Tramadol

2-[(Dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol

Ultram, Tramal, Ralivia, ConZip, Qdolo

Psychoactive Class

Chemical Class

Tramadol is a synthetic opioid analgesic of the phenylpropylamine class, structurally related to codeine and morphine. Developed in 1962 by German pharmaceutical company Grünenthal GmbH and launched commercially in 1977,¹ it is widely prescribed for moderate to moderately severe pain.¹ Tramadol is distinguished by its atypical dual mechanism, acting as both a weak μ-opioid receptor agonist and a serotonin-norepinephrine reuptake inhibitor (SNRI), with roughly one-tenth the potency of morphine.¹ It is listed among the WHO's Essential Medicines.

Dosage & Duration

Dosage

Threshold~25 mg

Light50-100 mg

Moderate100-150 mg

Strong150-200 mg

Heavy200+ mg

Bioavailability

75%

Doses exceeding 300 mg present increased risk of physical toxicity, particularly in opioid-naïve or smaller individuals. Tramadol carries additional hazards distinct from typical opioid use, including seizure risk and potential serotonin syndrome at higher doses.

Duration

Onset30-90 minutes

Peak2-4 hours

Offset2-4 hours

After Effects1-24 hours

Total6-8 hours

Half-life

5-6 hours

Subjective Effects

Effects vary widely by individual, dose, and context.

Physical

The cognitive effects of tramadol can be broken down into several components which progressively intensify proportional to dosage. The general head space of codeine is described by many as one of intense euphoria, relaxation, anxiety suppression and pain relief.

Constipation Cough suppression Difficulty urinating Nausea Sedation Pupil constriction Salivation

Cognitive

The physical effects of tramadol can be broken down into three components which progressively intensify proportional to dosage.

Anxiety suppression Compulsive redosing

Forked from Subjective Effect Documentation

by Josie KinsAugust 2015.

Reagent Testing

Loading reagent data

Expected colorimetric results are being prepared.

Pharmacology

Pharmacodynamics

Tramadol is a centrally acting analgesic with a dual mechanism involving monoamine reuptake inhibition and μ-opioid receptor activation.² As a racemic mixture, the (+)-enantiomer primarily inhibits serotonin reuptake while the (-)-enantiomer primarily inhibits norepinephrine reuptake.³ The μ-opioid component is predominantly mediated by the active metabolite O-desmethyltramadol, which displays approximately 700-fold higher affinity for the μ-opioid receptor than the parent compound⁴ and activates it with intrinsic activity comparable to morphine,⁵ while tramadol itself does not appear to possess functional efficacy at this receptor. Tramadol has additionally been shown to act as a serotonin releasing agent at micromolar concentrations.⁶ Secondary targets include antagonism of NMDA, 5-HT2C, α7 nicotinic acetylcholine, and M1/M3 muscarinic acetylcholine receptors, as well as agonism at adenosine A1 receptors.

Pharmacokinetics

Tramadol is rapidly and nearly completely absorbed after oral administration, with a bioavailability of approximately 75% due to 20-30% first-pass metabolism in the liver.⁷ It undergoes extensive hepatic metabolism through O-demethylation (catalyzed primarily by CYP2D6) to produce the active metabolite O-desmethyltramadol and through N-demethylation (catalyzed by CYP3A4 and CYP2B6) to produce N-desmethyltramadol, with at least 23 metabolites identified overall.⁴ The parent compound has an elimination half-life of approximately 5-6 hours, while O-desmethyltramadol has a longer half-life of 8-9 hours.³ Individuals with reduced CYP2D6 activity (approximately 6% of the population) produce less O-desmethyltramadol, which can result in diminished analgesic effect since this metabolite is the primary mediator of opioid activity.³

Interactions

Dangerous

Highest risk

These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.

AlcoholAmphetaminesAMTBenzodiazepinesCocaineDiphenhydramineDXMGHB/GBLKetamineLithiumMAOIsMDMAMephedroneMXEOpioidsPCPSSRIs

Unsafe

Avoid

There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.

