Tramadol and Alcohol

Tramadol and Alcohol

The practicality of prescribing strong painkillers such as morphine and codeine is limited by their significant risk of addiction in chronic users. Therefore, for long-term pain relief, clinicians often advise tramadol, as it has a partial opioid action with little dependence potential. However, there is considerable concern for those who consume alcohol regularly and are, at the same time, prescribed tramadol by physicians for pain relief and/or other ailments.

(Opioids are strong painkillers that are given during or after surgery to relieve pain and induce a much needed "calming effect" in the brain by changing the biochemical environment.)

What happens if tramadol is consumed with alcohol?

Tramadol exerts its action directly by interacting with the brain biochemical environment. Since alcohol and alcohol metabolic products are also released in the circulation acting as CNS (Central Nervous system or brain) depressant, concurrent consumption of alcohol and tramadol may lead to deleterious side effects. There could be an abnormal slowing of CNS (Central Nervous system or brain) activity with symptoms as trivial as drowsiness to as severe as depression of brain activity, coma, pinpoint pupils, and ultimately death.

Moderate alcohol consumption with tramadol may produce the following symptoms:

Mary G. Ripple [2] published a case study in which an alcoholic man developed fatal seizure activity while on tramadol for the management of chronic musculoskeletal issues. Chronic alcoholics have altered systemic functioning of kidney and liver that affects the metabolism and excretion of tramadol. This results in higher drug concentration within the body, leading to toxicity and seizure activity.

How can you avoid serious alcohol and tramadol interactions?

Alcohol and tramadol can be a toxic combination. The following recommendations are made to minimize risks:

Who is at risk of reaction with alcohol and tramadol co-consumption?

Any individual who consumes alcohol and tramadol simultaneously is at risk of impending toxicity and systemic damage, but more so individuals who:

In case of any undesired symptom after acute or chronic intake of tramadol and/or alcohol, seek emergency medical treatment immediately.


  1. Jovanovic-Cupic, V., Martinovic, Z., & NeŇ°ic, N. (2006). Seizures associated with intoxication and abuse of tramadol. Clinical Toxicology, 44(2), 143-146.
  2. Ripple, M. G., Pestaner, J. P., Levine, B. S., & Smialek, J. E. (2000). Lethal combination of tramadol and multiple drugs affecting serotonin. The American Journal of Forensic Medicine and Pathology, 21(4), 370.
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