Tramadol Overdose: Signs, Symptoms, and Treatment

Reading Time: 7 minutes

Tramadol is an opioid painkiller prescribed to manage moderate to severe pain, but many people misuse this medication to get high or for additional pain relief. People with a prior history of addiction or substance abuse may face an especially elevated risk of misusing tramadol.1 Whether used as prescribed or misused, individuals who use take tramadol can experience a potentially fatal overdose, although the risk is higher for those who abuse tramadol or have a tramadol addiction.

Signs of Tramadol Overdose

Using too much tramadol can result in an overdose, which occurs when a toxic amount of a drug like tramadol has been used and the body cannot process it. A tramadol overdose is dangerous and even potentially life-threatening. It’s important to know the signs and symptoms of a tramadol overdose so you can seek help for yourself or someone else immediately. Signs of a tramadol overdose include:1,2

  • Slowed heart rate
  • Feeling extremely sleepy or drowsy
  • Inability to wake up from sleep
  • Breathing appears to become shallow or strained
  • Breathing slows or stops altogether
  • Inability to speak
  • Reduced size of pupils
  • Cold skin
  • Damp, sticky, or slimy skin
  • Blue or purple lips or fingernails
  • Weak muscles
  • Body or muscles become limp
  • Vomiting
  • Gurgling sounds

Treat all suspected tramadol overdoses as a medical emergency and seek medical attention immediately.1,2 The faster you can take action or get support during an overdose, the sooner you can counter the potentially life-threatening effects.2

How Does Tramadol Overdose Happen?

An overdose occurs when someone takes a toxic amount of a substance.3 This process can lead to life-threatening consequences. Tramadol overdose can occur when someone takes too much of this opioid medication, whether accidentally or intentionally.1 If you receive a new prescription for a higher dose of tramadol, your doctor will want to monitor how you respond to the increase in medication.

Your doctor will provide specific instructions when prescribing tramadol solution, extended-release tablets, or capsules.1 Taking tablets and capsules exactly as prescribed can help you avoid accidental overuse or overdose. Chewing, licking, breaking, dissolving, or crushing these pills can affect how quickly this medication gets into your system. Make sure you take liquid doses or solution tramadol with proper measurements to avoid overdose.

Tramadol overdose can also occur when people mix this medication with other substances.2 Medications and substances that can lead to life-threatening consequences when mixed with tramadol include:1,2

Misusing or diverting prescription tramadol can also lead to overdose.2 Diverting a medication means that someone takes another person’s legally obtained prescription. When left unsecured, children might gain access to this medication and accidentally take it. If they take too much, this can result in an accidental tramadol overdose.1,2 Keep all medications in your home secure to prevent these accidents from occurring.

People who attempt to misuse tramadol may attempt to divert someone else’s prescription, obtain a prescription illegally, or purchase this medication from an illegal source.2,3 A person who attempts to buy this drug from a non-licensed drug dealer may get a substance that is cut with something else.3 When taking a dose from an illegal source, people risk-taking more than they intended. They may also take a potentially life-threatening combination of substances without knowing it.

Tramadol Overdose Risk Factors

Certain personal factors can influence a person’s risk of tramadol overdose. These factors include:1,2

  • Medical history
  • Sensitivity to opioid medications
  • Current use of other prescriptions or supplements
  • Advanced age
  • History of substance abuse

People who have a history of kidney or liver problems may face a higher risk of overdose on tramadol or other opioid medications.2 A history of breathing problems or respiratory illness, such as sleep apnea, may also lead to a greater risk of tramadol overdose. Children with certain illnesses and the elderly also need special considerations to prevent severe tramadol side effects or overdose when using this medication.1

Other health concerns you should mention to your doctor before starting a prescription for tramadol include:1,2

  • Chronic obstructive pulmonary disease (COPD)
  • Brain problems or injuries
  • History of head injury
  • Asthma
  • Malnourishment associated with illness

A personal or family history of substance abuse, addiction, or substance use disorder (SUD) can increase one’s risk of experiencing tramadol overdose.1 Your doctor will want to know if you or a family member has ever used illicit drugs, diverted medication, or overuse alcohol. Other signs of SUD include:4

  • Cravings or an urge to use mind-altering substances
  • Becoming tolerant to the effects of tramadol
  • Developing symptoms of withdrawal when not using substances (dependence)
  • Using drugs despite the health risks
  • Using drugs longer, or in greater doses, than originally intended
  • Using drugs despite the knowledge that use interferes with life

You may experience symptoms of tolerance, withdrawal, or cravings when using this tramadol as prescribed; these signs don’t necessarily indicate a tramadol addiction, which is characterized by a pattern of compulsive use. Talk with your doctor about supportive care if you develop a tolerance or dependence during the course of pain treatment.

