Can Pain Med Tramadol Cause Low Blood Sugar?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
Posted on

Tramadol (Ultram) is prescribed for pain more than ever, with new recommendations to limit the use of opioid analgesics. Tramadol is a non-opioid that works on the opiate receptors. Unlike other opioids (like hydrocodone and codeine), tramadol doesn’t affect your breathing or heart. It’s a good option for trying to avoid opioids if NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen) aren’t recommended for you.

Why use tramadol instead of an opioid like hydrocodone?
Tramadol works well for pain and is safe—because respiratory depression, cardiovascular side effects, drug abuse and dependence are minor, unlike with opioids.

However, with increasing use of tramadol have come reports of low blood sugar (hypoglycemia) as a side effect. It can be a problem even in people who don’t have diabetes and aren’t taking other medications to control blood sugar.

So does tramadol cause low blood sugar?

Yes. A recent large study found that tramadol use is associated with an increased risk of hospitalization for hypoglycemia.

That risk is highest around the time you first start taking it—mostly within 10 days of starting. In fact, people taking tramadol had more than three times an increased risk of hospitalization for hypoglycemia. This was true for folks with and without diabetes, and taking tramadol at the recommended doses.

Although it’s rare, occurring in only 7 out of 10,000 people, tramadol-induced hypoglycemia is a potentially fatal adverse event.

Why can tramadol cause low blood sugar?

One of the ways tramadol works is by inhibiting serotonin and norepinephrine reuptake. Serotonin pathways are known to have effects on blood sugar regulation. The activation of µ opioid receptors by tramadol (remember, it isn’t an opioid, but works on the same receptors) may also increase the risk of hypoglycemia.

Good to know.

Dr O.

Drugs featured in this story

Filed under