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Tramadol Overdose

Tramadol can lead to a life-threatening overdose, particularly when combined with other substances of abuse.[1,2]

Struggling with Opioid Addiction? Get Help Now

Opioids cause respiratory depression.[3] In high doses, opioids like tramadol can so severely depress respiration that the body cannot draw in enough air to support the brain’s needs. This can lead to many different problems, including brain damage and death. 

Tramadol overdose is treatable with the drug naloxone.[4] 

Key Facts

Key Facts

  • As an opioid, tramadol abuse can lead to a life-threatening overdose.[1]
  • Opioid overdoses were responsible for more than 80,000 deaths in 2021.[5]
  • Tramadol and other opioids become more dangerous if abused with other substances that can cause respiratory depression, including alcohol.[2]
  • A person overdosing on tramadol should be administered the drug naloxone, which can reverse a deadly overdose.[4]

Can You Overdose on Tramadol?

While tramadol is often considered less dangerous than some other opioids, it is possible to overdose on this drug, particularly if it is combined with other substances.[2] This is one of the factors that makes an addiction to tramadol so dangerous. The more a person misuses these and similar drugs, the more likely they are to accidentally experience a life-threatening overdose. 

How Much Is Needed to Overdose?

Tramadol is typically considered to have a daily maximum dose of 400 mg, and most patients are prescribed a lower dose of the medication.[6] 

An overdose on tramadol alone typically isn’t life-threatening, although it may still be serious enough to warrant medical attention.[2] Of greater concern is polysubstance use involving tramadol, where a person (intentionally or not) mixes tramadol with other types of substance use that may intensify its effects. Alcohol, which is commonly mixed with opioids, can more quickly lead to tramadol overdose.[2]

Respiratory Depression

Typically, the danger of an opioid overdose is from respiratory depression. This refers to the weakening of the body’s ability to draw in air, reducing the body’s ability to supply the brain and other parts of the body with oxygen. 

If respiratory depression becomes too severe, the body can become too weak to draw in enough air to support its needs, even if a person physically focuses on the task of breathing and tries to breathe more heavily than normal. This can result in hypoxia, where the brain no longer gets the oxygen it needs. This can cause a cascade of serious health problems, including brain damage and death.[7]

What Are the Signs of a Tramadol Overdose?

An overdose of tramadol or any other opioid should be viewed as a medical emergency. If you are unsure if someone is overdosing, assume that they are. An overdose on any opioid warrants a call to 911 immediately and the administration of the drug naloxone if available. 

Some common signs a person may be overdosing on tramadol include the following:[1]

  • Cold, clammy skin
  • Decreased pupil size 
  • Difficulty breathing
  • Diarrhea
  • Extreme drowsiness or sleepiness
  • Muscle cramps and weakness
  • Perspiration
  • Slow or shallow breathing
  • Slowed heartbeat
  • Unable to respond or wake up
  • Watery discharge from eyes and nose

Risk Factors for Tramadol Overdose

Tramadol should only be taken as prescribed, and any misuse of the drug is dangerous. Anyone who abuses tramadol is at risk of overdose. However, certain risk factors increase the likelihood of someone experiencing a tramadol overdose. 

Polydrug Use

Again, the biggest risk factor for a life-threatening tramadol overdose is polydrug use.[2] The effects of drugs usually stack if used together. Many people who misuse drugs underestimate this stacking effect and combine drugs in dangerous ways. 

If tramadol use is mixed with the use of other opioids, alcohol, benzodiazepines, or other drugs that cause respiratory depression, it can quickly become dangerous and lead to overdose.

Misuse & Abuse

Used as prescribed, it isn’t very likely that a person will overdose on tramadol unless their doctor makes a mistake or they have some undiagnosed health condition. Even then, a life-threatening overdose is very unlikely. 

Fundamentally, it takes misusing an opioid (including engaging in intentional abuse) for most people to experience the most dangerous types of overdoses. A doctor knows the dangers of opioids and prescribes a level of use that they consider to be safe. If you stick to that level of opioid use, opioids aren’t risk-free, but they’re much safer.


While excessive use of an opioid is dangerous, addiction causes a person to enter into a dangerous cycle of abuse. Because an individual repeatedly engages in misuse when addicted to tramadol, they experience many more opportunities than the average individual to miscalculate their drug use and experience a dangerous overdose.

Respiratory or Metabolism Problems

A body that metabolizes drugs differently than normal or with a weaker respiratory system has a higher chance of experiencing a dangerous overdose when using an opioid.[8] This is because opioids become more dangerous if the body isn’t processing them in the typical way or if their ability to weaken respiration is able to stack with pre-existing weakness caused by other health problems.

