Can You Overdose On Tramadol: symptoms, seizure risk and treatment

Yes, you can overdose on tramadol, and it carries more risks than most opioid overdoses. Like other opioids, tramadol can slow or stop breathing. It can also cause seizures, even at prescribed doses, and serotonin syndrome, especially when taken with antidepressants. If someone may have taken too much, give naloxone (Narcan) if they’re hard to wake or breathing slowly, and call for emergency help.

Why is a tramadol overdose different?

Tramadol is an opioid pain medicine, so its main overdose danger is the same as other opioids: slowed or stopped breathing. Its FDA-approved label (Ultram, revised February 2023) adds two extra warnings that most opioids don’t carry in the same way: seizures and serotonin syndrome.

Seizures

The label says seizures have been reported in people taking tramadol within the recommended dosage range, and that seizures can be part of an overdose. The Missouri Poison Center says seizure risk rises with the amount taken and is highest in the first 4 to 6 hours after taking too much.

In a study published in Clinical Toxicology in 2015, Australian researchers reviewed 71 tramadol overdoses. Eight people (about 1 in 9) had seizures, and 13 (about 1 in 5) had slowed breathing.

Serotonin syndrome

Serotonin syndrome happens when too much serotonin builds up in the body. The FDA label warns it can be life-threatening and has been reported with tramadol, especially when combined with other drugs that raise serotonin, such as many antidepressants. Signs include agitation, hallucinations, a fast heartbeat, high body temperature, overactive reflexes, stiff muscles, nausea, vomiting and diarrhea.

The same 2015 study found no cases of serotonin toxicity among its 71 overdoses and concluded it appears unlikely in tramadol overdose. The FDA warning still stands for people who take tramadol with other serotonin-raising medicines.

What are the signs of a tramadol overdose?

MedlinePlus and the FDA label list these signs:

• Slow, shallow or difficult breathing, or unusual snoring
• Extreme sleepiness, or being unable to respond or wake up
• Very small pupils
• Muscle weakness
• Cold, clammy skin
• A slow heartbeat
• Seizures (fits)

Sweating, shaking, agitation, fever or stiff muscles can point to serotonin syndrome, especially in someone who also takes an antidepressant. Any of these signs needs emergency care.

What should you do if someone overdoses on tramadol?

Act right away, even if you’re not sure. These steps follow overdose guidance from SAMHSA, the US government’s substance use and mental health agency, and seizure first aid from the CDC:

1. Check for a response. Shout their name and rub your knuckles firmly on the center of their chest.
2. Give naloxone if you have it. If they’re hard to wake or breathing slowly, give naloxone (Narcan). If they don’t respond after 2 to 3 minutes, give a second dose.
3. Call for help. Call 911 in the US or Canada, 000 in Australia, or the numbers in the box above. Say the person took tramadol, and keep the bottle.
4. If they have a seizure, stay with them and move anything nearby that could hurt them. Gently turn them onto their side. Don’t hold them down or put anything in their mouth.
5. Support breathing. If you’re trained and they aren’t breathing, give rescue breaths (not during a seizure). If they’re breathing, keep them on their side in the recovery position.
6. Stay with them. The label notes that naloxone wears off sooner than tramadol, so breathing can slow again.

Don’t put the person in a cold shower or bath, and don’t try to make them vomit. SAMHSA warns that both can cause harm, including choking.

Is it safe to give naloxone if tramadol can cause seizures?

Naloxone is the treatment for dangerously slow breathing from tramadol, and both main sources agree on that. The FDA label tells health workers to give an opioid reversal medicine for serious breathing problems from an opioid overdose. It also notes that naloxone “will reverse some, but not all, symptoms” of a tramadol overdose and that the risk of seizures is also increased with naloxone.

The Missouri Poison Center, which advises doctors on treating poisonings, says naloxone is safe after a tramadol overdose. What both points mean for you: if someone is barely breathing, give naloxone and call for help, and expect that they will still need hospital care. Read our guide to Narcan (naloxone).

What happens in the hospital?

• Breathing. Staff give naloxone if needed, support breathing and keep watching until the person breathes reliably on their own.
• Seizures. Hospitals treat seizures with medicines such as benzodiazepines.
• Serotonin syndrome. Doctors stop serotonin-raising drugs and give supportive care, including cooling for a high temperature.
• Other checks. The FDA label warns tramadol can cause low blood sugar and low sodium, and the Missouri Poison Center advises heart monitoring.
• Acetaminophen. If the tablets also contained acetaminophen, doctors test for it and may give an antidote called acetylcysteine.

Tramadol with acetaminophen (Ultracet): a second danger

Some tramadol tablets also contain acetaminophen (called paracetamol in Australia and India). Examples are the discontinued US brand Ultracet, Jamp-Acet-Tramadol in Canada and Zaldiar in Australia, which contain 37.5 mg of tramadol and 325 mg of acetaminophen per tablet.

An overdose of these adds a delayed threat to the liver, the same two-sided problem as a Percocet overdose. MedlinePlus says acetaminophen symptoms may not appear for 12 hours or more, and that treatment within 8 hours gives a very good chance of recovery. Get medical help even if the person seems fine. The FDA says adults shouldn’t take more than 4,000 mg of acetaminophen in 24 hours from all medicines combined. Learn more about acetaminophen overdose.

Which drugs interact dangerously with tramadol?

