Mixing Tramadol and Alcohol: Effects and Dangers
Tramadol goes by several different trade names, including Ultram, Rybix, and ConZip, and a combination of acetaminophen and tramadol is marketed as Ultracet.
Tramadol is a synthetic opiate drug that is useful in treating moderate to severe pain associated with surgery or numerous conditions.
Tramadol was marketed as a safer opiate drug for the treatment of pain compared to drugs with a higher abuse potential such as OxyContin and Vicodin, but it is still classified as a Schedule IV controlled substance by the United States Drug Enforcement Administration (DEA).
Drugs in this class are considered to have moderate potentials for abuse and may result in the development of physical dependence on the drug if it is used repeatedly.
The mechanism of action of tramadol is similar to the mechanism of action of other narcotic/opioid drugs. It readily attaches to specific neurons in the brain that are specialized for a group of neurotransmitters that are commonly referred to collectively as the endogenous opioid neurotransmitters. These neurotransmitters include substances like enkephalins and endorphins, and they assist individuals in coping with stress, exertion, and pain. The drug may also increase the availability of norepinephrine and serotonin when it is used. Tramadol is classified as a central nervous system depressant drug, like other opiate drugs, meaning that its overall effects result in reduction of neuron firing in the central nervous system (the brain and spinal cord).
Alcohol is the number one drug of abuse in the United States, and the majority of substance use disorders in the United States involve alcohol, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Alcohol is a central nervous system depressant like tramadol, but it operates on different neurotransmitters. It affects a number of neurotransmitters, including the inhibitory neurotransmitters gamma-aminobutyric acid (GABA) and glycline as well as the excitatory neurotransmitter N-methyl-d-aspartate (NMDA).
Although the rate of prescriptions for opioids has declined in recent years, the International Marketing Services for Health (IMS Health) still estimates that over 43 million prescriptions were written for tramadol in 2015. While the exact figures on the number of individuals who take tramadol while using alcohol on a regular basis are not available, given the rates of prescriptions for tramadol (and hence its availability on the market) and the number of individuals who abuse alcohol, it is a safe bet that there are many cases of co-occurring tramadol and alcohol abuse/misuse.
The Effects of Mixing Tramadol and Alcohol
Recommendations for the safe use of tramadol as a medicinal product include not drinking alcohol while taking the drug. Thus, there are no safe scenarios that can occur when an individual uses tramadol and alcohol together.
Obviously, the effects of mixing both drugs are limited when both drugs are taken in very low amounts; however, even at very low amounts, there may be deleterious effects that can include unpredictable personal reactions to the combination of these drugs. Tramadol has a number of potential side effects associated with its use, and drinking alcohol with tramadol can increase the potential that these will occur.
According to the book Drug Interactions: Analysis and Management, there are a number of potential dangers that can occur when individuals mix tramadol and alcohol.
- When individuals mix different central nervous system depressants together, it produces a synergism of the effects of both drugs. Often, the effects of the drugs are enhanced, meaning that the common effects of taking either drug individually become significantly increased when both are used in combination. The enhancement of effects includes increased feelings of relaxation, wellbeing, and euphoria at low doses.
In addition, the physiological effects of alcohol and tramadol taken singularly include suppressed respiration, blood pressure, and heart rate. These drugs decrease the firing rates of the neurons in the brain stem that control these automatic life-sustaining functions. When an individual combines alcohol with an opioid drug like tramadol, it can lead to a significant suppression of these neurons and a significant and potentially dangerous decrease in the above functions. Obviously, when taken in large amounts, either drug or both drugs can halt the firing of these neurons and result in a potentially fatal comatose state. Individuals who overdose on this combination would stop breathing and could conceivably die.
However, even slowing down the firing rates of these neurons significantly can result in organ damage due to a lack of oxygen as a result of decreased blood flow to important organs like the brain. This lack of oxygen, often termed hypoxia, can occur in an acute situation or over repeated administrations of significantly high doses of tramadol and alcohol in combination. The potential types of brain damage that can occur could be widespread but would often take place in areas of the brain that use high levels of oxygen in their routine functioning, such as those associated with memory and learning, attention and concentration, and complex problem-solving.
- Drinking alcohol with the extended-release form of tramadol may interfere with the extended-release mechanism of the drug, such that there is a “dumping effect.” This means that when a large dose of the drug is intended to be released slowly over time, as in the extended-release form of tramadol, taking it with alcohol may result in the entire dose of the drug being released much more quickly. Whether or not this effect actually occurs remains somewhat debated; however, the potential for it to occur is there.
- Consuming alcohol with opiate drugs often alters the absorption rates and distribution of the drug. Using tramadol in high amounts and drinking alcohol may increase the absorption rates of the tramadol and increase its central nervous system depressant effects.
- The potential for overdose from either drug is increased when tramadol and alcohol are used in combination. Because alcohol and tramadol have similar overall effects even though they operate by different neurotransmitter systems, the effect of each drug is enhanced when these drugs are used in combination. This includes the potential to overdose on one or both drugs.
- The potential for an individual to develop atypical responses to tramadol is increased when an individual uses the drug in combination with alcohol. These types of atypical responses are extremely difficult to predict because they are rare and not well documented in the literature. This may lead to difficulty diagnosing what is happening with an individual and could result in the delay of important interventions that can help the person.
- Chronic use of alcohol or opiate drugs like tramadol has devastating costs. Using these drugs in combination increases the risk of developing chronic diseases that are associated with using either drug alone. The likelihood of developing a number of different types of cancer, cirrhosis of the liver, gastrointestinal issues like ulcers, arteriosclerosis, stroke, neurological damage that can lead to dementia, issues with the kidneys, and a number of other chronic conditions is significantly increased when these drugs are used in combination. Drinking alcohol in combination with the combined form of acetaminophen and tramadol in large doses over lengthy periods of time increases the risks of liver damage even further.
- Even one-time use of alcohol and tramadol together can increase the risk that an individual will become involved in an accident, experience issues due to poor judgment, or experience severe issues due to risk-taking behaviors, such as engaging in unprotected sex, being a victim of a violent crime, etc. Chronic use of these drugs in combination increases the risks of these potential incidents even further.
- Men who chronically abuse tramadol and alcohol are at an increased risk for issues with sexual dysfunctions. Pregnant women who drink alcohol and use opiate drugs like tramadol increase the risk of having children with developmental disorders or physical dependence on drugs.
- There is a strong positive association between the development of a mental health disorder and substance abuse. This relationship is quite complicated and dependent on the number of individual circumstances, including a person’s genetic makeup, past experiences, how often they use the drugs, etc. However, individuals who chronically engage in polysubstance abuse are at greater risk to develop or be diagnosed with disorders, such as depression, anxiety disorders, etc. Of course, individuals who chronically abuse one or more drugs are at an extreme risk to develop a formal substance use disorder as well.
- Chronic use of alcohol and tramadol can accelerate the development of physical dependence on one or both drugs.
- Chronic use of central nervous system depressants is associated with increased risk of self-harm and suicide attempts.
This is because hospitalizations for younger individuals as a result of alcohol combined with prescription medications have increased significantly over the past several years, and the potential effects of overdosing on these drugs can be devastating and life-changing for these individuals.