Tramal® is the trade name for a pain reliever that contains the active ingredient Tramadol contains. Tramadol belongs to the group of opioids and is used to treat moderate to severe pain.

Tramadol requires a prescription, but is not subject to the Narcotics Act (BtMVV).


Tramal, an opioid, is used to control moderate pain.

The substance tramadol was synthetically developed by Grünethal GmbH, patented in 1965 and the first preparation was brought onto the market in 1977. Today, many generics are available in different dosage forms and doses (tablets, drops, suppositories, infusions).

Chemical name

(R, R / S, S) -2- (dimethylaminomethyl) -1- (3-methoxyphenyl) cyclohexanol


According to the level scheme of the World Health Organization (WHO) for pain therapy, tramadol is used for moderate to severe pain used in combination with, for example, ibuprofen, ASA, paracetamol, diclofenac (non-opioid analgesics).


Tramal acts in the nervous tissue, also in the brain. It works on the three different opioid receptors like morphine, the power however is only about 10% of morphine. Tramal has a very unspecific effect on the receptors and the binding force (affinity) is not particularly high, so the pain relief effect is not very strong. Tramal also inhibits the reuptake of norepinephrine and increases the release of serotonin from the nerves. These effects have one Anxiety relievers (anxiolytic) and slight antidepressant effect. However, the increased release of serotonin has an undesirable side effect of increased nausea.


  • Moderately severe pain: Single dose (ED) 50mg, if the pain does not improve, take another 50mg
  • Severe pain: ED 100mg
  • Tumor pain or severe pain after surgery: highest dose possible with prolonged-release tablets 100 mg in the morning and in the evening, if necessary increase to 150 mg or 200 mg twice a day

Interval between ingestions: keep at least 8 hours.

Daily dose of 400mg do not exceed.

Perhaps individual adjustment of the dose necessary (for acute pain, long-term treatment, elderly patients, liver and kidney damage)

Side effects

Tramal generally has few side effects in the area of ​​organ damage. However, there may be side effects like sweat, Drowsiness (Sedation), confusion, sleepiness and blurred vision.

Furthermore, stronger Reported nausea.

At dosages above the therapeutic dose are also Seizures been observed.

Unfortunately Tramal is right high rate of non-responders (not responding) of 30%. In this case, you have to switch to another active ingredient.

At a Tramal poisoning (if you take significantly more than the therapeutic dose), as with other opioids (morphine), circulatory collapse, impaired consciousness and even coma can occur. Vomiting, constriction of the pupils, cramps, breathing disorders up to and including respiratory arrest can also occur.

Therapy: If it is not more than 2 hours ago, you can take activated charcoal with tablets or do a gastric lavage if you are poisoned. Otherwise you can call it Antidote naloxone and at Convulsions Give diazepam.

Tramal contains the active ingredient Tramadol, which is one of the big ones Opioid drug group and just as all opioids can cause side effects in addition to the desired pain-relieving effects.

However, side effects do not always occur, as every person reacts differently to the intake of drugs or the special intake of Tramal. Plus, the side effects can also different depending on the form of application be.

Graded according to the frequency of occurrence, the following possible side effects are to be mentioned:

At very many patients (more than 1 in 10 people treated) to step nausea and Dizziness on.

Frequently (more than 1 in 100 but less than 1 in 10 patients) can be side effects like Dry mouth, constipation (Constipation), a headache, increased sweating, Vomit and Drowsiness Find.

Occasionally (more than 1 in 1000 but less than 1 in 100 patients) is about the occurrence of Feelings of weakness, Circulatory fluctuations, Circulatory breakdowns, allergic reactions (Reddening of the skin, Itching, rash), Heart rate acceleration and Palpitations, as well as gastrointestinal complaints such as Nausea, diarrhea and stomach pain reported.

In rare cases (more than 1 in 10,000 but less than 1 in 1,000 treated) occur side effects such as a Muscle weakness, Reduced performance, Changes in appetite, Tremble, Increase in blood pressure, slow heartbeat, blurred vision, shock, such as breath- or mental disorders (Hallucinations, confusion, depression, nightmares, trouble sleeping) on.
Furthermore, in rare cases about the occurrence of allergic reactions like the Shortness of breath or Skin swelling reported.

Very rare there is an increase in liver enzymes.

