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Dangers of Mixing Tramadol and Alcohol

Authored by Granite Recovery Centers    Reviewed by James Gamache    Last Updated: August 27th, 2021

James Gamache Medical Reviewer
Jim is a Licensed Clinical Social Worker (LICSW) and Licensed Masters Level Addictions Counselor (MLADC). He has been working in the field of mental health/addiction treatment since 1995. Jim earned a Bachelor’s Degree in Human Services from Springfield College in 2000, and a Masters Degree in Social Work from Boston University in 2002. In 2002 Jim was hired by the Mental Health Center of Greater Manchester holding the position of Clinical Case Manager. From 2004-2019, Jim was employed at WestBridge Inc. During his time at WestBridge, Jim held the following positions; Clinician, Team Leader, Director, & Chief Operations Officer. In 2019 Jim transitioned employment to GateHouse Treatment Center as the Clinical Director for 10 months. In October of 2020 Jim transitioned to Granite Recovery Centers and is currently serving as the Senior VP of Clinical Services and Quality Assurance.

Tramadol is a synthetic opioid that physicians prescribe for patients experiencing moderate to moderately severe pain. This drug has played a role in the U.S. opioid epidemic.

The Opioid Crisis in America

Physicians began to prescribe opioids for their patients on a much more frequent basis in the 1990s, and this led to an increase in deaths due to semi-synthetic opioids and natural opioids. These deaths began to increase in about 1999. Examples of semi-synthetic opioids include oxymorphone, hydromorphone, hydrocodone, and oxycodone. Natural opioids include codeine and morphine.

Approximately 10 years later, opioid overdose deaths began to increase again, but this time, they were mainly attributed to heroin.

Beginning in 2013, the third outbreak started with synthetic opioids as the main culprit. This wave mainly contained opioids that were created in drug laboratories for sale on the street. Fentanyl, which was created in this way, was the main type of opioid being ingested at this time. Illicitly made fentanyl is being paired with cocaine, counterfeit pills, and heroin on an increasing basis.

Death rates involving synthetic opioids other than methadone increased by 15% over the past 10 years. Deaths involving all opioids also increased by more than 6%. Since 1999, overdose deaths have quadrupled.

Tramadol Enters the Market

Tramadol is another synthetic opioid that the FDA approved for marketing in 1995. Physicians could prescribe tramadol for their patients for the treatment of moderate to moderately severe pain. Not long after, it became clear that some people were abusing this substance. Tramadol is now classified under Schedule IV of the Schedule for Controlled Substances Act.

Drugs under Schedule IV have a low potential for being abused compared to benzphetamine and ketamine, but tramadol is still considered a controlled substance.

How Does Tramadol Work?

Tramadol is an opioid agonist. An agonist is a substance that activates receptors in the brain. If a substance is a full agonist, it activates the brain’s receptors so that they result in the full opioid effect. Besides tramadol, full agonists include opium, morphine, hydrocodone, methadone, oxycodone, and heroin.

When a person ingests tramadol, his or her brain will begin to sense the pain in a different manner. For example, endorphins bind to the brain’s receptors, and tramadol is something like these endorphins. After the endorphins bind to the receptors, the receptors reduce the number of pain messages that they send throughout the body. This is similar to the way that tramadol works in the brain as it sends a reduced number of pain signals to the body.

Endogenous opioid neurotransmitters include endorphins and enkephalins, and they work to help people cope with pain, stress, and exertion. Tramadol may also increase the amount of serotonin and norepinephrine. Serotonin’s job is to stabilize your moods, and a person with too much norepinephrine may experience anxiety.

Drugs That Suppress the Central Nervous System

Tramadol is a drug that suppresses the central nervous system. Drugs such as these slow down the brain’s activity so that the person can feel more relaxed. Other opioid drugs also exist under this classification, and they reduce the neurons’ abilities to fire.

Although tramadol was initially seen as the answer to the opioid crisis, it turned out to be addictive as well. Even so, tramadol is considered to be a safer drug than heroin and similarly strong opioids.

Opioid Prescription Rates

Although prescriptions for opioids have gone down over the years, they remain very high. The number of opioid prescriptions in 2015 is actually three times higher than the number of opioid prescriptions from 1999. Unfortunately, many of the people receiving opioid prescriptions and experiencing a substance use disorder are also consuming alcohol, which can have negative effects.


More people were abusing alcohol than any other substance in the United States in 2019. Approximately 14.5 million people reported that they had an alcohol use disorder. The numbers can be broken down into 5.5 million women and 9 million men with alcohol use disorder.

Adults aren’t the only ones experiencing troubles with alcohol. Approximately 414,000 kids from age 12 to age 17 also reported having an alcohol use disorder in 2019. Females outnumber the males in this demographic with 163,000 boys and 251,000 girls stating that they have an alcohol use disorder.

Like opioids, alcohol also suppresses the central nervous system, but the neurotransmitters that alcohol works on are different. The result may be that the alcohol changes the person’s moods and behavior. It may also result in the loss of self-control. When people drink, they may begin to experience memory issues, and they may have trouble thinking clearly.

What Happens When You Mix Tramadol and Alcohol?

The medical community warns people taking tramadol that they will experience harmful side effects if they consume alcohol with the medication. Tramadol is a safe drug for people to take, but it is never safe to combine it with alcohol.

People should not think they are safe to mix tramadol and alcohol if they only take a low dose of tramadol and a small amount of alcohol. It doesn’t matter how small the doses are because this combination can result in life-threatening effects. Tramadol already causes several side effects, and if a person also drinks alcohol, the likelihood of experiencing those effects increases.

