Many people think of tramadol (ConZip, Qdolo) as a safer choice for pain control. After all, it’s not as potent as other opioid pain medications, like morphine. It also has dual activity. Although it’s technically an opioid, it also has effects on chemicals called norepinephrine and serotonin. This helps treat pain in multiple ways.
Tramadol also has a lower potential for misuse than other opioid pain medications, so it might be tempting to use it longer than necessary to ensure your pain is well controlled. But long-term use and high doses can still lead to unwanted side effects.
One of these side effects includes possible liver harm. So, is tramadol bad for your liver? Not necessarily. But there are specific scenarios where the risk is more likely.
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Is tramadol bad for your liver?
Tramadol doesn’t usually cause liver issues when it’s taken at normal doses. But higher doses, no matter if they’re taken intentionally or by mistake, can increase the risk.
There are also other situations where your body may have trouble breaking down (metabolizing) tramadol, which could lead to higher-than-expected levels of tramadol in your body.
Liver problems
Pre-existing liver conditions are one concern for safe tramadol use. If you have a liver condition, such as cirrhosis, hepatitis, or fatty liver disease, it may be harder for your body to break down tramadol. This can lead to lingering medication in your body, which isn’t ideal.
Before you start taking tramadol, your healthcare provider will likely do a blood test to look at how well your liver is functioning. If it isn’t functioning at full capacity, you may need to take a lower tramadol dose. Your healthcare provider may also decide to give you a different pain medication altogether.
Interactions
Drug interactions are another concern. Your liver makes many enzymes (proteins) that help your body break down medications. Your body relies on several of these enzymes to disassemble tramadol.
However, some medications can mess with these enzymes and make them work faster or slower. These interactions could change tramadol levels in your body, which impacts its tolerability and effectiveness. Examples of interacting medications include:
Antidepressants like bupropion (Wellbutrin SR, Wellbutrin XL), fluoxetine (Prozac), and paroxetine (Paxil)
Antibacterial medications like clarithromycin (Biaxin XL)
Antiviral medications like ritonavir (Norvir)
Anti-seizure medications like phenytoin (Dilantin)
It’s always a good idea to have your pharmacist check for interactions with your medications before starting tramadol.
Genetics
Genetic differences may also change how tramadol is broken down. These differences are something you are born with — they make tramadol-metabolizing enzymes work faster or slower than normal. Genetic variations to an enzyme called “CYP2D6” are associated with an increased risk of liver harm when taking tramadol.
It’s not required to get genetic testing prior to taking tramadol. But if you know you have a relevant genetic variation, you shouldn’t take it.
Is tramadol bad for your kidneys?
Tramadol doesn’t cause direct damage to the kidneys. But your kidneys are partially in charge of making the medication leave your body in a timely manner. If your kidneys aren’t fully functioning, that can lead to higher levels of tramadol in your body.
If you have any pre-existing kidney problems, your healthcare provider may have you take tramadol at lower doses or less frequently. This will help make sure tramadol levels don’t build up and cause extra side effects.
How much tramadol is safe to take?
A safe dose of tramadol depends on the person. It also hinges on the form of tramadol your healthcare provider prescribes for you. Tramadol comes in the following forms:
Immediate release (IR) oral tablet
IR oral solution (Qdolo)
Extended release (ER) oral tablet
ER oral capsule (ConZip)
A typical starting dose for tramadol IR is 25 mg to 50 mg every 4 to 6 hours as needed. The dose can be increased over time to 100 mg every 4 to 6 hours as needed. You shouldn’t take more than 400 mg in a 24-hour period.
Tramadol ER is typically started at 100 mg once daily and slowly increased as needed to a maximum dose of 300 mg daily.
Is it OK to take tramadol every day?
Yes. It’s OK to take tramadol every day during the time period you’re expected to have pain (such as after a surgery or injury). But this time frame is different for everyone.
