Is tramadol an opioid?

Q: Is tramadol an opioid?

Tramadol is an opioid (narcotic) analgesic that also has non-opioid effects. It is classified as a Schedule IV controlled substance due to its moderate potential for abuse and dependence, although this is less than traditional opioids. Tramadol is approved for the relief of moderate to moderately severe pain.

Medically reviewed by Carmen Pope, BPharm. Last updated on July 16, 2025.

Official Answer by Drugs.com

Tramadol is an opioid (narcotic) analgesic that also has non-opioid effects. It is classified as a Schedule IV controlled substance due to its moderate potential for misuse and addiction, although this is less than traditional opioids. Tramadol is approved for the relief of moderate to moderately severe pain. It is also known by brand names ConZip, Qdolo, Ultram, and Ultram ER.

Tramadol is a synthetic (man-made) opioid that requires metabolism in the body to become active. Once inside the body it binds to mu opioid receptors in the brain and spinal cord to relieve pain, in a similar way to how morphine works, although tramadol is 10 times weaker than morphine. Opioid activity is the main way tramadol works to relieve pain.

Tramadol also inhibits the reuptake of serotonin and norepinephrine, two neurotransmitters that are involved in the descending pain inhibiting pathway. This makes tramadol effective for nerve-related pain.

Immediate-release tramadol is intended for pain episodes lasting less than one week, while extended-relief tramadol is better at providing prolonged pain management around the clock and is used for pain persisting beyond one week. Tramadol has also been used off-label for restless leg syndrome and premature ejaculation that has not responded to other medications.

Tramadol is effectively absorbed when taken orally, typically prescribed in 50-100 mg tablets every 4-6 hours as needed for pain management, with a maximum daily dose of 400 mg. While seizures can occur even at recommended doses, the risk increases significantly with high-dose abuse.

Like other pain medications, tramadol carries risks of tolerance, dependence, and addiction. Stopping tramadol suddenly can trigger two distinct withdrawal patterns. The majority of patients (90%) experience typical opioid-like withdrawal symptoms including flu-like illness, restlessness, and drug cravings. However, about 10% of patients develop an unusual withdrawal syndrome characterized by hallucinations, paranoia, severe anxiety, panic attacks, confusion, and numbness or tingling in hands and feet.

This atypical withdrawal pattern makes tramadol cessation particularly challenging and highlights the importance of gradual tapering under medical supervision.

How long does it take for tramadol to start working?

Tramadol generally starts to relieve pain within an hour in its fast-acting forms, which are used for short-term pain management. With slow-release or extended-release (ER) forms, the drug may take longer to start because it’s gradually released over 12 or 24 hours, but pain relief lasts longer. Continue reading

Is tramadol stronger than codeine?

Both tramadol and codeine are prescription opioid painkillers, and they seem to be equally effective in terms of pain relief. There is no evidence that tramadol is any stronger than codeine at relieving pain. Continue reading

How long does tramadol stay in your system?

Tramadol is eliminated from your system within roughly 2 days of taking the drug, but this does not mean that it can no longer be detected by certain drug tests. Continue reading

Is tramadol an opioid?

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