Table of Contents
What is Tramadol?
Tramadol – also known by the brand name Ultram – is a centrally acting synthetic opioid agonist. Like other opioids, tramadol features analgesic (pain-relieving) and euphoria-inducing properties. To track down how long does tramadol stay in your system, tramadol binds with opioid receptors to increase dopamine levels in the brain, blocking the brain’s reuptake of serotonin and norepinephrine, like SNRI antidepressants. This dual-action prompts an addictive experience that both minimizes pain and increases feelings of pleasure.
While previously labeled an unclassified substance, the Drug Enforcement Agency reclassified tramadol in 2014 as a Schedule IV drug due to mounting research and statistics supporting its high potential for abuse, addiction, and overdose. Classification as a Schedule IV drug indicates tramadol’s chemically and emotionally addictive properties along with its widespread use in medical settings.1
What Does Tramadol Treat?
Physicians commonly prescribe tramadol for moderate to severe acute pain – like after an accident or surgery – and chronic pain when weaker painkillers no longer provide relief. Patients with conditions like neuropathy and cancer are often recipients of tramadol prescriptions.
Types of Tramadol Dosages
Tramadol doses come as tablets, capsules, drops, water-soluble tablets, and injections (usually delivered by a medical professional).2
Between these forms, tramadol dosages come in two forms – fast-acting and extended-release tramadol.3
- Fast-acting tramadol is typically prescribed for as-needed and short-term pain relief. This type of tramadol takes effect within thirty to sixty minutes, with peak effects felt between two to three hours. In total, fast-acting tramadol lasts about six hours. Prescriptions can range from two to four fast-acting doses in a day. The maximum recommended fast-acting tramadol dosage is 400mg, with doses available in 25mg, 50mg, and 100mg.
- Extended-release tramadol is often prescribed for those struggling with chronic pain that is not likely to disappear any time soon. This slow-releasing tramadol takes about ten to twelve hours for users to begin feeling it and should be taken at consistent times each day to maximize its pain-relieving effects. It comes in three doses: 100mg, 200mg, and 300mg.
There are five brand-name versions of tramadol in the U.S.: Ultram, Ultram ER, Conzip, and Ryzolt. It should be noted the U.S. has officially discontinued production of Ultram ER and Ryzolt in 2021. Still available are fast-acting Ultram and both fast and extended-release Conzip.
How Long Does Tramadol Stay in Your System?
The length of time tramadol stays in your system depends on which version of tramadol your physician prescribes. Fast-acting tramadol usually takes effect within thirty minutes to an hour and lasts for roughly six hours. Those with fast-acting tramadol prescriptions typically take between two to four doses daily.
Extended-release tramadol requires more time to take hold, with the onset of effects typically occurring ten to twelve hours after ingestion. Because this version releases slowly over time, one dose often lasts the entire day. People receiving a prescription for extended-release tramadol usually take one to two doses each day.
It takes roughly six to eight hours for the body to remove half the amount of tramadol in its system. The body removes most drugs after about four or five half-lives and takes about two days to clean out all traces of tramadol.
Tramadol Detection Tests
Blood Test: Blood tests detect tramadol up to forty-eight hours after last use.
Saliva Test: A saliva detection kit can test for and identify tramadol use up to forty-eight hours later.
Urine Test: Tramadol can be detected in urine between one to four days after last use.
Hair Test: Hair detection kits can identify tramadol up to ninety days after last use
What Factors Affect How Long Tramadol Stays in the Body?
Several variables impact how long tramadol stays in the body and how long its effects are felt.
Body Mass Index (BMI)
Tramadol is metabolized and stored in body fat, so when someone has a higher BMI or a greater amount of fat, tramadol may be detectable for longer periods.
Factors like age, weight, underlying health issues, and kidney or liver damage can all impact how quickly or slowly tramadol is processed through the system.
People who exhibit slower metabolism often find it takes their livers and kidneys a bit longer to process and fully excrete all tramadol from their systems. About 7% of people are born as “poor metabolizers” of tramadol due to decreased activity of certain enzymes.
Urine with lower acidity levels or a pH below seven speeds up the elimination of some drugs through the body. Conversely, higher pH levels above seven are more alkaline and slow the excretion process.
The amount of time tramadol remains in your system directly correlates to how much tramadol you take. The higher the dose, the more time it takes your liver and kidneys require to process it.
Type of Tramadol Used
Your body will process tramadol quickly or slowly depending on whether you take fast-acting or extended-release tramadol. Extended-release doses were created to last longer and for consistent recurring use. For this reason, extended-release doses remain in the body longer.
Tramadol Interactions with Other Drugs
Is Tramadol Addictive?