With the long-term use of Tramal, dependence is possible, although the likelihood of Dependency development is to be classified as low compared to other drugs. Withdrawal symptoms after stopping the Tramal are rare, but quite possible. These withdrawal symptoms are likely to occur in the event of sudden discontinuation after long-term use.

In the elderly (> 75 years), as well as in patients with kidney or liver dysfunction, the occurrence of side effects is due to the slowed elimination and excretion elevated. Therefore, in these patients, close monitoring while taking Tramal and a possible dose adjustment is necessary.

Furthermore, the doctor should know the patient's medication plan in order to rule out possible interactions of Tramal with other drugs and thus avoid possible side effects.

If side effects occur, they should vary according to their severity be sure to contact a doctorwho informed about the next steps (Dose reduction / discontinuation) can decide.


Tramal interacts with other drugs in a variety of ways, which can either weaken the effect or increase the side effects. For this reason, Tramal and the following drugs should only be administered together with strict indications.

The combination of Tramal and drugs for the treatment of depression (e.g. MAO inhibitors, SSRI (citalopram)) can lead to the most dangerous interaction, serotonin syndrome. This is understood to mean a complex of symptoms consisting of sweating, restlessness, rise in blood pressure, vomiting, hallucinations, disturbance of consciousness, feeling of flu. MAO inhibitors in particular can also have life-threatening effects on the central nervous system, breathing and circulation (drowsiness, respiratory arrest, circulatory arrest).
You can find much more information under our topic: Serotonin Syndrome

If Tramal is taken with alcohol, or other medications that act on the central nervous system, they can mutually reinforce the effects on the brain and lead to respiratory arrest or delirium.

Medicines that are used to treat epilepsies (carbamazepine) can increase the tendency to cramp. Together with Tramal, this effect is increased and there is an increased risk of having a seizure.

The effect of Tramal is not increased but rather weakened by other opioids, especially from the group of mixed antagonists / agonists (e.g. buprenorphine, nalbuphine, pantazocine), which are used to treat severe pain.

Particular care should be taken when combining blood-thinning agents, especially those from the group of coumarin derivatives (Marcumar, warfarin). Here the effect of the coumarins is intensified and there is an increased tendency to bleed. In this case, patients should be closely monitored.

For drugs that use the Cyp3A4, an enzyme in the liver, such as is the case with erythromycin or ketoconazole, the effect of Tramal is reduced.


Tramal should not be taken if the intracranial pressure is increased.

Tramal should only be used if strictly indicated in the following situations.

Already exists Dependence on other opiates or one increased tendency to abuse medication or drugs, then you shouldn't take Tramal, because like other opiates it also acts on the µ-receptor and can potentially make you dependent. Furthermore, one should be very careful when taking Tramal Impaired consciousness or shock with an unclear cause. Also at increased intracranial pressure, diseases of the brain, if you have epilepsy or increased tendency to cramp one should be careful with Tramal.

Tramal should also not be taken if Disorders of the respiratory center and respiratory function or hypersensitivity to opiates.

At Liver and kidney dysfunction a strict indication should be given and patients should be monitored.

For drops there is an additional restriction in the case of an innate Fructose intolerance (hereditary Fructose intolerance), an absorption disorder for grape sugar (glucose) and mucus sugar (galactose) or an intolerance to sugar (sucrose).

For the prolonged-release tablets, there is an additional restriction in the case of an absorption disorder for glucose and mucous sugar, in the case of lactose intolerance and intolerance to mucous sugar (galactose).

For people over 75 years of age, the dose should be adjusted and the intervals between the individual doses should be stretched.

The dosage forms prolonged-release tablets, hard capsules and suppositories are not suitable for children under 12 years of age. In addition, the drops and the injection solution are not recommended for infants.

In the pregnancy and breast feeding period should one avoid regular use. No side effects are to be expected with single doses. It does not affect the uterus uterus during labor. After the birth of the newborn, breathing adjustment disorders can occur, but these will quickly resolve themselves.

Tramal should not be used at all if one acute poisoning with alcohol, sleeping pills, painkillers, opioids and psychotropic drugs consists. Tramal should also not be used under any circumstances if therapy with MAO inhibitors has been carried out in the last 14 days, as this can lead to serotonin syndrome. Furthermore, the use is not allowed in the case of drug consumption and poorly controlled epilepsy.

Habituation and dependence

Since Tramal acts on the µ-receptor, it can basically lead to habituation and dependency. If the drug is used in the therapeutic dosage, the probability is rather low.