The opioid painkiller Tramadol (Ultram, Ultram ER, ConZip) is sometimes prescribed to treat moderate to severe pain, including pain from surgery and arthritis. However, it can cause serious and potentially fatal side effects when used off-label, especially in children ages 17 and younger and adults ages 55 and older.
The FDA recently issued a warning that in rare cases, tramadol may cause slowed or difficulty breathing in children 17 and younger, with the risk increasing for children who are taking this medication after having their tonsils or adenoids removed. It is believed that this serious side effect may affect a small percentage of the population who are ultra-rapid metabolizers. People with this genetic variation metabolize tramadol at a fast rate and are at a greater risk for having high levels of active drug in their bloodstream. The FDA has not approved tramadol for use in children, but some pediatricians still prescribe it to treat pain after a tonsillectomy. While off-label use such as this is legal, it is not encouraged.
Children aren’t the only demographic group at risk for improper tramadol use. Patients 65 and older make up the majority of tramadol-related ER visits, and adults 55 and older may be at a greater risk for side effects than younger adults. Part of the reason for this increased risk may be due to the fact that older adults are often taking multiple prescription medications, and certain drugs can increase the likelihood that tramadol side effects will occur. Some medications—especially certain antidepressants —increase a patient’s risk for serotonin syndrome. This condition occurs when the body produces a high level of the chemical serotonin, potentially causing an irregular heartbeat, muscle rigidity, seizures, or even death.
Using Tramadol Safely
Many patients use tramadol for pain management without experiencing serious side effects, and if you need this medication, there are certain precautions you can take to reduce your risk of adverse effects.
If your pediatrician wants to prescribe tramadol for your child, talk to them about pain medication alternatives that are FDA-approved for use in children.
If your doctor wants to prescribe tramadol to you, talk to them about your medical history and all medications (both over-the-counter and prescription) that you are currently taking. Your doctor should be able to tell you if any of your conditions or medications will increase your risk for tramadol side effects. It’s also a good idea to get all your prescriptions at a pharmacy with a computerized system, as they should be able to review your records and identify any potentially dangerous drug interactions.
Discuss the possible side effects of tramadol with your doctor, and be aware of rare but serious side effects that require immediate medical attention. These include difficulty breathing, extreme dizziness or drowsiness, a fast or irregular heartbeat, a high fever, fainting, and seizures.
You should never increase your dosage of tramadol without first talking to your doctor, even if you believe your current dose is not effectively managing your pain. You also shouldn’t stop taking tramadol before speaking to your doctor, as this opioid medication can cause withdrawal symptoms. Your doctor may reduce your dosage gradually to prevent these symptoms.
When used as intended, tramadol can be a safer pain medication than many of the stronger prescription opiates. As with all prescription medications, you should always follow your doctor’s instructions carefully when taking this drug. For more information about tramadol and to view available tramadol coupons, visit our Tramadol Drug Page.