Tramadol is a prescription drug that is commonly prescribed as the first opioid option for patients who struggle with ongoing pain that is moderate to severe. It is also sold under various brand names, including Ultracet and Ultram.[1] 

Because it is both an opioid analgesic and a non-opioid medication, tramadol is sometimes considered to be weaker than other opioid drugs (like morphine and oxycodone) and therefore safer. 

However, tramadol is classified as a schedule IV drug, which means that it has a higher potential for misuse and opioid use disorder (OUD) than other non-controlled medications. 

Tramadol is considered to be a low-level prescription painkiller designed for patients for whom over-the-counter medications are not working to manage pain. 

Tramadol can be prescribed in an extended-release formulation or a short-acting version. Short-acting formulations begin to leave the system within a few hours of taking them. 

Extended-release versions, as the name implies, release a dose of the medication periodically over a few hours. While short-acting tramadol must be taken multiple times per day for continual pain relief, extended-release tramadol only needs to be taken once per day.[2] 

The extended-release version can make it easier for chronic pain patients to manage their medication without missing a dose. The short-acting version may be more appropriate for those who only need pain relief on occasion. 

Tramadol is available in multiple formulations to help patients get the level of pain management assistance they need without taking too much or too little of the drug. 

Doctors will consider the needs of the patient when determining which formulation of tramadol will be the most effective option. If you have concerns that the type of tramadol you are prescribed is not the right formulation for your needs, speak to your doctor. 

These are the different types of tramadol:

Short-acting tramadol is the most commonly prescribed version of the drug. It is used for patients who may only need pain management assistance on an as-needed basis. If pain management is not required around the clock, this may be the formulation of choice because it only stays in the system for a few hours. 

Liquid tramadol hydrochloride comes in both plain and flavored formulations. It is most often used for children aged 12 and over who need only a few drops of the liquid to help them manage pain, but it may also be used for patients who have a hard time swallowing pills.[3]

Additionally, liquid tramadol may be used in situations where a very specific dose is needed. This can be a key factor for patients who are taking multiple medications and need to manage the dose of opioid medications very carefully. 

For those who require continual pain management, extended-release tramadol tablets and capsules may be appropriate. 

One extended-release tramadol pill can provide pain relief for up to 24 hours. Some patients may only need to take the medication once per day instead of four to six times per day, which is needed for continual pain management with the short-acting version of the drug.[2]

Tramadol is prescribed with caution because it does have the potential for misuse, leading to OUD, due to its opioid mechanism of action. Additionally, there are risks of overdose and contraindications when mixed with other medications, including other pain medications. Doctors consider the patient’s entire medical plan when determining whether or not tramadol is an appropriate treatment.[4] 

If prescribed, doctors will ensure that patients have all the information they need to take the drug safely. Follow these best practices:

If tramadol is prescribed for a time but then deemed unnecessary for treatment, a doctor will generally prescribe a tapering schedule. This involves slowly lowering the dose over time to avoid strong withdrawal symptoms. 

If you are taking tramadol and you miss a dose by accident, in most cases, you should take the missed dose as soon as you remember.[4] However, if you are close to the next dose, you can wait and take the next dose at the normal time. If you are unsure which is the most appropriate choice for you, contact your doctor. 

Yes, tramadol is addictive. Part of its pain-relieving effect occurs because the medication binds to the opioid receptors in the brain and body. This action also triggers the pleasure pathway in the brain, which prompts a flood of feel-good chemicals, reducing pain and increasing euphoria.[5] 

For opioid use disorder, Medication for Addiction Treatment (MAT) is the best option. MAT involves treatment with medication like Suboxone to decrease withdrawal symptoms and cravings associated with OUD. Therapy addresses the underlying issues that may be driving tramadol misuse. 

At Bicycle Health, we offer Suboxone via our telehealth MAT program. Reach out to us today to learn more about how you can get started with this life-saving program, no matter where you live.