Side effects associated with tramadol include:

  • Dry mouth
  • Heartburn or indigestion
  • Changes in mood
  • Tightness in the muscles
  • Uncontrollable shaking
  • Nervousness
  • Headache
  • Insomnia or waking up throughout the night
  • Sleepiness

The most serious side effects include:

  • Loss of consciousness
  • Changes in one’s heartbeat
  • Decreased sexual desire
  • Irregular menstruation
  • Erectile dysfunction
  • Dizziness, weakness, loss of appetite, vomiting, and nausea
  • Diarrhea, loss of coordination, severe muscle stiffness or twitching, shivering, rapid heartbeat, confusion, sweating, fever, hallucinations, and agitation
  • Hoarseness
  • Swelling in the lower legs, ankles, feet, hands, lips, tongue, throat, face, and eyes
  • Troubles breathing or swallowing
  • Blisters, rash or hives
  • Seizures

These serious side effects require immediate medical attention.

Enhanced Reactions to Both Drugs

Several dangerous things can occur when people mix tramadol and alcohol. Tramadol and alcohol are both central nervous system depressants, so they work together to create these effects. Therefore, if you take these substances together, the effects of each one will increase significantly. Some of the symptoms include a more intense feeling of relaxation, a sense of well-being, and euphoria. This can occur even if you are taking the drugs at low doses.

When you take tramadol, your central nervous system is depressed so that your heart rate, blood pressure, and respiration become suppressed. That’s because tramadol causes the brain stem’s neurons to fire at a slower rate. This is the same reaction that alcohol causes, so when the two substances are combined, they work together to suppress the firing of the body’s neurons. This can also lead to slowing of the person’s breathing, blood pressure, and heart rate, which can be very dangerous.

If you take large doses of tramadol and alcohol, they can cause the neurons to stop firing altogether, and you could end up in a coma. When this occurs, you may stop breathing and possibly die.

If a person doesn’t die in the manner described above, the neurons could slow down their firing, and in the process, they can stop sending the oxygen that the organs need. When there is not enough oxygen in the brain and other organs, it is known as hypoxia, and it can occur when people take tramadol and alcohol together. When these substances are mixed, it can damage your organs in a matter of minutes.

Some parts of the brain need more oxygen than others to maintain proper functioning, and when that oxygen is denied, those areas suffer the most. These areas include those that are involved in complex problem solving, attention and concentration, and memory and learning. The damage could be widespread.

Other Reactions

Tramadol also comes in an extended-release form. Combining alcohol with an extended-release tablet can cause the extended-release function to be useless. This version of tramadol is meant to be released slowly over an extended period of time, but drinking alcohol with it will cause the medication to be released in a much faster fashion. This is known as the “dumping effect.” Some people are not convinced that this actually happens, but there is the potential for it to occur.

If you drink alcohol and take tramadol at the same time, tramadol will be distributed and absorbed at an unexpected rate. If the dose of tramadol is high, the alcohol may have the effect of increasing the amount of tramadol that can be absorbed. This will also increase the depressant effects of the drug.

The Danger of Overdose

When people combine tramadol and alcohol, they also increase their chances of experiencing an overdose. Tramadol and alcohol both cause side effects, and combining these two substances enhances these side effects. This means that a person can experience an overdose because of one or the other substance.

Chronic Diseases

Taking tramadol and drinking alcohol is a combination that can lead to several chronic diseases. These chronic diseases include kidney issues, neurological damage, stroke, arteriosclerosis, ulcers, cirrhosis of the liver, and several types of cancer.


When people are drinking alcohol and using tramadol together, it only takes one time for them to exercise poor judgment. This could cause them to agree to take part in dangerous sexual practices, to take risks, or to be involved in an accident. This population is also at a high risk of being the victim of a violent crime.

If women combine tramadol and alcohol, their babies are at risk of being born with a developmental disorder. Infants may also be born addicted to these drugs. Men can experience sexual dysfunction when they indulge in tramadol and alcohol.

Dual Diagnosis

When people are diagnosed with a substance use disorder, they often receive a diagnosis of a mental health disorder. If someone has a mental health disorder, they often choose a drug that “medicates” the problem and then develop a substance use disorder. In fact, approximately 50% of people diagnosed with a mental health disorder will receive a substance use disorder diagnosis and vice versa.

The most common mental illnesses are anxiety disorders, which include post-traumatic stress disorder, panic disorder, and generalized anxiety disorder. Other commonly co-occurring disorders with substance use disorders include antisocial personality disorder, borderline personality disorder, psychotic illness, attention-deficit hyperactivity disorder, bipolar disorder, and depression.

The people most likely to use more than one substance at a time are more likely to be diagnosed with a mental health disorder as well as a substance use disorder.

Granite Recovery Centers

Substance use disorders used to be the only ailments treated at drug treatment centers, and psychiatric disorders were treated exclusively at psychiatric hospitals and clinics. The medical community learned that this is not the best approach to take when a patient has both a mental health condition and a substance use disorder. When medical professionals were treating the substance use disorder, they were not treating the mental health condition that may have been the underlying cause of the substance use.

At Granite Recovery Centers, we have a dual diagnosis program in which we address your substance use issue and your mental health disorder at the same time. After you have completed the drug detox program, we will place you in therapy for treatment. This may include dialectical behavioral therapy, cognitive behavioral therapy, trauma therapy, holistic addiction therapy, and 12-step support groups. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency.

If you or a loved one is having difficulties with an addiction to tramadol and alcohol, we want to help. Contact us at Granite Recovery Centers so that we can put you on the road to sobriety once again.

At Granite Recovery Centers, we want to provide accurate information about health and addiction so that our readers can make informed decisions.

We have credentialed medical doctors & clinicians who specialize in addiction treatment review the information on our website before it is published. We use credible sources such as government websites and journal articles when citing statistics or other medically related topics.