Tramadol

Tramadol is not suitable for everyone. For example, check with your doctor if you have breathing difficulty or kidney problems.

Tramadol comes as tablets, capsules and liquid that you swallow. Follow your doctor’s instructions about how to take it because it can be addictive.

Common side effects of tramadol include feeling sick and dizzy. More serious side effects can happen in rare cases.

It can cause problems to take tramadol with some other medicines, such as medicines for depression, anxiety or allergy symptoms.

Most adults and children aged 12 years old and over can take tramadol.

Tramadol is not suitable for some people. To make sure it's safe for you, before starting the medicine, tell your doctor or pharmacist if you:

• have ever had an allergic reaction to tramadol or any other medicine
• have a condition which causes seizures or fits
• have a head injury
• have an addiction to alcohol, strong painkillers or recreational drugs
• have breathing difficulties
• have kidney or liver problems
• ever had a reaction to other strong painkillers
• are pregnant, breastfeeding, or trying to get pregnant

Swallow each tramadol tablet or capsule whole with a glass of water.

How to take drops

Mix the drops into a glass of water then drink the whole contents of the glass.

How to take soluble tablets

Dissolve each tablet in 50ml of water and drink the whole contents of the glass.

How to take tablets that dissolve in the mouth (orodispersible tablets)

Make sure your hands are dry before handling the tablet. Pop the tablet out of its 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 small glass of water if you prefer.

How to take slow-release tablets and capsules

It's important to swallow slow-release tramadol tablets and capsules whole with a drink of water.

Slow-release tablets and capsules release the medicine into your body over either 12 or 24 hours. This type of tramadol takes longer to start working but lasts longer. It's used for severe pain.

Do not break, crush, chew or suck slow-release tablets and capsules. If you do, the slow-release system will not happen and the whole dose might get into your body immediately. This could cause an overdose, which can be dangerous.

When to take it depends on the type of tramadol you have been prescribed:

• standard tablets and capsules – usually 3 to 4 times a day
• drops – usually 3 to 4 times a day
• slow-release tablets and capsules – usually once or twice a day

If you're 65 or over, or you have liver or kidney problems, your doctor may tell you to take tramadol less often.

You can take tramadol at any time of day but try to take it at the same time every day, and space your doses evenly. For example, if you take tramadol twice a day and have your first dose at 8am, take your second dose at 8pm.

These common side effects of tramadol happen to more than 1 in 100 people. There are things you can do to help cope with them.

Try to rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if they do not go away or are severe.

Talk to your doctor if these symptoms do not go away.

Do not drive, cycle or use tools or machinery if you're feeling tired or dizzy.

Do not drink any alcohol as this will make you feel more tired.

Eat simple meals and avoid rich or spicy food. It might help to take tramadol after you've eaten a meal or snack. If you're being sick, try taking small, frequent sips of water. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or dark, strong-smelling pee.

If tramadol continues to make you feel or be sick, tell your doctor.

If you take the combined pill or the progestogen-only pill and tramadol makes you vomit, it may not protect you from pregnancy. Check the pill packet to find out what to do.

Try to get more fibre into your diet such as fresh fruit, vegetables and cereals. Also try to drink several glasses of water, or another non-alcoholic drink, every day. If you can, it may help to do some gentle exercise like swimming or going for a short walk.

Speak to your doctor or pharmacist about medicine to help prevent or treat constipation caused by tramadol if it does not go away.

Try chewing sugar-free gum or sucking sugar-free sweets. Your doctor may also prescribe an artificial saliva substitute to keep your mouth moist. This comes as a spray, gel or lozenge.

Try wearing loose clothing, using a strong anti-perspirant and using a fan, if possible. If this does not help and you're struggling to cope with excessive sweating, your doctor may prescribe a different painkiller.

Speak to your doctor as they may be able to adjust your dose or give you a different painkiller.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

It is important to treat pain in pregnancy.

If you have severe pain, tramadol might be your best option. Your doctor can help you decide what's right for you and your baby. It’s always best to only take tramadol for a few days if possible.

Tramadol is not known to cause problems with your baby’s development, but more studies are required to confirm this.

If you take tramadol at the end of pregnancy your baby might have withdrawal symptoms when they’re born, such as feeding problems or needing help with breathing. If this happens, your baby may be monitored in hospital for a few days after birth.

If you are taking tramadol regularly then discuss this with your doctor or midwife.

If your baby is healthy, you may be able to take tramadol while breastfeeding. However, it’s best to only take tramadol for a few days if possible. If you need to take it for longer, talk to your doctor who may recommend a different painkiller.

Tramadol passes into breast milk in very small amounts, and it’s unlikely to cause any side effects in your baby. However, it might cause your baby to be sleepy.

It's very rare for breastfed babies to have side effects from medicines you're taking. But it's important to keep monitoring your baby if you're taking any medicine while breastfeeding.

Contact your healthcare professional or call 111 as soon as possible if you notice that your baby:

• is not feeding as well as usual, or gaining weight as you’d expect
• seems unusually sleepy
• seems unusually irritable
• is constipated or being sick

It’s important to not share a bed with your baby while you’re taking tramadol.

• your baby has breathing problems

Ask for advice about whether to keep breastfeeding and taking your medicine.

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you or your baby takes with you.

Some medicines can affect the way tramadol works and increase the chances of you having side effects.

Before taking tramadol, tell your doctor if you're already taking any other medicines, including any medicines that:

• treat depression or other mental health problems
• relieve pain
• help you sleep
• reduce tension or anxiety
• treat symptoms of an allergy
• help prevent blood clots (such as warfarin)
• treat an infection

Some medicines may weaken or shorten the effect of tramadol. Tell your doctor if you're taking:

• carbamazepine to treat epilepsy
• buprenorphine, a painkiller
• ondansetron, to stop you feeling sick
• rifampicin, an antibiotic

These are not all the medicines that may cause problems if you take them with tramadol. For a full list, see the leaflet inside your medicine packet.

Do not take medicines called monoamine oxidase inhibitors or MAOIs with tramadol. Examples of MAOIs include moclobemide or phenelzine which are used to treat depression, or rasagiline or selegiline which are used to treat Parkinson's disease. The combination can cause serious side effects such as anxiety, confusion and hallucinations.

It's safe to take tramadol with paracetamol, ibuprofen or aspirin (aspirin is only suitable for people aged 16 and over).

Do not take medicines that contain codeine with tramadol because you are more likely to get side effects. This includes some painkillers you can buy from pharmacies, such as co-codamol,  ibuprofen and codeine (Nurofen Plus) and Solpadeine.

There's very little information about taking complementary medicines, herbal remedies or supplements with tramadol. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.