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Psychedex
Facts label

Tramadol Facts

Opioid; Depressant; Substituted phenethylamine; Mu-opioid receptor partial agonist

Dose and durationby route · individual sensitivity varies

Oral(mg)
Threshold< 25 mgLight50 – 100 mgCommon100 – 200 mgStrong200 – 300 mgHeavy300+ mg

Starts in 15 – 60 minLasts 6 – 10 hoursAfter-effects 2 – 5 hours

Body and dependence

Acute toxicity
Moderate
Chronic toxicity
Moderate
Physical dependence
Moderate
Psychological dependence
Moderate
Withdrawal
Moderate · medical supervision
Compulsive redosing
Low

Tolerance

Builds
Moderate
Fully resets after
Not recorded
Carries over to
codeine; morphine; oxycodone; hydrocodone; heroin; fentanyl; other mu-opioid agonists

Effectslikely at a common dose

Perception
none likely · 3 possible, including Vestibular distortion
Body
Pain suppression; +31 possible, including Respiratory depression, Nausea, Dizziness
Thinking
none likely · 20 possible, including Cognitive impairment, Compulsive redosing urge, Analysis suppression
Feeling
none likely · 11 possible, including Anxiety, Anhedonia, Depression
Self
none likely · 6 possible, including Craving, Communication suppression, Social disconnection
Time
none likely · 2 possible, including Temporal disorientation
Awareness
none likely · 1 possible

Who shouldn't take it

Absolute
MAOI use (current or within 14 days); CYP2D6 ultrarapid metabolizer status; Children under 12 years; Post-tonsillectomy/adenoidectomy pain in patients under 18
Relative
Concurrent CNS depressant use; Epilepsy or lowered seizure threshold; Concurrent SSRI/SNRI/TCA use; Severe hepatic impairment; Pregnancy; Breastfeeding (especially CYP2D6 UM mothers)

Combinations142 recorded

Lethal (83)
2-Aminoindane; 2-FA; 2-FEA; 2-Fluorodeschloroketamine; 2-FMA; 3-FA; 3-FEA; 3-FPM; 3-MMC; 3,4-CTMP; 4-FA; 4-FMA; 4F-EPH; 4F-MPH; 5-APB; 5-Hydroxytryptophan; 5-MAPB; 6-APB; 6-APDB; A-PHP; A-PVP; Acetylfentanyl; Alcohol; Amphetamine; Armodafinil; Buprenorphine; Butylone; Cocaine; Codeine; Cyclazodone; Desoxypipradrol; Dextroamphetamine; Dextromethorphan; Dextropropoxyphene; Dihydrocodeine; Ephylone; ETH-CAT; Ethylmorphine; Ethylone; Ethylphenidate; Fenethylline; Fentanyl; GBL; GHB; Heroin; Hydrocodone; Hydromorphone; Isopropylphenidate; Ketamine; Kratom; Lisdexamfetamine; MAOIs; MCPP; MDA; MDAI; MDEA; MDMA; MDPV; Mephedrone; Methadone; Methiopropamine; Methoxetamine; Methylnaphthidate; Methylone; Methylphenidate; Mexedrone; Modafinil; Morphine; N-Ethylhexedrone; NEP; NM-2-AI; O-Desmethyltramadol; Oxycodone; Oxymorphone; PCP; Pentedrone; Pethidine; Prolintane; Propylhexedrine; Rolicyclidine; Sufentanil; Tapentadol; U-47700
Dangerous (40)
Alpha-2 adrenergic receptor antagonist; Anticholinergics; Benzodiazepines, Barbiturates; Gabapentin, Pregabalin; MDMA, Amphetamines; MDMA, MDA; Naloxone, Naltrexone; Naltrexone; NRIs; Opioids; 5-HTP, Tryptophan; Amphetamines; Antihistamines; Antipsychotics; Atypical antipsychotics; Buspirone; Caffeine; Clonidine, Guanfacine; Dopamine agonists; DXM; Ephedrine, Pseudoephedrine; GHB, Baclofen; GHB, GBL; Glutamate modulator; and 16 more, see full page
Caution (15)
See full page: psychedex.org/substances/tramadol
Not graded (4)
Not listed never means safe.

Seek help immediately if

  • Unresponsive / can't be woken, even to a firm sternal rub
  • Slow, shallow, or stopped breathing
  • Pinpoint pupils
  • Blue/grey lips, fingertips, or skin (cyanosis)
  • Limp body; pale, clammy skin
  • Choking or gurgling sounds ("death rattle")
  • Slow, erratic, or absent pulse

What to do

  1. Try to wake them — shout their name, firm sternal rub
  2. Call emergency services immediately
  3. Administer naloxone if available
  4. Give rescue breaths (or CPR if there is no pulse)
  5. Place them in the recovery position
  6. Stay with them; re-dose naloxone every 2–3 minutes if there is no response
Reversal agent
Naloxone (Narcan) — opioid antagonist. May require repeated doses; its effect can wear off before the opioid does.

With prompt naloxone and rescue breathing, reversal is usually rapid. Because naloxone can wear off before the opioid — especially with long-acting opioids (methadone) or high-potency ones (fentanyl) — a period of monitoring is needed even after the person revives.

988 Suicide & Crisis LifelineFireside Project: 62-FIRESIDE

psychedex.org/substances/tramadol · Version r1 · Not medical adviceValues as of
On the printout