Tramadol is a type of opioid often prescribed for moderate or severe pain in adults. It is a synthetic form of codeine designed to have less potential for abuse than other opioids. Tramadol works in the brain to alter the body’s response to pain.

See Opioids for Back Pain: Potential for Abuse, Assessment Tools, and Addiction Treatment

Tramadol is available as a generic and under brand names, including:

  • Ultram
  • Synapryn FusePaq
  • ConZip

Tramadol is generally prescribed to provide short-term pain relief. The body can develop a tolerance to tramadol quickly, making the dose less effective over time.

See The Difference Between Opioid Addiction and Physical Dependence

Tramadol is generally advised for just one or two weeks’ use, to reduce the risk of dependency. Also, the body develops a tolerance for tramadol quickly, making the dose less effective over time. The doctor may suggest a longer interval between doses for those older than 75.

Like all medications, tramadol has potential benefits and drawbacks. Understanding them may help people avoid tramadol’s side effects and risks.

See Opioid Medication Potential Risks and Complications

How Tramadol Is Used

Tramadol is available in several forms and strengths. Examples of tramadol formulations include:

Immediate-release form of tramadol (Ultram).

This form of tramadol is available as a tablet and typically is prescribed to be taken every 4 to 6 hours. It is used for back pain, sciatica, and for postoperative pain following spine surgery. For most adults, the maximum safe dose is 400 mg per day of the immediate-release tablets.

Extended-release tramadol (ConZip).

An extended-release (ER) form of tramadol is available as a capsule that contains more medication than the immediate release tablets. Taken just once a day, the extended release medication is formulated to be released in the body gradually over a 24-hour period.

See Addressing Pain and Medical Problems Disrupting Sleep


Extended release tramadol products are designed to help individuals with chronic pain. Their 24-hour effectiveness can potentially help prevent pain from re-appearing throughout the day and promote better sleep. The extended-release medication should not be split or crushed, as that could cause a dangerously strong amount of medication to be activated at once. The maximum dose of the extended-release formulations is typically 300 mg per day. Dosages may need to be decreased for those with renal or hepatic impairment.

See Pain Management for Chronic Back Pain

As a general rule, doctors prescribing tramadol will typically start with a low dose and may increase the dose slowly and as needed for pain relief.

Follow prescription instructions

Label instructions for both the dose and the timing of the doses should be followed exactly. If the medication does not seem to work, the doctor should be contacted. The dose should never be increased without a doctor’s approval.


How Tramadol Works

Tramadol works similarly to other opioids by binding to receptors in the brain and spinal cord— located on nerve endings—that work to block pain signals from being transmitted. However, some researchers believe that tramadol may also effect levels of the neurotransmitters serotonin and norepinephrine, similarly to how an antidepressant medication works. 1 Dayer P, Desmeules J, Collart L. [Pharmacology of tramadol]. Drugs. 1997;53 Suppl 2:18-24. doi: 10.2165/00003495-199700532-00006. Review. PubMed PMID: 9190321.

As with all medications, there are several unique potential risks and complications associated with tramadol that are important to know about.

  • 1 Dayer P, Desmeules J, Collart L. [Pharmacology of tramadol]. Drugs. 1997;53 Suppl 2:18-24. doi: 10.2165/00003495-199700532-00006. Review. PubMed PMID: 9190321.

Dr. Kathee de Falla is a licensed and certified pharmacist. She has more than a decade of experience providing medical advice and supplying prescription medications in a retail setting. Dr. de Falla spent several years developing drugs at Abbott Laboratories, a pharmaceutical company where she holds a patent for a drug formulation.