If your pain is expected to be short-lived, you may be prescribed tramadol IR. This formulation is only intended to be used as needed, so if you’re not experiencing pain, there is no need to take it.
Some people have chronic pain that isn’t expected to go away any time soon. Tramadol ER is an option for people who need pain control around-the-clock for an extended period of time. In this case, taking tramadol every day for a longer period of time may be appropriate.
In general, it’s important that you take the lowest effective dose for the shortest time possible. At a certain point, increasing the dose is more likely to cause side effects and less likely to be beneficial for pain. Long-term use can also make your body used to tramadol. If you’ve been taking tramadol regularly (longer than a month), your healthcare team may need to slowly lower your dose over time to prevent withdrawal symptoms.
Is Ultracet (tramadol / acetaminophen) worse for the liver than tramadol?
Ultracet is a combination of two medications: tramadol and acetaminophen. It’s not any worse for your liver than tramadol by itself.
Acetaminophen (Tylenol) is known to cause liver issues, but typically only at high doses. The normal dosages found in Ultracet don’t further increase the risk for liver damage.
Ultracet is, however, more likely to contribute to liver problems in these situations:
You take more than the maximum dosage of either active ingredient. If you’re prescribed Ultracet, the maximum recommended daily dose is 300 mg of tramadol and 2,600 mg of acetaminophen. Try not to take Ultracet in addition to other products that contain acetaminophen, such as over-the-counter cold and flu products.
You drink alcohol with Ultracet. Using alcohol with Ultracet increases the risk of liver harm. It can also worsen the risk of drowsiness and breathing problems.
You have pre-existing liver problems. It’s difficult for your body to break down two medications that are hard on the liver. Alternate pain medications or lower doses of stand-alone tramadol are still an option.
How does tramadol compare to other opioids?
Tramadol isn’t as strong as many other opioids. Medications like hydrocodone (Hysingla), oxycodone (Roxicodone), and morphine (MS Contin) are all more potent. Tramadol doesn’t attach as strongly to pain receptors (chemical binding sites), so more tramadol is needed to provide the same level of pain relief. For example, morphine is about 10 times stronger than tramadol.
Along the same lines, tramadol has a lower likelihood of dependence and misuse compared to other common opioids. It’s in a lower risk category.
Schedule | Abuse potential | Dependence potential | Medication examples |
|---|---|---|---|
Schedule 2 | High | Severe | Hydrocodone, oxycodone, morphine |
Schedule 3 | Less than schedule 2 | Moderate to low physical dependence or high psychological dependence | Acetaminophen/codeine (Tylenol with Codeine, Tylenol #3), buprenorphine (Subutex) |
Schedule 4 | Less than schedule 3 | Less than schedule 3 | Tramadol |
Schedule 5 | Less than schedule 4 | Less than schedule 4 | Codeine-containing cough medications, such as codeine/promethazine (Phenergan with Codeine) |
On the other hand, tramadol has some risks that other opioids don’t have. The two biggest concerns are serotonin syndrome (too much serotonin) and seizures.
This is because of the unique way tramadol works. Tramadol attaches to opioid pain receptors and boosts serotonin and norepinephrine levels in your brain and spinal cord. Increased amounts of these chemicals are thought to decrease how much pain you feel. They can also contribute to these extra side effects.
So, is tramadol bad for you?
Not usually. Tramadol isn’t known to cause liver or kidney damage at normal doses. High doses and long-term use can cause problems, though. And tramadol might not be the best choice if you have pre-existing liver or kidney problems, take medications that interact with tramadol, or were born with genetic changes that affect how tramadol is broken down.
The bottom line
Tramadol is an opioid pain medication. It doesn’t cause damage to the liver or kidneys at normal doses. But high doses, long-term use, and drug interactions can increase the risk. And if you already have liver or kidney issues, your risk of side effects goes up. It’s important to talk to your healthcare provider to determine if tramadol is right for you.
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References
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