What to Do if You Think Someone Is Overdosing on Tramadol

Quick Answer

If you believe someone is overdosing on tramadol, call 911 immediately. Administer naloxone (Narcan) if available to reverse the overdose. Follow the instructions of the emergency operator, and answer all questions as clearly and accurately as possible. Stay with the person until help arrives.

In the event of a tramadol overdose, follow these steps to maximize the chances of saving the person’s life:

  • Call 911 and tell the operator the situation, including your current location.
  • Administer naloxone to the individual if possible.
  • Answer any questions the operator has. If the individual overdosing is conscious, ask what drugs they took and in what doses. Ask if they have any medical conditions.
  • If the individual overdosing has their breathing or heart dangerously slowed or stopped, begin CPR if you know it. If you don’t know CPR, loudly ask if anyone nearby is trained in CPR and alert them to the situation.
  • Stay on the line with the 911 operator, and stay with the person overdosing until emergency responders arrive.

Good Samaritan Laws

Forty states and the District of Columbia have Good Samaritan laws related to opioid overdose.[9] These laws are designed to encourage people to seek help for themselves or others in overdose situations. In these situations, if a victim or witness calls 911, they will have some form of immunity for illegal activities, such as drug use or possession.  

These laws exist to reduce overdose deaths. Without them, there is a risk that a person won’t call when help is needed to avoid legal consequences.

Preventing an Overdose

Opioids are dangerous drugs and should only be used as prescribed. To prevent an overdose, it’s important not to misuse or abuse any type of opioid. 

If you struggle with opioid misuse, you likely qualify as having an opioid use disorder (OUD), often just called opioid addiction. People with OUD need help from a professional addiction treatment service, like what we offer at Boca Recovery Center.

Withdrawal from tramadol can increase a person’s risk of engaging in dangerous levels of tramadol use, as this is when a body often craves opioids most strongly. Prolonged abstinence from opioid use can also decrease tolerance for opioids, making lower doses more dangerous than expected.[10] This is one of several reasons that you should seek help when trying to quit opioids, even if you feel you may not have a particularly severe addiction. 

Get Help for Tramadol Addiction at Boca Recovery Center

As long as you are abusing tramadol, overdose is always a risk. If you combine tramadol with other substances, the risk is even higher. 

At Boca Recovery Center, we can help you stop all opioid abuse, including tramadol. We’ll ensure you are safe and comfortable throughout the tramadol withdrawal process, so your risk of relapse is reduced. And we’ll equip you with the skills you need to manage long-term recovery.

If you struggle with tramadol or other types of opioids, reach out to us. We offer medical detox, inpatient treatment, outpatient care, MAT, and evidence-based therapy. Our team of empathetic and professional addiction treatment experts is ready to help. 

Check out the locations of our addiction treatment facilities in Florida, New Jersey, and Indiana. Whether you live locally or are traveling for treatment, we can get you set up today. Call now.

Updated March 22, 2024
  1. Tramadol. U.S. National Library of Medicine. Published May 2023. Accessed March 11, 2024.
  2. Aliasghar Manouchehri, Zahra Nekoukar, Abdollah Malakian, Zakaria Zakariaei. Tramadol poisoning and its management and complications: A scoping review. Annals of Medicine and Surgery. 2023;85(8):3982-3989.
  3. Bateman JT, Saunders SE, Levitt ES. Understanding and countering opioid‐induced respiratory depression. British Journal of Pharmacology. 2021;180(7):813-828.
  4. Britch SC, Walsh SL. Treatment of opioid overdose: current approaches and recent advances. Psychopharmacology. 2022;239(7):2063-2081.
  5. Opioid data analysis and resources | CDC’s response to the opioid overdose epidemic. Centers for Disease Control and Prevention. Published June 22, 2021. Accessed March 11, 2024.
  6. Tramadol dosage. Accessed March 11, 2024.
  7. Non-Fatal Opioid Overdose and Associated Health Outcomes: Final Summary Report. ASPE, U.S. Government. Published September 3, 2019. Accessed March 11, 2024.
  8. Schiller EY, Mechanic OJ. Opioid overdose. StatPearls. Published 2019. Accessed March 11, 2024.
  9. West B, Varacallo M. Good Samaritan laws. StatPearls. Published May 27, 2019. Accessed March 11, 2024.
  10. Kosten T, George T. The neurobiology of opioid dependence: Implications for treatment. Science & Practice Perspectives. 2002;1(1):13-20.
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