2C-T-x compounds2C-x compounds5-MeO-xxT tryptaminesDMTDOx compoundsLSDMescalineNBOMe compoundsPregabalinPsilocybin mushrooms

Caution

Use caution

These combinations are not usually physically harmful, but may produce undesirable effects, such as physical discomfort or overstimulation. Extreme use may cause physical health issues. Synergistic effects may be unpredictable. Care should be taken when choosing to use this combination.

Nitrous oxide

TripSit

Tolerance

Full Tolerance

Prolonged repeated tramadol use can produce tolerance to many effects. The pace varies by effect, and constipation-related tolerance appears to develop especially slowly. In studies, 50 mg/kg given for 7 days did not cause significant tolerance, while 11- and 15-day exposure was associated with a significant reduction in analgesic efficacy. Tramadol analgesic tolerance may develop more slowly than with other opioids.

Baseline Reset

1-2 weeks in the absence of further consumption

Half Tolerance

3-7 days

Cross Tolerance

Opioids

Harm Potential

Addiction & Dependence

Psychological

Moderate

Tramadol is described as moderately addictive, with high abuse potential and the ability to cause psychological dependence.⁸⁷ Compulsive redosing is reported, and its capacity to relieve stress and improve mood without significant impairment contributes to its abuse potential.

Physical

Moderate

Physical dependence develops with chronic use. Withdrawal symptoms include both opioid-typical effects (body aches, diarrhea, nausea, tremors, sweating, tachycardia) and SNRI-related symptoms (numbness, tingling, paresthesia, tinnitus).⁹ Withdrawal typically lasts longer than other opioids, with acute symptoms persisting seven days or more compared to three to four days for similar compounds.

Toxicity

Central Nervous System

Tramadol produces respiratory depression by direct action on brainstem respiratory centres; this effect is dose-dependent and becomes clinically significant at high doses or in combination with other depressants.¹⁰ Long-term use may be associated with diminished libido, apathy, and memory loss.

Cardiovascular

Acute cardiovascular effects include hypotension in susceptible individuals and mild QTc prolongation at higher doses; serious cardiac events are rare at typical doses.¹⁰

Endocrine

Chronic opioid use may influence the hypothalamic-pituitary-adrenal and gonadal axes, with potential increases in serum prolactin and decreases in cortisol and testosterone.

Gastrointestinal

Tramadol causes reduced gut motility and increased smooth muscle tone, resulting in constipation; this effect develops more slowly to tolerance than other opioid effects.

Hepatic

Caution is advised in patients with liver impairment due to hepatic metabolism of tramadol to its active metabolite.

Renal

Caution is advised in patients with kidney failure due to renal elimination of tramadol and its metabolites.

Psychosis Risk

Hallucinations, confusion, delirium, and paranoia can occur at high doses or during overdose.⁹ Psychiatric symptoms including hallucinations, extreme anxiety, and panic attacks may also emerge during withdrawal.⁹ These effects are not typical at common doses.

Seizure Risk

Tramadol is established to lower the seizure threshold in humans, distinguishing it from other opioids.¹¹ Seizures have been reported within the recommended dosage range, with risk increasing at doses above 300mg.¹⁰ Seizures occur in approximately half of acute poisoning cases.¹² Risk is further elevated in patients with epilepsy, history of seizures, or concurrent use of other medications that lower seizure threshold.¹¹ Grand mal seizures have been reported at doses as low as 100-400mg orally in rare cases.

History & Culture

Tramadol was developed in 1962 by researchers at Grünenthal, a German pharmaceutical company.¹ Despite its early synthesis, the compound did not receive regulatory approval in Germany until 1977, when it entered the market under the trade name…

Legality

International

1961 Single Convention: not internationally scheduled.

1971 Convention on Psychotropic Substances: not internationally scheduled.

1988 Convention: not listed as a controlled precursor.

By Country

United StatesPrescription onlySchedule IV

21 CFR 1308.14⁴⁹

Federally scheduled as of August 18, 2014 under the Controlled Substances Act.⁴⁸ Prior to federal scheduling, several states independently controlled tramadol including Arkansas, Illinois, Kentucky, Massachusetts, New York, Oklahoma, and Wyoming. Possession without prescription is illegal.

