Tramadol and Alcohol: Interactions and Risk

Pain from a recent surgery or injury can be a burden. For relief, we may be prescribed an opioid such as Tramadol. As we start to recover, we might be tempted to start our normal routines and activities. That Friday night happy hour with coworkers sounds like the perfect way to unwind after a long week! But wait … what about that Tramadol? What happens if we have just one drink? Is it safe? 

In this blog, we will learn that it is not safe to drink alcohol while taking Tramadol. Keep reading to learn the science behind the dangers of mixing alcohol and Tramadol. Learn some tips for cutting back on both substances and when it is safe to drink alcohol after we stop taking Tramadol.

What Is Tramadol? 

Tramadol is a prescription medication used to relieve moderate to severe pain. It is in the class of medications called opioids, which are derived from or mimic the opium poppy plant. Opioids are prescribed by physicians for pain management but are known for being highly addictive. Tramadol is a synthetic opioid and has a lower level of opioid content than other opioids such as morphine, oxycodone, or fentanyl, so it is thought to have lower addiction potential than others. Taking Tramadol outside of the prescription parameters is illegal and has dangerous consequences! 

How Tramadol Works

Tramadol is a depressant drug, meaning it slows down the central nervous system by acting on opioid receptors and neurotransmitters in our brains. Our brains have an endogenous (built-in) opioid-production system that helps us cope with stress and pain while increasing feelings of pleasure, relaxation, and contentment.

Endogenous opioids also control our breathing, coughing, and that warm, relaxed, satisfied feeling following exercise. When we take Tramadol, it partially binds to our opioid receptors, which then release endorphins (euphoria hormones) that reduce the sensation of pain. 

Tramadol vs. Other Opioids

Tramadol is not one of the strongest opioids, because it doesn’t bind as strongly to opioid receptors. However, Tramadol affects other neurotransmitters in our brain. Neurotransmitters are chemicals in the brain that are responsible for communication between the cells (neurons). 

Tramadol impacts the neurotransmitters norepinephrine and serotonin. Norepinephrine is known as the body's “fight-or-flight” chemical and is responsible for the regulation of arousal, attention, cognitive function, and stress reaction. That rapid increase in heart rate after hearing a loud noise comes from norepinephrine. Serotonin is referred to as the “happy” chemical because it regulates feelings of satisfaction, happiness, and optimism.

Tramadol increases the release of serotonin and blocks the reabsorption of serotonin and norepinephrine to neurons. By blocking reabsorption of excess serotonin and norepinephrine, there are more feel-good chemicals to act on nearby neurons and change our thoughts or behavior and reduce our pain.

Side Effects of Tramadol

Tramadol is effective at reducing moderate to severe pain, but it does come at a cost. Let’s review some common side effects associated with Tramadol.

• Dizziness
• Headaches
• Sleepiness, tired, “spaced out”
• Nausea, vomiting, heartburn
• Constipation
• Dry mouth
• Sweating 
• Low energy

Serious (and less common) side effects include the following:

• Extreme dizziness
• Hallucinations
• Confusion
• Extreme fatigue 

There is a risk for overdose with Tramadol if we do not follow the medically prescribed doses. If you notice any of the following signs of overdose, immediately seek emergency medical care! 

• Loss or change of consciousness 
• Lack of awareness or unresponsive 
• Difficulty breathing 
• Lack of muscle tone
• Lightheadedness
• Pinpointed pupils 
• Severe sleepiness or drowsiness
• Slow or irregular heart rate 

Tramadol misuse can be dangerous to our health. If we take Tramadol as prescribed, we might only experience minor side effects. Before we decide to have a drink while we are on Tramadol, let’s figure out how alcohol and Tramadol might interact.

Is It Dangerous To Mix Tramadol and Alcohol? 

You should never drink alcohol while on Tramadol or other opioids! It doesn’t matter if it's beer, wine, or your favorite spirit — even a low amount of alcohol can have life-threatening consequences! Let’s go through some of the dangers of having alcohol and Tramadol.

• Increased chance of overdose. Tramadol and alcohol slow our brains down, which can impact key functions such as breathing and heart rate. If the effects are severe enough, the combination can result in unconsciousness or death. 
• Enhanced side effects. Drinking alcohol while on Tramadol can intensify the reaction to both substances. The mix can lead to atypical reactions such as nausea, vomiting, confusion, disorientation, dizziness, blurred vision, increased blood pressure, insomnia, coma, or seizures. 
• Increased risk of accidents or injury. The intense lack of alertness, coordination, or impaired judgment can lead to risky decision-making that can result in injury to ourselves or others. 
• Damage to the liver. Alcohol and Tramadol are both metabolized in the liver. Both substances can cause extra strain on the liver and lead to liver-related diseases. When paired, the liver has to work overtime, amplifying the stress. 

Drinking alcohol while on Tramadol is not advised! It can lead to severe consequences such as injury or death!

Treating Comorbid Substance Use Disorders

Treatment for polysubstance drug dependence (misusing more than one drug at once) must focus on treating both substances at once to have the best success. It’s not easy quitting multiple substances at once, but thankfully there are ways to make quitting alcohol and Tramadol more manageable.

• Detox. The first step to quitting both substances is ridding them from the body through a detoxification process. During this time, the body will go through withdrawal symptoms for both substances. Detoxing at a hospital or medical facility is the safest option due to the risks associated with withdrawal. 
• Therapy. Talk therapy or counseling can help along the way to sobriety. There are many options for therapy such as cognitive behavioral, art, or psychotherapy. Finding one that is best for you can help with the road to recovery. 
• Support groups. Support groups can be a great resource — they offer validation and encouragement during the recovery process. A supportive community is a pivotal factor in successful recovery.

Abruptly stopping Tramadol and alcohol can be dangerous! Quitting alcohol cold turkey can result in life-threatening withdrawal symptoms such as seizures or delirium tremens. Seek advice from medical professionals before attempting to quit Tramadol and alcohol use. 

Other Medications To Avoid Mixing With Tramadol 

There are many other medications that are unsafe to mix with Tramadol. In general, sedatives or medications that slow the brain, medications that raise serotonin levels, or other opioids should be avoided while taking Tramadol. Let’s review some other substances that you should not mix with Tramadol. 

• Antidepressants (e.g., bupropion (Wellbutrin), fluoxetine (Prozac), or paroxetine (Paxil))
• Benzodiazepines (e.g., Xanax, Valium, or Klonopin)
• Sleep medications (e.g., Ambien, Edlura, ZolpiMist)
• Barbiturates (e.g., phenobarbital, secobarbital)
• Muscle relaxants (tizanidine, methocarbamol, diazepam (Valium))
• Diphenhydramine (Benadryl)
• Other opioids (oxycodone, hydrocodone, morphine, codeine)

Always consult your physician and a pharmacist before adding any medications to your regimen.

How To Wait Before Drinking After Tramadol 

We learned that drinking alcohol while taking Tramadol can be extremely dangerous, but you may be wondering, “How long after taking Tramadol can I drink alcohol?”

Tramadol has a half-life of six to eight hours. A half-life is the amount of time our bodies take to reduce the amount of drug by one half. It takes the body about four or five half-lives to fully get rid of Tramadol. It’s safest to wait 30-40 hours after our last dose of Tramadol before we start drinking. That’s about a day and a half.

Key Takeaways

Tramadol is an opioid medication used to treat pain. Alcohol and Tramadol are both depressants and when taken together, they can intensify one another’s side effects. We should not drink alcohol while on Tramadol because it can lead to serious side effects and increase our chances of overdose. Trying to quit both substances at once can be dangerous and it’s advised to seek medical attention while detoxing.