Drugs that raise the risk of a serious reaction with tramadol, from the FDA label and MedlinePlus

Drug group	Examples	Main risk
Antidepressants (SSRIs, SNRIs, tricyclics)	Such as sertraline (Zoloft)	Serotonin syndrome; SSRIs and tricyclics also raise seizure risk
MAO inhibitors and related drugs	Phenelzine, linezolid, methylene blue	Serotonin syndrome; the label says not to use tramadol with an MAO inhibitor or within 14 days of one
Migraine triptans and supplements	Triptans, St. John’s wort, tryptophan	Serotonin syndrome
Benzodiazepines, alcohol and other sedatives	Such as benzodiazepines	Deep sedation, slowed breathing, coma and death
Antipsychotics and other opioids	Neuroleptics, other opioid pain medicines	Seizures
Drugs that affect liver enzymes CYP2D6 or CYP3A4	Paroxetine and fluoxetine (CYP2D6)	Changed tramadol levels and higher seizure risk

Tell your doctor and pharmacist about every medicine and supplement you take before starting tramadol.

Is tramadol safe for children?

No. On April 20, 2017, the FDA restricted tramadol use in children after finding nine cases of serious breathing problems, including three deaths, in children under 18 (reports from 1969 to 2016). The FDA says:

• Tramadol should not be used to treat pain in children younger than 12.
• It should not be used for pain after tonsil or adenoid surgery in anyone under 18.
• It is not recommended for 12- to 18-year-olds who have obesity or conditions that raise the risk of serious breathing problems.
• Breastfeeding is not recommended while taking tramadol.

The label explains that some people process tramadol unusually fast (“ultra-rapid metabolism”), which is linked to life-threatening breathing problems in children. MedlinePlus also warns that tramadol may harm or kill other people who take it, especially children, so keep it out of their reach.

Tramadol in our five countries

We checked each country’s official law notices and medicine databases in October 2026: the DEA’s Federal Register rule, Health Canada and Drug Shortages Canada, healthdirect Australia, and India’s Ministry of Finance notification.

Tramadol brands, legal status and acetaminophen combinations in five countries (checked October 2026)

Country	Brands we verified	Legal status	Controlled since	With acetaminophen (paracetamol)
United States	Conzip; Ultram and Ultram ER discontinued	Schedule IV controlled substance (DEA)	August 18, 2014	Ultracet brand discontinued; 16 NDC listings (our count)
Puerto Rico	Same as the US	US federal Schedule IV; no separate Puerto Rico listing found	August 18, 2014 (federal)	Same as the US
Canada	Zytram XL (extended-release), listed as marketed	Schedule I of the Controlled Drugs and Substances Act and the Narcotic Control Regulations	March 31, 2022	Generic tablets such as Jamp-Acet-Tramadol, listed as marketed
Australia	Tramal, Zydol	Schedule 4: Prescription Only Medicine	Prescription only, not a Schedule 8 controlled drug	Zaldiar, Schedule 4
India	No official brand list found; capsules and injection are on the 2022 National List of Essential Medicines	Psychotropic substance under the NDPS Act, 1985 (S.O. 1761(E))	April 26, 2018	No official listing found

What the comparison shows:

• The US brought tramadol under federal drug control first, in 2014, after ten states had already controlled it. India followed in 2018 and Canada in 2022 (Federal Register; Health Canada).
• Australia still lists tramadol products as Schedule 4 prescription medicines, not in the stricter Schedule 8 used for oxycodone and morphine.
• We searched the FDA’s National Drug Code Directory (data updated October 2, 2026) for listings that contain acetaminophen and found 16 that also contain tramadol, compared with 136 for oxycodone and 212 for hydrocodone.
• Main national death figures in the US (CDC) and Australia (ABS) group tramadol with fentanyl as “synthetic opioids,” so those headline numbers can’t show tramadol deaths on their own.

How can you prevent a tramadol overdose?

• Take it exactly as prescribed. Never take extra for pain that isn’t controlled; call your doctor instead.
• Tell your doctor if you have epilepsy, a history of seizures or a head injury, which the label says raise seizure risk.
• Don’t drink alcohol or take sleep medicines or benzodiazepines with it unless your doctor says it’s safe.
• Keep naloxone at home, and store tramadol in its original container, out of children’s reach.
• Make sure a pill is what you think it is with our pill imprint search, or see pictures of tramadol pills. Pills bought outside a pharmacy may be fake, and a matching imprint doesn’t prove a pill is real.
• Take leftovers to a medicine take-back program. See how to dispose of unused medicines.

For the signs and steps that apply to every opioid, see our guide to opioid overdose.

Common questions

How much tramadol is too much?

Anything more than your prescribed dose is too much. The FDA label for Ultram tablets says not to go over 400 mg a day, and extended-release products have their own limits on their labels. Seizures can happen even within the recommended range, so if you’ve taken more than prescribed, call a poison center now.

Does Narcan work on tramadol?

Yes, naloxone (Narcan) reverses tramadol’s effect on breathing. The FDA label says it may not reverse every symptom of a tramadol overdose, so the person still needs emergency care. Naloxone can also wear off before the tramadol does.

Can tramadol cause seizures at normal doses?

Yes. The FDA label says seizures have been reported in people taking tramadol within the recommended dosage range. The risk is higher with some antidepressants, antipsychotics and other opioids, and in people with epilepsy, a head injury or alcohol or drug withdrawal.

Can you take tramadol with sertraline or other antidepressants?

Only if your doctor knows and agrees. The FDA label warns that tramadol with SSRIs such as sertraline, SNRIs or tricyclic antidepressants can cause serotonin syndrome and raises seizure risk. Never combine tramadol with an MAO inhibitor or within 14 days of taking one.

Is tramadol a controlled substance?

Yes, in most of our five countries. It is Schedule IV in the US and Puerto Rico (since 2014), a psychotropic substance under India’s NDPS Act (since 2018) and a narcotic in Canada (since 2022). In Australia, it is a Schedule 4 prescription-only medicine.