Tramadol and Alcohol

Table of Contents


Tramadol and alcohol do not mix well, as both substances are central nervous system depressants.

A synthetic opioid, tramadol is sometimes prescribed for the treatment of moderate to severe pain. First appearing in the United States in the 1990s, tramadol is the thirty-fifth most prescribed drug in the US (with almost 20 million prescriptions per 2019 data).Like all opioids, tramadol has the potential for abuse, and it can be addictive. As such, tramadol is a Schedule IV controlled substance. Drugs in this class are deemed to have moderate abuse potential, with physical dependence potentially developing after repeated use. If prescribed tramadol for pain relief, take this medication only as directed.

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So, while tramadol was initially marketed as a safer alternative to opioids like Vicodin and OxyContin, it remains classified as a Schedule IV controlled substance. 

How about mixing alcohol and tramadol, then? Why can an alcohol and tramadol interaction be so dangerous? 

Tramadol and Alcohol Interaction

Tramadol shares a similar mechanism of action to other opioid narcotics. The substance will attach itself readily to specific groups of endogenous opioid neurotransmitters in your brain.

What are these neurotransmitters or chemical messengers?

Well, they include endorphins and enkephalins, substances that help you to efficiently deal with pain, stress, and exertion.

It is believed that tramadol can also spike the availability of serotonin and norepinephrine. These are neurotransmitters associated with pleasure and stress.

In the same way as other opioids and opiates, tramadol is a CNS depressant, causing fewer neurons to ping around your CNS – that is, your spinal cord and your brain.

Alcohol, by contrast, is the primary substance of abuse in the United States, legal and widely tolerated, even though NSDUH 2020 data showing over 28.5 million adults in the US have alcohol use disorder.

Just like tramadol, alcohol is classified as a central nervous system depressant, although it attaches itself to different neurotransmitters, including:

SAMHSA (Substance Abuse and Mental Health Services Administration) recommends that the safe use of tramadol includes not consuming alcohol while taking the medication. 

Using two CNS depressants in combination is not considered safe in any scenario. 

Mixing different central nervous system depressants triggers a synergism of the effects of both substances. Oftentimes, the effects of these drugs are magnified, and they become much more intense than when either substance is used in isolation. 

The enhanced effects of using tramadol and alcohol include: 

  • Euphoria
  • Relaxation
  • Wellbeing

These immediate effects of the combination use of alcohol and tramadol are noticeable even at low doses. 

What about the potential Tramadol and alcohol side effects? 

An image of a woman in distress, having taken tramadol and alcohol together

Side Effects of Mixing Tramadol and Alcohol

Alcohol and tramadol taken in isolation both induce suppression in the following areas: 

  • Heart rate
  • Blood pressure
  • Breathing

Both alcohol and tramadol cause the neurons in the brain stem controlling the above functions to slow down. 

Now, when you use alcohol and tramadol together, the suppression of these neurons occurs to a much higher degree, with the decrease in these functions potentially becoming dangerous. 

If you take the substances in larger amounts, either or both substances can suppress heart rate, respiration, and blood pressure to such an extent that a fatal coma is triggered.

Even if you avoid the worst outcome of mixing tramadol and alcohol – coma – even the slowing of the neurons taking place can be enough to cause organ damage. Decreased blood flow and lack of oxygen to the brain is called hypoxia, and this can lead to brain damage in areas associated with concentration, memory, problem-solving, and learning. 

Tramadol and alcohol side effects might also manifest when you consume alcohol while taking the medication in extended-release form. Some researchers feel a dumping effect can occur if you drink alcohol while using this form of tramadol, causing the whole dose to be prematurely released. Research in this area is ongoing.

Beyond this, if you consume large amounts of tramadol while drinking alcohol, the absorption rate of the medication can be increased, as well as the effects it induces on your central nervous system. 

When you take tramadol in combination with alcohol, you are at heightened risk of developing atypical responses to the medication. 

There is also a strong interrelationship between substance abuse and the development of mental health disorders – dual diagnosis or co-occurring disorder. Anyone abusing more than one substance is at increased risk of developing substance-use disorder. 

The chronic use of CNS depressants leads to a heightened tendency to suicidal ideation, suicide attempts, and self-harm. 

The combined use of alcohol and tramadol can hasten the development of dependence on one or both substances. 

Can you overdose on Tramadol and alcohol together?

Overdose Risk Mixing Alcohol and Tramadol

It is possible to overdose on tramadol and alcohol, both independently and in combination. 

95,000 deaths each year in the United States are associated with alcohol abuse. Tramadol, like other opioids, can also cause overdose in isolation. Unlike other opioids, though, tramadol overdose cannot be completely reversed by naloxone. 

As with all the effects of alcohol and tramadol, the risk of overdose is also increased when you abuse the substances in combination, resulting in an FDA Black Box warning alerting you to this heightened danger of tramadol overdose.

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Overcome Tramadol and Alcohol Addiction at California Detox

Whether you are addicted to alcohol, prescription medications, or illicit drugs, we can help you break the chains of addiction here at California Detox in Orange County.

We provide tailored addiction treatment programs at all levels on ASAM’s continuum of care, including: 

  • Residential rehab (inpatient programs)
  • Outpatient programs
  • IOPs (intensive outpatient programs)
  • Virtual IOPs (remote rehab programs)
  • PHPs (partial hospitalization programs)
  • Supervised medical detoxification
  • Dual diagnosis (for addictions with co-occurring mental health conditions)

Whether you need the support and structure of inpatient treatment or the flexibility and affordability of outpatient therapy, you can access a personalized array of evidence-based interventions and holistic treatments here at California Detox. These include: 

  • Medication-assisted treatment
  • Individual counseling
  • Group therapy
  • Family therapy
  • Psychotherapies (talk therapies like CBT and DBT)
  • Holistic therapies

When you are ready to address the physical and psychological aspects of addiction to alcohol and Tramadol, reach out to California Detox by calling 949.390.5377.


Yes. You could experience alcohol poisoning (alcohol overdose), Tramadol overdose, or both when mixing these CNS depressants.
Yes. A Tramadol overdose cannot always be reversed with naloxone, the opioid overdose reversal agent. Additionally, alcohol poisoning can be fatal if untreated. Combining these substances increases the risk of life-threatening outcomes.


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