Tramadol and Alcohol Interaction Effects

Tramadol and Alcohol: There are a number of different painkillers available on the market, both in the form of over the counter drugs or those requiring strict prescriptions. All these drugs follow different mechanisms for action and have different effects on the body. Some have a quick action period with short-lived effects while others may take a comparatively long time to get absorbed by the body but last for a much longer time. While some painkillers are harmless, others tend to have serious side effects, which get amplified even further when mixed with other drugs. Hence, it is important to have a good knowledge about the types of drugs you are taking and the effects it can have on your body.

Tramadol and Alcohol

Topics Covered

What is Tramadol?

Tramadol is a synthetic drug that acts as an effective analgesic. The exact mechanism of Tramadol is not yet fully known. However, it functions in a similar way to morphine. It mainly shows the effect by binding to the brain through opioid or narcotic receptors, which have an important role in the transmission of pain in different parts of the body.

Tramadol is categorized under a class of drugs that are known as opioid analgesics. It acts directly on the central nervous system and helps in relieving all types of pain. It does not fall under the category of NSAID or non-steroidal anti-inflammatory drug and therefore, is not associated with the risk of internal bleeding or stomach ulcers, which are a common occurrence with NSAIDs.

Tramadol is mainly used for the treatment of moderate to severe pain and require a doctor’s prescription. It is commonly used by adults who need continuous treatment for chronic pain caused due to various health issues. However, there are some groups who are advised not to use Tramadol. This includes children under the age of 12, people who have had recent surgery for adenoids or tonsils, overweight people with respiratory issues and people suffering from sleep apnea and lung diseases.

Tramadol is sold under different brand names, out of which, the two most common ones are Ultram and Ultracet. When taken orally, it gets released into the body almost immediately, providing quick relief from pain. Sometimes, it may also be prescribed together with other drugs such as paracetamol which is known to increase the effectiveness of the drug. However, if taken carelessly, it can also lead to side effects such as seizures, nausea, itchiness, constipation, reduced alertness, liver, and kidney problems and increase the risk for serotonin syndrome. It is not recommended for pregnant or breastfeeding women and people with depressive symptoms.

However, similar to other narcotics, using Tramadol continuously for a long period of time can lead to the addiction problem. The dependence could be both physical as well as mental. The negative side effects are even magnified when it is taken together with alcohol. If the drug is stopped abruptly, the patient may develop various withdrawal symptoms. In some cases, it could even be lethal.

Is it safe to Drink Alcohol while on Tramadol?

Tramadol is categorized under the class of opiate agonists and is prescribed for moderate to severe pain. Upon entering the body, it immediately gets attached to the pain receptors present in the brain, thereby numbing the sensation of pain. Although Tramadol has little risk for dependence as compared to codeine and morphine, the risk is still huge, especially among the patients who use it as a treatment for chronic pain or those who have been combining it with alcohol.

Since combining Tramadol with alcohol amplifies the pleasurable effects associated with both the drugs, people often end up mixing the two. However, Tramadol also causes the body to develop resistance towards alcohol by altering the brain chemistry. Hence, this can easily lead to the problem of overdrinking. Although the potential consequences may be overlooked in the beginning, if continued for a long period of time, it can lead to serious negative side effects.

Tramadol acts directly on the brain, thereby interacting with its biochemical environment. It also enters the circulatory system together with other metabolic products and acts as a depressant for the central nervous system. This could lead to an abnormal slowing down of the central nervous system, resulting in symptoms such as pinpoint pupils, drowsiness, and reduced brain activity. These are just the trivial symptoms. Drinking moderate amounts of alcohol while on Tramadol can lead to the following side effects:

  • Nausea and vomiting
  • Gastrointestinal issues
  • Agitation and mood disorders
  • Increased risk for depression
  • Irregular functioning of the nervous system, leading to issues such as memory changes, behavioral changes and lack of proper coordination
  • Sedation
  • Recurrent headache
  • Vertigo
  • Increased risk for liver damage
  • Toxic interactions, also known as acute alcohol syndrome
  • An increase in the intracranial pressure by a significant degree.
  • Renal failure
  • Decrease in the threshold for seizures among the susceptible individuals

Hence, mixing alcohol and Tramadol enhances the negative effects of both and also increases the chance of overdosing. The Food and Drugs Association strictly warns against the mixing of the two. However, if you are still bent on alcohol, you may consult a doctor on how far apart they should be placed so as to minimize the serious consequences. It is always advisable to be extra careful while you are on Tramadol.

Tramadol and Alcohol Interaction Effects

It is recommended not to mix Tramadol with alcohol as well as other centrally acting drugs. This is because both work as depressants on the central nervous system. Hence, taking the two together can only lead to even stronger side effects. Given that the extent of damage cannot be exactly measured at any given time, it is best to avoid taking the two together. Usually, Tramadol is not recommended for people who are prone to any kind of addiction, especially alcohol. Furthermore, it should never be taken in an intoxicated state.

