Tramadol and Seizure Disorders: What You Need to Know About the Increased Risk

Tramadol and Seizure Disorders: What You Need to Know About the Increased Risk

Tramadol is often prescribed for moderate to severe pain, but for people with seizure disorders or a history of seizures, it can be dangerous-even at normal doses. This isn’t just a theoretical risk. Real cases show that tramadol can trigger seizures in people who’ve never had one before, and make existing seizures much worse. The FDA and major medical guidelines now clearly warn against using tramadol in anyone with a seizure disorder. But many patients and even some doctors still don’t fully understand how serious this risk is.

Why Tramadol Can Trigger Seizures

Unlike most opioids, tramadol doesn’t just work on opioid receptors. It also affects serotonin and norepinephrine in the brain. This dual action is what makes it effective for pain, but also what makes it risky. The (+) enantiomer of tramadol blocks serotonin reuptake, while the (-) enantiomer blocks norepinephrine reuptake. When these neurotransmitters build up too much, they can overstimulate brain cells, lowering the threshold for seizures.

Studies show that tramadol can cause seizures even when taken exactly as prescribed. One case report described a patient on 75 mg per day-well below the maximum recommended dose-who had a seizure after just a few days. Another study of 28 patients with tramadol-induced seizures found that 89% had their first seizure within 24 hours of taking the drug. These weren’t overdoses. These were people taking what their doctor told them was a safe dose.

The risk doesn’t stop at the drug itself. Tramadol’s effect on serotonin also makes it dangerous when combined with other medications. Antidepressants like SSRIs and TCAs, antipsychotics, and even alcohol can multiply the risk. One report from New Zealand found three patients on tricyclic antidepressants who had seizures after starting tramadol. In two of those cases, the seizures happened only after the tramadol dose was increased.

Who’s Most at Risk

While anyone can have a seizure from tramadol, certain groups are more vulnerable. Men between the ages of 20 and 35 make up the majority of reported cases-about 93% of patients in one 3-year study. But that doesn’t mean women are safe. About 7% of cases occurred in women, and some of those were in people with no prior history of seizures.

People with kidney problems are also at higher risk. Tramadol is cleared from the body through the kidneys. If they’re not working well, the drug builds up faster, increasing the chance of a seizure. One patient with renal failure had a seizure after receiving 300 mg intravenously-a dose that would be considered safe in someone with normal kidney function.

Those with a history of epilepsy, head trauma, alcohol withdrawal, or brain infections are especially vulnerable. Even if their seizures are well-controlled, adding tramadol can tip the balance. One documented case involved a patient with a known seizure disorder who saw their seizure frequency jump dramatically within 24 hours of starting tramadol at 400 mg daily.

How Common Are These Seizures?

Between 2001 and 2006, tramadol was the most commonly reported medication linked to seizures in New Zealand’s national adverse drug reaction database. In the U.S., emergency room visits related to tramadol rose by 250% between 2005 and 2011, while prescriptions increased by 88% during the same period. That’s not a coincidence.

Even more concerning: seizures from tramadol happen at both low and high doses. A 2013 study found that 46% of patients who had seizures were taking more than 400 mg per day, but the other 54% were within the recommended range. This means you can’t assume that taking the right dose makes you safe.

EEG tests after a tramadol-induced seizure often show abnormal brain activity-but usually only in the first 24 hours. By the time a week has passed, most EEGs return to normal. That’s good news for recovery, but it doesn’t change the fact that the seizure happened. And for someone with epilepsy, even one seizure can be life-altering.

What Doctors Say

Major medical institutions are clear: tramadol should not be used in patients with seizure disorders. The UCSF Pain Management Education program explicitly lists this as a contraindication. The same warning appears in the prescribing information from manufacturers and in guidelines from the American Epilepsy Society.

Experts also point to the mechanism: tramadol and its main metabolite, M1, are believed to reduce the activity of GABA-the brain’s main inhibitory neurotransmitter. Less GABA means less braking power on brain activity, making seizures more likely. Some research even suggests tramadol may trigger seizures through histamine H1 receptor activation, adding another layer to how complex and unpredictable this reaction can be.

What to Do If You’re on Tramadol

If you have a seizure disorder and are currently taking tramadol, do not stop suddenly. Abruptly stopping opioids can cause withdrawal, which can also trigger seizures. Talk to your doctor about switching to a safer pain medication.

Some alternatives include:

• Acetaminophen (Tylenol) for mild to moderate pain
• NSAIDs like ibuprofen or naproxen, if your kidneys and stomach can handle them
• Morphine or oxycodone for more severe pain-these have a lower seizure risk than tramadol, though they carry other risks like addiction
• Non-drug options like physical therapy, nerve blocks, or acupuncture

If you’re taking tramadol for pain and have never had a seizure, but you’re on antidepressants, antipsychotics, or drink alcohol regularly, ask your doctor if you’re at risk. Even if you’ve been on tramadol for months without issue, adding another medication or changing your alcohol intake could put you in danger.

What to Watch For

Seizures from tramadol are often brief, generalized tonic-clonic episodes-meaning the whole body stiffens and shakes. They usually last less than a minute and stop on their own. But they can happen suddenly, without warning.

Signs that a seizure might be coming include:

• Sudden confusion or staring spells
• Unexplained muscle twitching or jerking
• Feeling like you’re “out of it” or disconnected
• A strange taste, smell, or sensation in your head

If you experience any of these, especially within 24 hours of taking tramadol, seek medical attention immediately. Even if it doesn’t turn into a full seizure, it could be a warning sign.

The Bottom Line

Tramadol is not just another painkiller. Its unique chemical makeup makes it a hidden risk for people with seizure disorders or those taking other brain-altering medications. The evidence is clear: seizures can happen at normal doses, even without overdose. The risk is real, documented, and preventable.

If you or someone you care for has epilepsy or a history of seizures, tramadol should be avoided entirely. There are safer alternatives available. Don’t assume that because your doctor prescribed it, it’s safe for you. Always ask: Could this trigger a seizure? If the answer is yes, push for a different option.

The goal isn’t just to manage pain-it’s to manage it without putting your brain at risk.