How to Treat a Tramadol Overdose

Treat suspected overdose as an emergency and seek medical attention right away by calling 911.2

If someone overdoses, you will want to help them stay awake and make sure they can breathe.2 Help this person avoid suffocating or choking on vomit by turning them on their side. Call for emergency medical support and stay with a person who you suspect has begun to overdose.

Naloxone for Opioid Overdose

Naloxone can serve as an antidote to opioid overdose.1 This medication works by countering some of the potentially life-threatening tramadol overdose symptoms, such as respiratory depression. Available in nasal sprays or injectable doses, you don’t need to be a professional to administer naloxone and save a life.5

The effects of naloxone may only last for a short time.5 You may need to administer this medication again after a few minutes if tramadol overdose and breathing problems persist.1 If possible, continue to administer this medication until medical personnel arrives.

Your doctor can prescribe this medication if you or someone else in your home has an elevated risk of overdose.1 Some states allow pharmacists to offer this medication without a prescription.5 Some local programs or health groups may offer this medication for free.

Sometimes, naloxone can trigger opioid withdrawal symptoms that may cause pain or discomfort.5 A doctor and medical staff can treat withdrawal symptoms while helping you or your loved one manage the symptoms of tramadol overdose. Carry this medication with you and teach your loved ones how to use it so they can know how to respond to a potential overdose.

Withdrawal Management: Detox After Overdose

Symptoms of tramadol withdrawal can develop when a person who was dependent on tramadol suddenly stops using it.1 This is because the brain and body became accustomed to the presence of the opioid and cannot function optimally without it.

Symptoms of tramadol withdrawal may include:1

  • Panic
  • Anxiety
  • Sweating
  • Nose running
  • Difficulty sleeping
  • Pain
  • Goosebumps
  • Coughing
  • Sneezing
  • Nausea
  • Shaking
  • Diarrhea
  • In rare cases, hallucinations

This period of withdrawal after quitting tramadol can raise your risk of overdose.3 This is because a person’s tolerance to opioids may lower after they quit. So, if they return to using the same amount of tramadol they’d previously been using, they could possibly experience an overdose.

Withdrawal management or detoxification services can help you remove tramadol from your system safely.6 After managing the emergency from an overdose, a doctor or medical treatment team can help you through this process. Tramadol withdrawal management can occur in a hospital, outpatient, or residential treatment setting, depending on your symptoms and health needs.

After you complete this process, your withdrawal management team can help you connect with a supportive recovery program for tramadol addiction.6

Transitioning to Long-Term Tramadol Addiction Treatment

Tramadol use recovery does not start or stop at emergency tramadol overdose treatment and withdrawal management.6 Outpatient or inpatient tramadol rehab begins when you have recovered from withdrawal effects and begin looking at the challenges that lead to addiction, relapse, and potential overdose.

Qualified medical and substance use treatment professionals can help you get started with a recovery plan.6 Together, you and your treatment team can confront concerns related to tramadol misuse and addiction. Treatment professionals can use evidence-based techniques to help you achieve wellness and long-term sobriety.

Some of the different interventions that you may encounter in tramadol abuse recovery include:6

  • Professional counseling
  • Medication management, or medication-assisted treatment
  • Group therapy
  • Holistic treatment practices
  • Case management services
  • Peer and mutual support groups
  • Case management services

If you have concerns about misusing tramadol and want to avoid overdose, getting matched to the right program can help you achieve your goals and preserve your health. Call 800-681-1058 (Info iconWho Answers?) today to discuss your choices for recovery with a treatment specialist.


  1. U.S. National Library of Medicine. (2020, November 15). Tramadol. MedlinePlus.
  2. U.S. National Library of Medicine. (2020, December 12). Opioid overdose. MedlinePlus.
  3. Hoey, N.M. (2019). Overdose. Salem Press Encyclopedia of Health. Salem Press.
  4. American Psychiatric Association. (2013). Substance-related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).
  5. National Institute on Drug Abuse. (2021). Naloxone DrugFacts.
  6. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals. The Guilford Press.
Ruben Bermea, LPC
Licensed Professional Counselor, Author
Ruben Bermea, LPC, is a Licensed Professional Counselor who has had the privilege of serving Texans as they navigate personal and mental health challenges. Ruben has provided therapy to clients in inpatient, residential, private practice, and community mental health settings. His personal and professional interests include the intersection between technology and mental health, the impact of misinf