Taking Tramadol and alcohol can even put you directly into dangerous situations through poor judgment, sedation, behavioral problems and inadequacy to maintain physical and mental coordination. It is advisable not to get involved in driving or operation of heavy machinery if you have mixed alcohol with Tramadol. Since Tramadol readily increases the tolerance for alcohol, the usual quantities of alcohol that you take may not have any effect. Hence, the chances are that you will end up taking very high amounts without even realizing it.

The interaction of Tramadol and alcohol gets even more intense if the person already has an abnormally functioning liver. Not only that, it can lead to even further damage. In addition to this, it can also cause psychological side effects increasing the risk of depression and giving rise to suicidal thoughts. All of these, combined with a highly reduced threshold for seizure can make put anyone into serious, life-threatening situations. The combination can even prove to be lethal for epileptics and people who are prone to other kinds of seizures.

Some of the most common plan for detoxification side effects arising out of Tramadol and alcohol interaction are given below:

  • Sedation
  • Dizziness
  • Vertigo
  • Nausea
  • Sleepiness
  • Loss of proper coordination
  • Behavioral changes
  • Problem with memory formation

In some cases, the patients may also experience severe depression, lose complete consciousness and end up in a coma which may eventually lead to death. Therefore, if you have been on Tramadol for a considerably long period of time or have been mixing it with other prescription or over the counter drugs, it is advisable to consult the doctor before continuing with the usage. Even if you have decided to get off of Tramadol, it should only be done under strict medical supervision. In any case, it can be helpful to open up to your respective health care provider and discuss the issue in detail.

Dangers of taking Alcohol and Tramadol together

Since both Tramadol and alcohol act as central nervous system depressants, mixing the two can only intensify the dangerous effects of each. If there has been an interaction, it may show up as drowsiness, sleepiness, and lightheadedness. You may also notice a considerable decrease in the reaction time, intoxication, fuzzy thinking and have difficulty with concentration and coordination. All of this combined can easily increase the chances of getting into a life-threatening accident or at the least, it can lead to a serious alcohol poisoning. Other dangerous consequences include

  • Overdose
  • Lowered heart rate
  • Shallow breathing
  • Confusion
  • Brain damage
  • Respiratory depression

These, combined with a significantly reduced brain activity, can prove to be outright fatal. It should also be noted that certain groups of people are at an increased risk of systemic damage and toxicity arising out of combining alcohol and Tramadol. The groups of individuals with a higher level of risk have been mentioned below.

  • People who are above the age of 60 years
  • People who have a weak or damaged liver, kidney and suffer from gastrointestinal problems
  • People who have asthma or other respiratory illnesses

If you notice any of the undesirable symptoms with both chronic as well as acute consumption of Tramadol, it is best to consult a doctor and get medical treatment right away.

Withdrawal Symptoms of Tramadol and Alcohol Addicts

As mentioned above, mixing Tramadol and alcohol sure has a lot of negative consequences. However, the greatest danger is that of developing an addiction, not only to Tramadol, but to a combination of both alcohol and Tramadol. Since taking the two together is known to offer a greater pleasure, chances are very high for this to happen. The risk of dependence is even greater in the case of alcoholics. When dependence has been established, it gets quite difficult to overcome the addiction and may even need medical intervention.

Upon proper treatment, the symptoms of withdrawal can be quickly overcome. However, the toxicity that it leaves on the central nervous system can last for some time and may require a long-term plan for detoxification. According to a report released by the Drug and Alcohol Dependence in 2003, more than 33 % of the percent of the people who were being treated for Tramadol addiction had notable amounts of toxic symptoms of the on the central nervous system during the detoxification process even though the withdrawal symptoms were long gone.

Some of the most common withdrawal symptoms associated with mixing Tramadol and alcohol have been listed below:

  • Agitation
  • Panic attacks
  • Paranoia
  • Hallucinations
  • Confusion
  • Itchiness and tingling sensation on the skin
  • Numbness of the skin
  • Diarrhea
  • Nausea
  • Vomiting
  • Distress
  • Anxiety depression
  • Intolerable pain
  • Cold sweats

The physical symptoms of withdrawal from Tramadol share a lot of similarity with the symptoms of flu. Most often, they reach the peaks within an interval of just a few days and then gradually become milder. The psychological symptoms of withdrawal, however, may last for a much longer period of time. It is not entirely necessary for the withdrawal symptoms to be even. It is very likely for different people to experience different side effects with different intensities and for different durations depending on a large number of influencing factors.

The degree of dependency that has been developed towards the combination of alcohol and Tramadol is often the main contributing factor in how long the withdrawal symptoms are going to last. Since the brain gets the direct hit, it may take a long while for it to fully recover from the long-term damage that has been caused due to chronic usage and bounce back to normal functioning. The dosage is another one of the factors that contribute to the amount of dependency. People who are subjected to a chronic usage of Tramadol on larger doses generally develop a heavier dependence and also take a longer time to recover.

The method in which Tramadol is being used is another one of the factors that determine the drug dependence and consequences of withdrawal. For example, people who opt for snorting, injecting or smoking may not develop so great a dependence as compared to those who have been consuming it orally combined with alcohol. The risk also gets intensified if the patients are on other prescription drugs together with Tramadol.

