Long-term side effects of tramadol

In this article:

• Side effects
• How long do tramadol long-term side effects last?
• Treatment and prevention
• Alternatives

In this article

• Side effects
• How long do tramadol long-term side effects last?
• Treatment and prevention
• Alternatives

Tramadol (the generic name of brand names like Ultram) is an opioid and controlled substance that treats moderate to severe pain. A central nervous system depressant, it works by binding to opioid receptors and blocking pain messages.

Compared to oxycodone, another opioid analgesic, tramadol is less potent but about as effective. However, be aware it has side effects that can be especially concerning with long-term use.

Common side effects of tramadol

Experts agree that the most common side effects of tramadol are nausea, dizziness, and constipation. 

“These happen because tramadol slows things down in the body, like digestion, and makes you drowsy,” explains Dr. Raj Dasgupta, MD, chief medical advisor for Garage Gym Reviews and a quadruple board-certified physician. “These side effects are usually manageable, but can get annoying if they don’t go away.”

Another provider says some symptoms may be more problematic than others. “Nausea and dizziness can often diminish with regular use, but constipation tends to persist unless managed with diet or medication,” says Dr. Arthur Shektman, MD, the head plastic surgeon at the Gynecomastia Center of Boston. He often prescribes tramadol for pain post-surgery.

Other common side effects, according to the Mayo Clinic, include: 

• Feeling discouraged, sad, or empty
• Dry mouth
• Joint pain
• Feeling unusually cold
• Runny or stuffy nose
• Sore throat
• Tiredness or weakness
• Trouble concentrating
• And more

Serious side effects of tramadol

Some side effects of tramadol use are more serious than others. The main adverse reactions after long-term use of tramadol, according to Dr. Shektman, are the risk of respiratory depression, seizures, and addiction. 

“In high doses or when combined with other sedatives, tramadol can slow breathing significantly,” he says. “The risk of seizures is particularly high for patients with epilepsy or those taking other medications that affect the brain. Tramadol can also be highly addictive with prolonged use.”

For what it’s worth, individuals can take opioids for pain relief without becoming addicted. People with a greater risk of tramadol addiction or physical dependence may also have risk factors such as a family history of addiction, neglect or trauma, social isolation, and peer pressure. 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), substance use disorders are a mental illness and medical condition (not a choice) in which individuals meet at least two of 11 criteria, such as needing more to get the same effect and spending a lot of time using. Staying on top of these signs is crucial because the risks of addiction are real, including work problems, family problems, accidents, health issues, and more.

But back to the other severe side effects. Dr. Dasgupta agrees about respiratory depression (or trouble breathing) and seizures. He also adds serotonin syndrome to the list. Serotonin syndrome is what it sounds like: a condition in which serotonin levels are too high.

“Taking tramadol with certain medicines can increase the risk of serotonin syndrome,” he says. These rarely happen, he adds, but can be dangerous. 

Other severe side effects that come with large doses and/or long-term tramadol use include, but aren’t limited to: 

• Mood or behavior changes
• Thoughts of hurting yourself or others
• Seeing or hearing things that aren’t there
• Blue lips, fingernails, or skin
• Dizziness
• Trouble breathing
• Slow or rapid heartbeat
• Stomach upset, such as nausea, vomiting, and/or diarrhea 
• An allergic reaction or rash
• An increased risk of kidney damage and liver damage

Be sure to seek medical attention immediately after noticing these symptoms.

What are the long-term side effects of tramadol?

Taking tramadol long-term can lead to specific, various side effects throughout the body. Doctors share the examples listed below.

Cognitive impairment

• Memory issues
• Difficulty concentrating or poor focus
• Decreased mental sharpness

Less than 5% of people have these side effects, per the Food & Drug Administration.

Gastrointestinal issues 

• Bloating
• Overall abdominal discomfort
• Chronic constipation
• Other long-term bowel problems

Between 1% and 5% of users experience dyspepsia (indigestion) or flatulence, and 9.3% of users experience constipation. 

Mental health consequences

• Anxiety
• Mood swings 
• Depression
• Tramadol dependence

Less than 5% of people have these side effects.

Cardiovascular concerns 

• Irregular heartbeat
• Dips in blood pressure

Between 1% and 5% of people have cardiovascular effects, which require prompt medical attention.

“These are all much less common with short-term, therapeutic use that’s appropriately managed,” Dr. Shektman says.

Other risk factors also play a role in long-term side effects. Besides long-term use and/or higher doses, Dr. Shektman lists pre-existing conditions, such as epilepsy, mental health conditions, or kidney and liver impairment; concurrent use of other medications or substances that interact with tramadol; and delayed treatment of adverse effects, such as prolonged respiratory depression or repeated seizures.

According to Dr. Dasgupta, heart problems and taking the medicine without medical oversight are other factors that can increase the likelihood of those effects.

With that said, try to not worry too much. “Tramadol is commonly prescribed for short-term pain management (like post-surgical pain), and long-term side effects are uncommon for these use cases,” Dr. Shektman says. “For patients taking tramadol over the long term for chronic pain, the long-term risk of dependency and side effects is greater.”

How long do tramadol long-term side effects last?

How long these side effects last depends on the patient and the particular symptoms, according to Dr. Shektman. “Short-term side effects, like nausea and dizziness, typically resolve within a week of discontinuation,” he says. “If there is some physical or psychological addiction, withdrawal symptoms can last weeks.”

The long-term effects—like memory problems and digestive issues—can stick around for months or longer, Dr. Dasgupta says, if the damage is severe. A healthcare provider can help patients assess their specific side effects and treatment needs.

How to treat or prevent long-term side effects of tramadol

Noticing these side effects and want to get rid of them? First and foremost, Dr. Shektman encourages medical interventions and medication adjustments. “Patients should work with their doctor to taper off tramadol gradually to reduce withdrawal symptoms,” he says.

If long-term pain relief is a concern, he encourages alternative pain management, such as acetaminophen or NSAIDs.

It’s also crucial to look out for signs of addiction, such as continuing to use despite use causing problems, social isolation, and higher tolerance. “If addiction symptoms are present, patients can also engage in counseling to address dependency issues,” Dr. Shektman says. 

Healthcare professionals at addiction treatment programs will treat individuals by meeting their unique needs. A treatment plan may include detoxing, cognitive-behavioral therapy, group therapy, and other medical care. A medical detox for an opioid addiction entails not having access to the drug—which may cause withdrawal symptoms—all under medical supervision and with medical support.

Tramadol users with a history of long-term use may experience withdrawal symptoms, such as anxiety, insomnia, body aches, a runny nose, stomach cramps, and more.

Dr. Dasgupta adds some lifestyle modifications and dietary recommendations. “Stay active, drink lots of water, and eat fiber to avoid constipation,” he says. Examples of fiber-rich foods include raspberries, green peas, lentils, and whole-wheat spaghetti.

Last but not least, note that patients may need to see their healthcare provider more than once. In fact, it’s a smart idea. “See your doctor regularly to catch any problems early, and adjust your treatment if needed,” Dr. Dasgupta says.

Tramadol alternatives

Another option is Tramadol alternatives. Those can include prescription medications, over-the-counter (OTC) medications, and non-pharmaceutical options. Below, check out a couple of examples of each:

Prescription medications

• Belbuca (buprenorphine)
• Cymbalta (duloxetine)

OTC medications

• Aleve (naproxen)
• Motrin (ibuprofen)

Non-pharmaceutical options

• Physical therapy
• Acupuncture