While often prescribed as a “safe” alternative to well-known addictive opioid analgesics, tramadol has received renewed attention and criticism for its highly addictive properties and widespread prescriptions. For those without a prescription, tramadol uses involve feelings of pleasure and euphoria. Tramadol uses also include stress relief and suppression of anxiety.
The Drug Abuse Warning Network (DAWN) documented and reported that in 2011 there were 21,649 emergency room visits involving nonmedical use of tramadol, marking a 250% increase from 2005.5 Of these, over 6,000 visits resulted from tramadol abuse alone. With millions of prescriptions each year – 36.5 million tramadol prescriptions were written in 2018 – the ease of accessing tramadol paired with its chemically addictive qualities makes it a potent option for abuse.6
Due to mounting evidence from emergency rooms and states, the DEA reclassified tramadol from an uncontrolled substance to a Schedule IV drug to reflect its potential for abuse and addiction. Due to changing regulations, physicians are now only allowed to write up to five tramadol prescriptions within six months per patient.
Tramadol Side Effects
While often prescribed as a “safe” alternative to opioids, tramadol still carries several side effects.
Common Tramadol Side Effects
- Feeling sick (i.e., nauseous, vomiting, constipation, diarrhea, stomach pain)
- Agitation and anxiety
- Dry mouth
- Decreased appetite
- Weakness (asthenia)
Serious Tramadol Side Effects
- Shallow or depressed breathing
- Feeling lethargic
- Difficulty urinating
- Confusion and agitation
- Experiencing dizziness or vertigo
- Feeling fatigued or with low energy
- Seizures (if you experience a seizure, it’s essential to seek medical assistance immediately)
Signs of Tramadol Abuse
Tramadol abuse occurs whenever tramadol is consumed outside the prescription’s directions. Abuse can look like consuming higher doses than prescribed, consuming tramadol differently than directed (snorting, chewing, injecting), or using tramadol without a prescription.
Additionally, many who abuse tramadol mix it with other drugs, leading to dangerous tramadol interactions. Tramadol should not be consumed with alcohol, sedative-hypnotics, or other opioids.
Signs of Tramadol Addiction
- Increased tolerance that prompts individuals to take higher doses
- A growing obsession with obtaining and consuming tramadol
- Failure to uphold responsibilities at work, school, or with family due to tramadol
- Finding activities you once enjoyed no longer bring happiness
- Wanting but being unable to stop or lessen the use
- Experiencing withdrawal as you reduce or eliminate the use
- Isolating oneself from close relationships
- Doctor shopping to obtain new prescriptions
Signs of a Tramadol Overdose
While rare, tramadol overdoses occur more frequently when tramadol is taken improperly by crushing and snorting, chewing, or injecting it. This heightened overdose risk is due to the nature of extended-release doses, which are intended to release slowly over an entire day.
When massive amounts of tramadol enter the bloodstream at once, it can decrease the oxygen available to the brain and potentially cause irreparable damage. Naloxone is often prescribed to counteract the effects of an overdose. Overdose symptoms include:
- Increased agitation or anxiety
- Nausea and/or vomiting
- Fatigue and lethargy
- Skin appears with a gray or blue tint
- Cold and clammy skin
- Decreased pupil size
- Reduced, slower, or shallow breathing
How Long Does Tramadol Withdrawal Last?
The onset of tramadol withdrawal typically begins within eight to twenty-four hours after the last dose. Most long-term or chronic users find withdrawal lasts between four to ten days.
Withdrawal Symptoms of Tramadol Abuse
- Intense cravings
- Cold chills
- Increased sweating
- Runny nose
- Excessive sneezing
- Flu-like symptoms
- Nausea and/or vomiting
- Muscle spasms
- Uncontrollable tremors or shakes
- Issues with sleep
- Respiratory issues
- Pain (increased pain sensitivity can sometimes occur with prolonged use)
- Hallucinations (typically rare)
- Seizures (can occur with long-term use and dependence)
Treatment Options for Tramadol Addiction
The idea of going through tramadol withdrawal can be scary, but you don’t have to go through it alone. Many treatment options exist for those experiencing tramadol withdrawal who want to recover from addiction. Most physicians will guide patients through a tapering process, slowly decreasing the amount of tramadol in your body so your system can relearn how to function without it.
Most treatment for tramadol addiction revolves around therapeutic tools to help the user identify triggering emotions and events, learn emotional coping skills, and embrace motivational systems to help them stay in recovery. Cognitive-behavioral therapy, contingency management, and group therapies are all standard methods of treating tramadol addiction.
Some treatment centers may use additional drugs like methadone, naltrexone, and buprenorphine-naloxone to curb cravings and reduce withdrawal symptoms.