Genetics, physiology, and biology also have their own role in determining the dependence, which has a direct influence on the severity of the withdrawal symptoms. Although mental and medical health condition are also known to have a contribution, more than half of the time, genetics have been found to be the major factor. Hence, patients who have had family members addicted to Tramadol are at a higher risk of developing an addiction to the same as compared to those who have a clear family history.

It should be noted that involvement in other forms of substance abuse, neglect, trauma and chronic stress are among the factors that increase the risk of Tramadol addiction. The age of the person may also play a role. For example, there are several parts of the brain that are not yet fully developed even till adolescence. These are the parts that are responsible for controlling and influencing memory, learning, controlling impulses and decision making. Hence, when teenagers get addicted to Tramadol, the withdrawal symptoms may not be similar to that of adults. It may even lead to permanent damage to some parts of the brain. If the dependence has been developed during the teenage years, it is more likely for the person to develop a substance use disorder as compared to those who developed the dependence during the adult age.

How to treat Tramadol and Alcohol addiction?

There are a large number of treatment facilities established especially for patients who have developed dependence to concurrent Tramadol and alcohol abuse. It is upto the patients to choose between an outpatient or an inpatient treatment. Irrespective of the treatment approach, it is important for the patients to undergo a well planned medical detoxification for a minimum period as advised by the doctor. This should be done under strict medical guidance. Detoxification is important, especially because the withdrawal symptoms can get quite intense. Especially due to an increased risk of seizures, it can get outright dangerous for the patients.

The doctors may prescribe certain drugs such as diazepam during the detoxification process so as to make the symptoms more manageable. A detoxification process that is undertaken under close medical assistance from professionals will help in successfully removing all the drugs remaining in the body. One may also choose to get into rehab for round-the-clock medical assistance. The programs designed for rehabs also teach the patients different skills that are required during the recovery period and how to identify and avoid the triggers. The duration of the rehab may vary from 30 to 60 to 90 days depending on the severity of the dependence. However, longer programs are available to patients who need greater support.

The most common treatments for Tramadol and alcohol addiction include:

  • Medication management
  • Behavioral therapy
  • Rehabilitation of physical health

Patients who have opted for rehab programs are often kept of outpatient treatments for a certain period of time after they have completed their time in the rehab. This is done in order to prevent relapse and offer assistance with the coping skills.

Overdosing on Alcohol and Tramadol

Taking alcohol and Tramadol together can completely modify the effect of each drug. The combination tends to bring out the most negative aspects of each. The side effects are much stronger when the two are taken together as compared to when they are taken separately. Hence, there should be a safe amount of gap between the consumption of the two or atleast it is considered not to take both on the same day. Furthermore, Tramadol suppresses the effects of alcohol. Since one may not experience any intoxication with the regular amounts, it can easily lead to excess consumption of alcohol. The overdosing on alcohol and Tramadol usually depends on the amount of exposure an individual can tolerate opiates. 25 mg per dosage is considered to be the safe limit, and it should not be taken any more than four times per day, or in other words, the daily dosage should not cross 100mg.

Some of the symptoms that can arise from overdosing on alcohol and Tramadol include:

  • Slow breathing
  • Respiratory issues
  • Drastically reduced blood pressure
  • Hallucination
  • Anxiety
  • Seizures
  • Diarrhea
  • Memory loss
  • Noticeable changes in the behavior

Can Drinking Alcohol along with Tramadol Cause Death?

A large number of researches have established a direct correlation between concurrent alcohol and Tramadol intake and an increased rate of mortality. One of the case studies showed that a patient who had been using Tramadol for the musculoskeletal issues without controlling alcohol consumption developed a seizure that eventually turned out to be fatal. This is mainly because alcohol consumption weakens and damages the livers and kidneys, which has a direct impact on the metabolism as well as the elimination of Tramadol, thereby resulting in a higher level of toxicity. Since the combination can turn out to be fatal, it is advisable not to drink while on Tramadol.

How to Prevent Tramadol and Alcohol Interaction?

  • Avoiding the use of Tramadol if you are already on treatment for other narcotics or addiction-related issues
  • If you regularly consume alcohol, have a consultation with the doctor regarding an alternative form of treatment
  • Quit drinking, atleast for the period during which you are required to take Tramadol
  • If you have been mixing alcohol and Tramadol for over four weeks, inform your doctor about it.
  • Avoid getting involved in activities that require a precise central nervous system coordination such as driving, operating heavy machinery, etc., if you have mixed alcohol and Tramadol


Over the years, Tramadol has become more of a generic drug. It is effective, cheap and easily available. In fact, it was found out that approximately 43.8 million prescriptions were given for Tramadol in 2013 alone. With this, the risk for abuse is at an all-time high. When alcohol abuse is already a huge problem affecting millions, Tramadol can only make it worse. It has been estimated that there are about 88,000 deaths in the United States each year owing to alcohol abuse. Hence, it is advisable to take extra care when you are on Tramadol.

Other Posts:

You May Also Like