Tramadol Dosage Guide | Proper Use, Abuse, & Lethal Dose

Manish Mishra, MBBS

Medically Reviewed By: Manish Mishra, MBBS

on February 21, 2023
Fikret Terzic

Written by: Fikret Terzic MD, MS

Proper use of tramadol is following your prescription. This likely means taking 50 to 100 mg every four to six hours and not exceeding 400 mg per day. Tramadol abuse can lead to physical dependence, addiction, and fatal overdose.

Tramadol (brand name Ultram) is an opioid analgesic for moderate to severe pain management. Unlike other opioids, it increases the presence of serotonin and norepinephrine, hormones that regulate mood and brain activity. 

The Drug Enforcement Administration (DEA) classifies tramadol as a Schedule IV controlled substance, while other opioids are Schedule I or Schedule II drugs. 

This classification is because tramadol does not bind as strongly to the mu-opioid receptor as heroin, morphine, and other opioid medications do.

Schedule IV drugs are not the most commonly abused substances, but they have a potential for abuse, addiction, and physical dependence. Proper use of tramadol can help you avoid complications.

Proper Use Of Tramadol 

Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Motrin) can often relieve mild to moderate pain. Doctors should only prescribe tramadol when non-opioid pain medications don’t work. 

Tramadol hydrochloride comes as a tablet, capsule, or oral solution and is available in immediate-release (IR) or extended-release formulations. It’s intended for use by people who need around-the-clock pain relief.

If your doctor prescribes tramadol, follow the prescription and take it as intended. Sticking to prescribing guidelines will decrease the chance of overdosage, drug interactions, and adverse effects.

Tramadol Dosage

Tramadol dosage varies depending on your needs. Typically, your doctor will start at a low dose and increase it gradually so they can see the effects of tramadol on your body. 

The starting dose of tramadol is different for acute and chronic pain.

Moderate To Severe Pain Dosage 

The starting dose of tramadol for moderate to severe pain is 25 mg once a day. Every three days, a separate dose of 25 mg can be added until the total dosage is 100 mg daily. Then 50 mg can be added to the dosage every three days until it reaches 200 mg. 

After this process, called “titration,” you may take tramadol 50 mg or 100 mg every four to six hours as needed. 

Titration is ideal and works well for people who don’t need a rapid analgesic effect (immediate pain relief). However, if you need pain relief right away and the benefits outweigh the risk of skipping titration, your starting dose may be tramadol 100 mg (or 50 mg) every four to six hours.

The max dose is 400 mg per day for most people, but some exceptions apply:

  • Max dose is 200 mg daily if you have low creatinine clearance (metabolism of waste products from muscle breakdown).
  • Max dose is 50 mg every 12 hours for individuals with cirrhosis (severe liver disease).
  • Max dose is 300 mg daily for older adults over 75 years of age.

Chronic Pain Dosage

The recommended dose of tramadol for chronic pain is 100 mg once a day. If you have chronic pain, your doctor will likely prescribe extended-release tablets or capsules. Dosage may be increased as needed, with the max dose typically no higher than 300 mg per day.

Tramadol Abuse In Ohio

Some people abuse tramadol by not following their prescription or obtaining the drug illegally. If used as recommended, tramadol can ease pain during a difficult time. But if you abuse it, the results can be fatal. 

Ohio has the fourth highest death rate from drug overdoses in the United States, with 86 percent of overdose deaths involving opioids in 2020.

You’re abusing tramadol if you:

  • take a higher single dose than prescribed
  • take a higher max dose than prescribed
  • take it longer than recommended
  • take it more often than recommended
  • crush the tablets to snort or inject
  • inject the oral solution

Tramadol is an opioid agonist and central nervous system (CNS) depressant. It activates opioid receptors and relaxes your brain and body by slowing down brain activity, breathing, and heart rate. Over time, your body and mind can become dependent on tramadol.

Tramadol Addiction

First, you develop a tolerance to tramadol, meaning you’ll need a higher dose to have the same effect. Tolerance occurs as your body adjusts to working with the drug in your system. 

Physical dependence is the condition of needing the drug to function physically. Your body becomes so used to tramadol that it reacts adversely (with withdrawal symptoms) if you stop taking it.

Addiction often follows. If you abuse tramadol, your brain forms new connections that reinforce drug-taking behavior. You’ll begin to have cravings and feel that you need the drug to feel normal.

Signs Of Tramadol Abuse

Signs of tramadol abuse include:

  • multiple prescriptions from different doctors
  • unmarked pill bottles or bags of pills
  • a constant state of sedation
  • taking tramadol without physical pain
  • an inability to cut back or stop taking tramadol

Tramadol abuse raises the risk of serious side effects. If you’re getting tramadol illegally, your risk of overdose and complications significantly increases.

The Ohio Attorney General recently released a warning about nitazenes—potent opioids 1.5 to 40 times more potent than fentanyl—combined with tramadol. These drugs have no medical use but are being made in secret labs and sold on the street in Ohio.

What’s A Lethal Dose Of Tramadol?

As with any opioid, you can take a lethal dose of tramadol. How much is a lethal dose depends on your body and unique situation. For example, if you’re used to taking 100 mg at a time and suddenly take 300 mg, you’ll likely have life-threatening overdose symptoms.

Opiate overdose symptoms include extreme drowsiness, dangerously low blood pressure, and respiratory depression (breathing problems). 

Naloxone—an opioid overdose reversal agent—can temporarily stop opioid overdose symptoms, but it’s less effective with tramadol than other opioids.

Tramadol Overdose Risk Factors

Many risk factors can lead to a dose of tramadol becoming lethal:

  • Mixing tramadol with depressant drugs like alcohol, benzodiazepines, or opioids
  • Snorting or injecting tramadol rather than taking it orally (the extended-release formulation is especially dangerous because it’s concentrated)
  • Decreasing tramadol use then suddenly resuming your previous dose
  • Some medical conditions that make it more difficult for you to metabolize tramadol, such as renal or hepatic impairment (kidney or liver disease)

Taking tramadol with antidepressants, such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs), raises the risk of serotonin syndrome.

Serotonin syndrome is an adverse reaction to drugs that can be life-threatening.

None of these should be a problem if you work closely with a trusted healthcare professional to ensure you take tramadol safely. 

If you or a loved one are struggling with tramadol abuse, it’s a good time to explore drug rehab programs. Personalized care and evidence-based treatment options can turn your life around. Reach out to a treatment specialist at Ohio Recovery Center today to learn more.

  1. Centers for Disease Control and Prevention — Drug Overdose Mortality by State
  2. Drug Enforcement Administration — Controlled Substances
  3. National Library of Medicine: DailyMed — Label: Tramadol Hydrochloride Tablet
  4. National Library of Medicine: DailyMed — Label: Tramadol Hydrochloride Tablet
  5. National Library of Medicine: MedlinePlus — Tramadol
  6. National Library of Medicine: StatPearls — Tramadol
  7. Ohio Department of Health — 2020 Ohio Drug Overdose Data: General Findings

Written by Ohio Recovery Center Editorial Team

© 2024 Ohio Recovery Center | All Rights Reserved

* This page does not provide medical advice.

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