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Side Effects of Tramadol (Ultram, ConZip, Ryzolt)


Description: Tramadol (also sold under the brand name Ultram) is a synthetic opioid (narcotic) medication which is used to treat moderate to severe pain. Tramadol, like other opioids, may be habit-forming, even at regular doses, so it is very important to take this medicine precisely as prescribed by your healthcare provider. Moreover, it should never be shared with another person.

Black Box Warning for Ultram/Tramadol

The FDA issued tramadol drug safety labeling changes in 2008 to warn that some medicines can interact with tramadol and cause a serious and life-threatening condition called “serotonin syndrome.” To avoid this, tell your healthcare provider if you also take medicine for serious infections, migraine headaches, Parkinson’s Disease, prevention of nausea and vomiting, or with drugs that impair the metabolism of tramadol (called CYP2D6 and CYP3A4 inhibitors), which would cause a toxic build-up of tramadol metabolites.

Tramadol/Ultram Addiction, Serious Side Effects and Drug-Drug Interactions

Misuse of narcotic pain medication, including tramadol, can cause addiction, overdose, or death.
Tramadol can slow down or stop your respiration, especially when starting this medicine or when its dose is adjusted. Because of this, it should never be taken in larger amounts or for longer than prescribed. This risk of respiratory problems is higher in elderly people and in people who are severely ill, poorly nourished, or otherwise debilitated. It is also more likely when co-administered with benzodiazepines.


Some patients can suffer seizures (convulsions) after taking tramadol. Seizures are more likely if you have a metabolic disorder, have a history of convulsions or head injury, or if you are taking certain medicines such as muscle relaxers, antiemetics, or antidepressants.


Additionally according to the Postmarket Drug Safety Information for Patients and Providers provided by the NIH, it is recommended that tramodol should not be used “off-label” in pediatric populations,as it can have fatal implications in so-called ultra rapid metabolizers of the medication.

Common Side Effects

According to the Ultram drug label as reported by the FDA, common tramadol/Ultram side effects may include:

  • Dizziness
  • Drowsiness
  • Headache
  • Constipation
  • Diarrhea
  • Nausea
  • Vomiting
  • Stomach pain
  • Feeling nervous or anxious
  • Itching
  • Sweating
  • Flushing
  • Understand Your Risk for Side Effects with the Rxight® Genetic Test

    To help avoid tramadol toxicity and improve efficacy, Rxight® pharmacogenetic testing employs a process called “SNP genotyping” to analyze your unique genetically modulated metabolism of over 200 common prescription medications, including tramadol/Ultram. All that is required is a simple non-invasive cheeks swab. The results from our labs, which will be reviewed with you in detail, indicates which medications you metabolize more quickly than normal, resulting in inefficacy, or metabolize slowly, which results in a higher potential for adverse reactions. Thus, the results of the Rxight® Genetic Test help you and your prescriber determine a safe and effective dose tailored to your precise genetics, rather than relying on trial and error.

    How Does Pharmacogenetic Testing Work?

    Tramadol is metabolized primarily by a liver enzyme called CYP2D6; individuals with low CYP2D6 activity are generally more prone to developing side effects. There is strong evidence to support the pharmacogenetic testing to determine CYP2D6 activity to elucidate the serious side effects and dose determination of tramadol. In addition, genetic variations in the drug transporter, ABC1 and opioid receptor gene, OPRM1 have also been implicated in tramadol efficacy and toxicity.

    Contributors to this Article: Michael Sapko, MD, Phd and Deborah Ka


    Contributors to this Article:
    Michael Sapko, MD, PhD; Deborah Kallick, PhD, Medicinal Chemistry


    llick, PhD, Medicinal Chemistry

    Read more about Rxight® pharmacogenetics