin or direct agonism at the serotonin receptors [ 5 , 53 ].
This syndrome is often due to complex interactions between the consumed medications. Three key clinical features of this syndrome include:. Neuromuscular hyperactivity tremor, clonus, myoclonus, hyper-reflexia, stiffness, impaired coordination. Autonomic hyperactivity profuse sweating, fever, tachycardia, tachypnea, chills, nausea, diarrhea, vomiting.
Usually, SS happens after tramadol overdose or its concurrent use with other medications especially antidepressants; however, it may happen even after a single therapeutic dose of tramadol [ 5 , 98 , ]. Patients who consume mono amine oxidase MAO inhibitors are at the risk of development of SS [ 66 , ]. SS has been reported after concurrent use of tramadol with serotonin reuptake inhibitors SSRIs , venlafaxine, atypical antipsychotics, fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine, moclobemide, clomipramine, mirtazapine, and tricyclic antidepressants [ 5 , 7 , 53 , 97 , ].
In patients who develop lethargy, hypotension, hypoxia, agitation, tachycardia, hypertension, confusion, hyperthermia, or hyper-reflexia, diagnosis of SS should be borne in mind [ 7 , , ]. Treatment is conservative and includes cessation of the culpable medication as well as administration of the antiserotonergics ciproheptadine, metisergide, propranolol, and chlorpromazine.
Clinical manifestations recover within 24 hours except in those who have consumed medications with longer half-lives [ 5 , 53 , 97 ]. Pretreatment with chlordiazepoxide may prevent tramadol-induced SS [ 48 ].
Opioids metabolized by CYP including tramadol may induce many drug-drug interactions [ ]. In an Australian study, unwanted drug interactions were evaluated in patients who consumed antidepressants. As previously clarified, tramadol is similar to venlafaxine in structure and is believed to have antidepressant effects.
Keep from freezing. Drop off any unused narcotic medicine at a drug take-back location right away. If you do not have a drug take-back location near you, flush any unused narcotic medicine down the toilet. Check your local drug store and clinics for take-back locations.
You can also check the DEA web site for locations. Here is the link to the FDA safe disposal of medicines website: www. There is a problem with information submitted for this request. Sign up for free, and stay up-to-date on research advancements, health tips and current health topics, like COVID, plus expert advice on managing your health.
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If you take recreational drugs, such as cannabis, cocaine and heroin, while you are taking tramadol, you're more likely to get serious side effects.
These include breathing difficulties, heart problems, seizures fits and even going into a coma. Some recreational drugs, such as cannabis, will also increase tramadol side effects such as sleepiness and dizziness. Serotonin syndrome occurs when the levels of a chemical in your brain called serotonin become too high. Tell your doctor if you think you may take recreational drugs while you're on tramadol. Page last reviewed: 26 November Next review due: 26 November Tramadol On this page About tramadol Key facts Who can and can't take tramadol How and when to take it Taking tramadol with other painkillers Side effects How to cope with side effects Pregnancy and breastfeeding Cautions with other medicines Common questions.
About tramadol Tramadol is a strong painkiller. Help us improve our website Can you answer a quick question about your visit today? The most common side effects of tramadol are feeling sick and dizzy. It's possible to become addicted to tramadol, but your doctor will explain how to reduce the risks of becoming addicted.
If you need to take tramadol for more than a few weeks, your treatment plan may include details of how and when to stop taking this medicine. It's best not to drink alcohol with tramadol as you're more likely to get side effects like feeling sleepy. Tramadol can be taken by adults and children aged 12 and over. Tell your doctor or pharmacist before starting the medicine if you have: had an allergic reaction to tramadol or any other medicines in the past an illness which causes seizures a head injury an addiction to alcohol, strong painkillers or recreational drugs breathing difficulties kidney or liver problems had a reaction to other strong painkillers in the past.
The dose can vary but you should not normally take more than mg a day. Different types of tramadol Tramadol comes as: fast-acting tablets — these contain 50mg of tramadol slow-acting tablets — these contain 50mg, 75mg, mg, mg, mg, mg or mg of tramadol fast-acting capsules — these contain 50mg of tramadol slow-acting capsules — these contain 50mg, mg, mg or mg of tramadol drops that you swallow — these contain mg of tramadol in 1ml of liquid an injection usually given in hospital soluble tablets — these contain 50mg of tramadol tablets that dissolve in the mouth — these contain 50mg of tramadol an injection usually given in hospital Tramadol drops, injections and some tablets and capsules are fast-acting.
How much to take Dosages vary from person to person. Take the tablet out of the blister pack and put it on your tongue.
Suck the tablet, do not chew it. After it has melted, swallow or have a drink of water. You can also dissolve the tablet in a glass of water if you prefer. Important Do not break, crush, chew or suck slow-release tablets and capsules. When to take it When to take it depends on the type of tramadol that you have been prescribed: fast-acting tablets and capsules — usually 3 to 4 times a day drops — usually 3 to 4 times a day slow-release tablets and capsules — usually 1 or 2 times a day If you're 65 and over, or you have liver or kidney problems, you may be asked by your doctor to take tramadol less often.
What if I forget to take it? This will vary depending on which type of tramadol you are taking. Never take 2 doses at the same time to make up for a forgotten one. What will happen if I stop taking it? Tramadol can cause unpleasant withdrawal symptoms if you come off it suddenly, such as: feeling agitated feeling anxious shaking sweating.
Important If you have been taking tramadol for more than a few weeks do not stop taking it without speaking to your doctor first. What if I take too much? Taking too much tramadol can be dangerous. Urgent advice: Contact for advice now if:. Very common side effects Very common side effects of tramadol happen in more than 1 in 10 people and include: feeling sick feeling dizzy Common side effects Common side effects of tramadol happen in more than 1 in people. They include: headaches feeling sleepy, tired, dizzy or "spaced out" feeling or being sick vomiting constipation dry mouth sweating low energy Serious side effects Serious side effects are rare.
Serious allergic reaction In rare cases, it's possible to have a serious allergic reaction anaphylaxis to tramadol. Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. What to do about: headaches — make sure you rest and drink plenty of fluids.
Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking tramadol. Talk to your doctor if they last longer than a week or are severe. Talk to your doctor if they carry on for longer. Do not drink any alcohol as this will make you feel more tired.
It might help to take your tramadol after you've eaten a meal or snack. If you're being sick, try small frequent sips of water.
If it carries on, tell your doctor.
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