AustraliaPrescription onlySchedule 4

Therapeutic Goods (Poisons Standard—June 2026) Instrument 2026¹⁵

Classified as a Prescription-Only Medicine since 2001 under the Poisons Standard. Requires a valid prescription to obtain legally.

BelarusPrescription-only (Category B)

Classified under Category B pharmaceutical regulations requiring a valid prescription for legal possession.

BrazilPrescription onlyLista A2

Portaria SVS/MS nº 344/1998¹⁹²⁰

Classified under List A2 as a narcotic substance by ANVISA (Agência Nacional de Vigilância Sanitária). Requires prescription and is subject to controlled substance regulations.

CanadaPrescription onlySchedule I

Controlled Drugs and Substances Act and Narcotic Control Regulations²¹²²²³

Tramadol, its salts and isomers, and specified derivatives are Schedule I controlled substances under the Controlled Drugs and Substances Act. The Schedule I order and corresponding Narcotic Control Regulations amendment took effect on 31 March 2022. Pharmacists may provide a narcotic only on a practitioner’s signed and dated written prescription, subject to the Regulations; unauthorized possession is prohibited.

ColombiaAvailable without prescription

Can be purchased over-the-counter at drug stores along with other opioid-containing medications.

DenmarkPrescription onlyListe B

Bekendtgørelse om euforiserende stoffer²⁷²⁸

Tramadol is listed as a controlled substance in Denmark’s Executive Order on euphoriant substances. The Order permits euphoriant substances only for medical or scientific purposes. The Danish Medicines Agency identifies tramadol as a prescription-only analgesic.

EthiopiaAvailable without prescription

Regularly sold over-the-counter at fair-sized pharmacies, particularly in Addis Ababa. Official regulatory status unclear but practical availability is unrestricted.

GermanyPrescription onlyAnlage 1

Arzneimittelverschreibungsverordnung³¹

Regulated as a prescription medication according to Anlage 1 AMVV (Arzneimittelverschreibungsverordnung).³² Not classified as a narcotic under the BtMG but requires medical authorization.

IndonesiaAvailable without prescription

Reportedly available over-the-counter from pharmacies without prescription, though pricing may vary for tourists versus locals.

IrelandPrescription onlyPart A / Part B

Medicinal Products (Prescription and Control of Supply) Regulations 2003 (S.I. No. 540/2003)³³

Regulated under S.I. No. 540/2003. Legal to possess and use only with a valid prescription from a licensed medical practitioner.

JapanControlled import

Requires a simplified license to import for personal use, with a maximum 60-day supply permitted. Subject to customs inspection and possible review for reclassification.

LithuaniaControlled narcoticCitation needed

Controlled as a narcotic substance grouped with other opiates. Requires a specialized prescription form to acquire legally, rather than a standard prescription.

MexicoPrescription-only

Officially marked for prescription-sale only though enforcement varies by pharmacy. Possession without proper prescription can result in detention, arrest, or demands for bribes.

NorwayPrescription-only (not scheduled)

Requires a prescription but is not classified as a scheduled narcotic substance. Available through pharmacies with medical authorization.

PolandPrescription-only (not scheduled)

Not scheduled as a narcotic substance but classified as a prescription-only medication. Legal possession requires valid medical prescription.

RomaniaPrescription-only

Requires valid medical prescription for legal possession and use. Available through licensed pharmacies.

SingaporeControlled (poison legislation)

Not available over-the-counter. Controlled under poison legislation rather than drug control laws. Requires prescription for legal access.

SpainPrescription onlyPrescripción médica

Real Decreto Legislativo 1/2015³⁹⁴⁰

Launched in 1992 and was one of the only opioids not requiring special prescription forms. Usage increased significantly from 2.1 to 570.6 defined daily doses per million people per day between 1992 and 1998.

SwedenSchedule III (controlled)Citation needed

Classified as a controlled substance since December 2007, in the same category as codeine and dextropropoxyphene. Unlike other scheduled opioids, a normal prescription can be used rather than special prescription forms.

ThailandAvailable without prescription

As of May 2014, tramadol in 50mg and 100mg oral forms is available from pharmacies without prescription. Sold under the brand name Tramagesic.

