What are the contraindications for Tramadol (Ultram)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 20, 2025 • View editorial policy

From the Guidelines

Tramadol is contraindicated in patients with a history of seizures, and its use should be avoided in patients with severe liver or kidney impairment, as well as those taking monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs) due to the risk of serotonin syndrome 1.

Key Contraindications

  • Seizure disorders: Tramadol may reduce the seizure threshold, making it contraindicated in patients with a history of seizures 1.
  • Severe liver or kidney impairment: Tramadol should be used with caution in patients with hepatic or renal dysfunction, as it may accumulate and increase the risk of adverse effects 2, 3.
  • Monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs): Tramadol should be avoided in patients taking MAOIs or SSRIs due to the risk of serotonin syndrome 2, 3.
  • Pregnancy, breastfeeding, and children under 12 years old: Tramadol is contraindicated in these populations due to the potential risks of respiratory depression, seizures, and other adverse effects 4.

Additional Considerations

  • Elderly patients: Tramadol should be used with caution in elderly patients, as they may be more prone to adverse effects such as confusion and respiratory depression 1.
  • Substance abuse: Tramadol should be used with caution in patients with a history of substance abuse, as it may have a higher potential for abuse and dependence 5.
  • CYP2D6 enzyme variations: Patients with CYP2D6 enzyme variations may experience reduced efficacy or increased side effects due to altered metabolism of tramadol 5.

From the FDA Drug Label

Tramadol hydrochloride tablets, USP should not be administered to patients who have previously demonstrated hypersensitivity to tramadol, any other component of this product or opioids. Tramadol hydrochloride tablets, USP are contraindicated in any situation where opioids are contraindicated, including acute intoxication with any of the following: alcohol, hypnotics, narcotics, centrally acting analgesics, opioids or psychotropic drugs. Patients with a history of anaphylactoid reactions to codeine and other opioids may be at increased risk and therefore should not receive tramadol hydrochloride

Tramadol Contraindications:

  • Hypersensitivity to tramadol or any other component of the product
  • Opioid contraindications, including acute intoxication with: + Alcohol + Hypnotics + Narcotics + Centrally acting analgesics + Opioids + Psychotropic drugs
  • History of anaphylactoid reactions to codeine and other opioids 6

From the Research

Tramadol Contraindications

Tramadol has several contraindications due to its potential for serious adverse effects. Some of the key contraindications include:

  • Respiratory depression: Tramadol can cause respiratory depression, especially in pediatric patients, drug abusers, or during concomitant use of opioids, benzodiazepines, or antidepressants 7.
  • Serotonin syndrome: Tramadol can increase the risk of serotonin syndrome, especially when administered with other serotonergic medications 8, 9.
  • Seizures: Tramadol can cause seizures, particularly in individuals with medical comorbidities, using supratherapeutic doses, or concomitantly administering proconvulsant serotonergic cytochrome P-450 inhibitors 9.
  • Concomitant use of CYP2D6 inhibitors: The use of CYP2D6 inhibitors with tramadol can increase the risk of adverse effects, including respiratory depression 7.
  • Opioid abuse: Tramadol can be abused, and its use should be carefully monitored in individuals with a history of substance abuse 7, 10.
  • Hypersensitivity: Tramadol can cause hypersensitivity reactions, including anaphylaxis and urticaria, although these are uncommon 8.

Special Populations

Tramadol should be used with caution in certain populations, including:

  • Pediatric patients: Tramadol can cause respiratory depression in pediatric patients, and its use should be carefully monitored 7.
  • Elderly patients: Tramadol can cause adverse effects, including respiratory depression, in elderly patients, and its use should be carefully monitored 7.
  • Patients with medical comorbidities: Tramadol can increase the risk of adverse effects in patients with medical comorbidities, including respiratory depression and serotonin syndrome 7, 8, 9.

References

2
Guideline

adult cancer pain.

Journal of the National Comprehensive Cancer Network : JNCCN, 2013

3
Guideline

adult cancer pain, version 3.2019, nccn clinical practice guidelines in oncology.

Journal of the National Comprehensive Cancer Network : JNCCN, 2019

9
Research

Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures.

The American journal of medicine, 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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