The FDA recently issued new warnings against prescribing tramadol and codeine to children and adolescents. After the agency reviewed event reports from about the past 50 years, they found that 64 reports of severe breathing difficulty, including 24 deaths, were linked to codeine in children and adolescents. In addition, nine cases, including three deaths (!), were linked to tramadol.
Following these discoveries, the FDA now states that tramadol should not be used in children under 18 years old to treat pain due to a tonsillectomy or adenoidectomy. It also states that codeine and tramadol should not be used in adolescents aged 12–18 who are obese or who have breathing conditions, such as obstructive sleep apnea or severe lung disease. Do not breastfeed if you are using tramadol or codeine. (1)
What Is Tramadol? Is Tramadol a Narcotic?
Tramadol is an analgesic, or pain reliever, used to treat moderate to moderately-severe pain. What kind of drug is tramadol? Is tramadol a narcotic? Tramadol is considered narcotic-like. There seems to be debate about whether or not tramadol is officially an opioid. It’s generally considered very similar to an opioid. Interestingly, it’s also an anti-depressant; because of this, it packs a one-two punch. The active ingredient in tramadol is hydrochloride. (2)
Brand names of this drug include ConZip® and Ultram®, among others. It’s available as a “regular” tablet and in an extended-release form. (03) This type of tramadol is not for as-needed pain relief, and it should never be cut or crushed as the dose may be too strong outside of the extended-relief coating — and could result in an overdose. Do not take tramadol during pregnancy. Never crush tramadol and inhale it, or dilute it with liquid and inject it. Using tramadol in this way may result in dangerous side effects, overdose or even death. (4)
So, why would you be prescribed tramadol?
Tramadol is effective at treating nerve pain and pain that is not responding to over the counter medications. (5) It may be prescribed for back pain as well. Because of its anti-depressant effects, tramadol also helps to create a feeling of well-being. That said, it’s usually only advised for about one or two weeks’ use, given its potential for dependency. (6)
Some side effects of tramadol may include: (7)
If any of the following serious, but unlikely, side effects occur, then tell your doctor right away:
- Mental/mood changes (such as agitation, hallucinations or confusion)
- Stomach/abdominal pain
- Difficulty urinating
- Signs of adrenal fatigue (loss of appetite, unusual tiredness, weight loss)
Get medical help immediately if any of these rare, but serious, side effects occur:
- Slow/shallow breathing
- Unusual drowsiness/difficulty waking up
Tramadol vs. Codeine
Is tramadol a narcotic? Yes, but how does it compare to codeine? Of the two, tramadol is far stronger. Although it still has similar pain-relieving effects, it is less constipating and euphoric than codeine, and it has less respiratory effects, though they are still present. (8)
Researchers studying the effects of tramadol vs. codeine and aspirin plus codeine for pain relief after dental surgery found that in comparison with codeine, tramadol has similar pain-relieving properties, but may have fewer constipating, euphoric and respiratory depressant effects.
In this study, higher doses of tramadol (100 mg) were found to be “statistically superior to placebo” in total pain relief, whereas tramadol (50 mg) was only statistically superior at remedication time. Codeine was not found to be statistically significant against the placebo in any measure. However, gastrointestinal side effects, including nausea, difficulty swallowing and vomiting, were reported by participants more frequently with tramadol 100 mg, aspirin (ASA) 650 mg with codeine 60 mg, and codeine 60 mg than with placebo.
So, in general, tramadol 100 mg was found to be more effective than codeine or codeine with aspirin. Tramadol 100 mg, codeine 60 mg, and ASA/codeine resulted in more side effects. (9)
10 Reasons to Never Use Tramadol, Including Side Effects
Tramadol is a powerful drug that you should carefully consider before using, or, ideally, never use. Consider the following information as proof of its dangers.
In addition to the side effects listed above, the following are also possible commonly reported side effects. Side effects can occur with a regular tramadol pill and with the extended-release version: (10)
- Diaphoresis (excessive sweating)
- Pruritus (intense itching)
- In total, there are over 50 more common, less common and rare side effects listed.
Tramadol is known to interact with 745 drugs (4,347 brand and generic names).
Of these, there are : (11)
- 436 major drug interactions (2,189 brand and generic names)
- 305 moderate drug interactions (2,143 brand and generic names)
- 4 minor drug interactions (15 brand and generic names)
- Tramadol also interacts with alcohol and cause 9 disease interactions, including: (12, 13)
- Acute alcohol intoxication
- Drug dependence
- Liver disease
- Renal dysfunction
- Seizure disorders
- Acute abdominal conditions
- Intracranial pressure
- Respiratory depression
Better Natural Alternatives for Pain Relief
What can you do if you don’t want to take tramadol or other risky pain relievers? Fortunately, there are natural alternatives for pain relief, with little to no side effects. These natural pain killers include:
- Capsaicin: Add some cayenne pepper to your food for a healthy and spicy kick.
- Essential oils: Try rubbing on arnica oil or lavender oil for relief.
- Epsom salts: Soak in the tub to soothe muscle or joint pain.
- Massage and myofascial release: Relax your muscles and soft tissues to find relief.
- Bone broth: Sip on some chicken soup to heal your soul and your body.
- Graston® technique: See a DO (Doctor of Osteopathy) to naturally treat chronic pain, carpal tunnel syndrome, back and shoulder pain and other muscle, bone and nerve pain.
- Dry needling: Stimulate trigger points to relieve migraines, whiplash, pelvic pain, tendonitis and many other dysfunctions of the muscles, nerves, bones and soft tissues.
- Rolfing: Find relief for TMJ, chronic back pain and asthma, among other ailments.
- Is tramadol a narcotic? Yes, it is a serious, narcotic-like, prescription pain killer. It’s highly potent with a long list of side effects ranging from common to rare and minor to life-threatening.
- Tramadol is available in an extended-release format. Never crush these extended-release pills as it could result in an overdose.
- The FDA warns against giving tramadol to children under 18 years old.
- Don’t take tramadol if you are pregnant or breastfeeding.
- If your doctor prescribes tramadol, approach it with caution and consider other less-dangerous alternatives.
- Try natural pain killers instead.
Read Next: 20 Reasons to Never Use Codeine
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