The Effects of Mixing Tramadol and Alcohol

What is Tramadol?

Tramadol (Ultram) is an opioid pain medication prescribed to treat moderate to severe pain as well as chronic pain when weaker pain relievers are no longer effective.^1,2 Tramadol blocks pain signals that travel along the nerves to the brain in order to relieve pain.² When taken as prescribed, its most common side effects are nausea, dizziness and vomiting.^2,3

Although tramadol has a low potential for dependence (when compared to morphine), dependence can still occur when used for prolonged periods of time.³ In 2014, tramadol went from being viewed as a drug of concern to a controlled substance by both the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA).⁴

Tramadol can be misused by chewing, breaking, or crushing extended-release pills.² Taken recreationally, tramadol can cause feelings of euphoria that makes individuals experience elevated moods and relaxation.³ It can also lead to a potentially life-threatening issue called serotonin syndrome.⁵ The risk of developing serotonin syndrome is increased by taking multiple medications or by misusing tramadol.⁵ Some symptoms of serotonin syndrome include agitation, confusion, abnormal eye movements, fever, diarrhea, muscle spasms, shivering, and tremor.⁵

According to the National Survey on Drug Use and Health, 8.5 million Americans ages 12 and older misused prescription pain relievers in 2022.⁷ In the same year, of those who misused prescription pain relievers, 16.6 percent misused tramadol.⁷ Overall, 6.1 million people were diagnosed with an opioid use disorder and among drug overdose deaths in the U.S., more than 75% of them involved opioids. ^7,8

For those struggling to not drink while taking tramadol, it may be time to seek professional help to quit use. Alcohol.org is a subsidiary of American Addiction Centers, which specializes in the treatment of alcoholism and other substance use disorders. Consider reaching out to our 24/7 helpline to discuss your situation with a compassionate admissions navigator who can help provide treatment information and help you determine your next steps.

What Are the Dangers of Mixing Tramadol and Alcohol?

Tramadol and alcohol can be dangerous when used in combination because both substances depress the central nervous system. Combining them could intensify the sedative and respiratory depressing effects of both, which could lead to unconsciousness, coma, respiratory arrest, overdose, or death.⁹

When opioids are combined with alcohol and other central nervous system depressants, it can lead to life-threatening respiratory depression, causing severe oxygen deprivation and long-term brain damage.¹⁰ This can quickly result in coma or become fatal.¹⁰

Taking too much tramadol can also produce an overdose when combined with other substances such as alcohol, and requires immediate medical attention.² Warning signs of a potentially fatal tramadol overdose include:^1,2

• Increased heart rate.
• Cold, sweaty skin.
• Excessive sleepiness.
• Loss of muscle control.
• Pinpoint pupils.
• Trouble breathing.

Dependence & Addiction

Addiction develops as a person loses control over many, if not all, aspects of their lives despite knowing the negative consequences of their drug or alcohol use.¹¹ According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must meet at least 2 of the following criteria within a 12-month period to receive a diagnosis of an opioid and/or alcohol use disorder (AUD): ¹²

• Cravings or strong urges to use.
• Developing a tolerance where larger amounts, or more frequent doses, are needed to achieve prior effects.
• Experiencing withdrawal symptoms when trying to quit.
• An inability to quit or cut back on use.
• Drinking alcohol or taking higher amounts of opioids more frequently than originally intended.
• Spending a significant amount of time obtaining, using, and recovering from the effect of opioids or alcohol.
• Having a psychological or physical problem that is likely the result of use but continuing to use regardless.
• Continuing use despite recurring or persistent interpersonal or social problems due to use.
• Using alcohol or drugs in situations where it is physically dangerous to do so (e.g., driving).
• No longer fulfilling obligations at work, home, or school due to use.
• Stopping recreational, social, or work activities because of use.

Is it Safe to Quit Tramadol & Alcohol Cold Turkey?

It can be dangerous to abruptly stop using opioids and alcohol without the supervision of a medical professional.¹³ Withdrawal from opioids is associated with vomiting and diarrhea, which can cause dehydration and electrolyte disturbances.^14,15 Though opioid withdrawal symptoms may be severely unpleasant on their own, people who are also alcohol-dependent may experience a risky alcohol withdrawal syndrome when trying to quit cold turkey.

When detoxing from alcohol, withdrawal symptoms may include anxiety, agitation, increased heart rate and blood pressure, vomiting, high body temperatures, hallucinations, and seizures.^13,14 A combined alcohol and opioid dependence can increase the likelihood of an additionally severe or complicated withdrawal.

A medical detox allows individuals to go through the withdrawal process that is monitored and treated by medical professionals.¹⁴ Medications may be provided to manage symptoms of withdrawal while reducing the risk of experiencing life-threatening complications.^13,14

How Are Comorbid SUD & AUDs Treated?

When a person has both an AUD and an opioid use disorder, they have comorbid substance use disorders or polysubstance addiction. Effective treatment should offer more than just substance withdrawal management in order to best address a person’s recovery needs, including  psychological, social, physical, vocational, and/or legal concerns.¹⁴

The first step in addiction treatment is typically medical detox to minimize withdrawal symptoms and avoid potential health complications.¹⁴ Upon completion of detox, attending inpatient or outpatient treatment can help address thoughts and behaviors associated with addiction or substance use and provide new coping skills to assist in staying sober.¹⁶

Behavioral therapies are also an important part of addiction treatment and may be administered in individual, family and group settings.¹⁶ Medication may be used to reduce cravings for opioids and alcohol and lower the likelihood of relapse.^{15, 16} Combining therapy with medication can be more effective than either method individually.¹⁷ Treatment facilities can also often manage other issues that may occur with addiction, such as health problems, mental health disorders, and legal troubles.¹⁶

Are You Ready To Get Help?

If you suspect that you or someone you care about has an opioid and/or alcohol addiction, it may be time to seek professional help. Alcohol.org is a subsidiary of American Addiction Centers (AAC) which offers a nationwide portfolio of treatment facilities is committed to making recovery accessible to everyone in need.

AAC offers multiple levels of care as well as a combination of proven therapies and services to meet your individual needs. Depending on your insurance coverage and the type of program, the cost of a treatment program can vary. Find out if your insurance covers treatment at an AAC facility by calling our 24/7 helpline at .