Tramadol Overdose Signs & Symptoms

Tramadol, known by brand names like Ultram, Ryzolt, and ConZip, is an SNRI, or serotonin/norepinephrine reuptake inhibitor and an atypical opioid analgesic that is chemically similar to codeine.^{1, 2} Tramadol is different from other opioids because it also affects other neurotransmitters, including serotonin and norepinephrine.² Tramadol is FDA-approved to treat pain that is severe enough to require an opioid and which cannot be alleviated by other medications.³

Tramadol is still an opioid, and it has the potential for misuse, addiction, and overdose. Tramadol overdoses may manifest differently from opioid overdoses, however, and they require medical attention.³ If you think you or a loved one may be experiencing a tramadol overdose, you should contact 911 emergency services right away.

Can You Overdose on Tramadol?

Tramadol use exposes a person to the risks inherent with opioid use: addiction, misuse, and overdose.³ An overdose means that a person has taken enough tramadol to result in serious or life-threatening effects.⁴ An overdose on tramadol can, like any opioid overdose, result in respiratory depression, or slowed or stopped breathing, which can be dangerous and potentially fatal.³ As it is an atypical opioid, however, there are other manifestations of overdose that can occur.

While there is always a risk of overdose with tramadol use, the risk of opioid overdose increase if a person concomitantly uses benzodiazepines, other opioids, or other central nervous system depressants (including alcohol).³ The risk of other, tramadol-unique overdose symptoms increases with concomitant use of antidepressants and certain other drugs.

Signs of Tramadol Overdose

Signs of a tramadol overdose (sometimes known as tramadol poisoning or tramadol toxicity) can be similar to those associated with other opioids, but may also include other symptoms not typically associated with other opioids.²

As with other opioids, tramadol overdose symptoms can include:²

• Respiratory depression (slow, shallow, or stopped breathing). ³
• Signs of oversedation (e.g., sleepiness progressing to loss of consciousness or coma). ³
• Weak or limp muscles. ³
• Cold and clammy skin³
• Constricted pupils or, in some cases, dilated pupils. ³

As mentioned above, tramadol toxicity can differ in ways unique from toxicity resulting from overdose of other opioids. Tramadol overdose, for example, can potentially trigger seizures and a potentially fatal condition known as serotonin syndrome.^{2, 3} Both of these conditions can occur with tramadol alone at therapeutic doses, but appear more likely to occur during misuse as well as with the coadministration of other drugs, particularly antidepressants (e.g., monoamine oxidase inhibitors (MAOIs), tricyclics,  selective serotonin uptake inhibitor anti-depressants (SSRIs), SNRIs, and other drugs that affect the serotonergic neurotransmitter system, like triptans, 5-HT3 receptor antagonists, mirtazapine or trazodone.¹⁴

Serotonin syndrome can cause different symptoms, some of which can resemble opioid overdose, such as:³

• Mental status changes (such as agitation, hallucinations, or coma).
• Autonomic instability (such as rapid heart rate, labile blood pressure, or low body temperature).
• Neuromuscular abnormalities (such as overactive reflexes, incoordination, or muscle rigidity)
• Gastrointestinal symptoms (such as nausea, vomiting, diarrhea)

What to Do If Someone Is Overdosing on Tramadol?

As with any opioid overdose, a tramadol overdose is a medical emergency.⁴ If you suspect an overdose, call 911 right away and administer naloxone, an opioid overdose medication, if available.⁴

Can you Reverse Tramadol Overdose?

Immediate medical attention is required to potentially reverse and treat a tramadol overdose.³ Naloxone is a temporary overdose treatment that can be administered as a pre-metered nasal spray (Narcan) by anyone without medical training, or emergency medical personnel will administer it when they arrive.^{4, 6, 7}

Naloxone helps reverse an opioid overdose by blocking or blunting the effects of opioids to restore a person’s breathing.^{4, 7} Medical attention is still necessary after naloxone administration, as naloxone wears off rapidly and a person can return to overdoses a result of tramadol that’s still in their system.³

Medical treatment can also include monitoring for seizures, supportive measures to restore breathing, and treatments to manage shock, pulmonary edema, cardiac arrest, or severe arrhythmias.³

Getting Treatment for Tramadol Misuse and Addiction

A tramadol overdose may indicate that a person is struggling with tramadol misuse or an opioid addiction.⁸ Evidence-based addiction treatment, including medication and behavioral therapies, can help people safely stop using tramadol and begin their journey to recovery.⁴

To find tramadol addiction treatment, you might first consult your doctor to have an evaluation, discuss treatment options, and ask for referrals to rehabs. You can also search online resources or call American Addiction Centers’ addiction helpline at to learn more about tramadol overdose, find rehab centers that meet your needs, and verify your insurance benefits.