UkrainePrescription onlyTable II · List 1

Cabinet of Ministers Resolution No. 770 of 6 May 2000⁴¹⁴²⁴³

Tramadol is listed in Table II, List No. 1 of Ukraine's national list of narcotic drugs, psychotropic substances, and precursors. It is supplied for medical indications through the controlled narcotic-medicines system, including electronic prescriptions and licensed pharmacies.

United KingdomPrescription onlyClass C · Schedule 3

Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001⁴⁵⁴⁶

Classified as a Class C drug under the Misuse of Drugs Act as of June 10, 2014.⁴⁷ Previously available as a prescription-only medicine without controlled substance status. Annual tramadol-related deaths declined following scheduling.

ArgentinaTechnically prescription-only

Officially requires prescription but practically available over-the-counter at many pharmacies in 50mg and 100mg tablets as well as IV ampules.

AustriaPrescription onlyAnlage III

Suchtgiftverordnung¹⁶¹⁷¹⁸

Legal for medical use under the Arzneimittelgesetz (AMG). Possession or sale without a valid prescription is illegal under the Suchtmittelgesetz (SMG).

BoliviaAvailable without prescription

Available in 50mg tablets and IV ampules over-the-counter at pharmacies without prescription.

CambodiaAvailable without prescription

Available from pharmacies without prescription. Typical cost approximately $1-2 USD for 10 capsules as of 2010.

ChinaPrescription onlyCategory II

Catalogue of Narcotic Drugs and Psychotropic Substances (2013 Edition), as adjusted by NMPA Announcement No. 43 of 2023; Regulations on the Administration of Narcotic Drugs and Psychotropic Substances²⁴²⁵²⁶

Tramadol is listed as a Category II psychotropic substance in China's Catalogue of Narcotic Drugs and Psychotropic Substances (2013 Edition), whose entry covers its salts and single-ingredient preparations. NMPA Announcement No. 43 of 2023 additionally placed compound tramadol preparations in the Category II psychotropic-substances catalogue from 1 July 2023. Under Article 32 of the Regulations on the Administration of Narcotic Drugs and Psychotropic Substances, retail supply of Category II psychotropic substances requires a practising physician's prescription and may not be made without one.

Costa RicaVariable enforcement

Available at some pharmacies without prescription though many require it. Sold in 50mg capsules and extended-release tablets up to 300mg.

EgyptControlled (prescription-only)

Listed as controlled since October 2002 and requires prescription. Despite national control, tramadol remained widely abused, with nearly 70% of people treated at addiction facilities using the drug as of 2015.

FrancePrescription onlySur ordonnance

Code de la santé publique; Base de données publique des médicaments²⁹³⁰

Tramadol Evolugen 50 mg is recorded in the French public medicines database as a medicine supplied only on prescription. French medicines authorities also limit tramadol prescriptions to 12 weeks. Supply is therefore restricted to the prescription-medicine system.

IndiaControlled substance

Classified as Schedule H (prescription-only) and brought under the Narcotic Drugs and Psychotropic Substances Act in April 2018 due to abuse concerns and links to criminal organizations.

IranPrescription-only

Was widely available over-the-counter until late 2009 when the Ministry of Health prohibited non-prescription sales. Now manufactured domestically and available through pharmacies with prescription only.

ItalyPrescription onlyTable I + Medicines A/D

Ministerial Decree of 29 July 2022 updating the tables under D.P.R. 309/1990³⁴³⁵

The Ministry of Health’s Decree of 29 July 2022 inserts tramadol itself in Tabella I of the controlled-substances tables under D.P.R. 309/1990. It also adds tramadol medicines to Allegato III-bis and to the Table of Medicines: tramadol as a pure substance and parenteral preparations are in section A, while compositions for non-parenteral administration are in section D. The decree entered into force on 8 November 2022, so medical products are subject to the controlled-medicines prescription rules applicable to their assigned section rather than being freely supplied.

KuwaitAvailable without prescription

Available over-the-counter in 50mg and 100mg capsule forms as of 2003.

MalaysiaNot controlled

Not listed as a First Schedule drug under the Dangerous Drugs Act 1952. May still require prescription under pharmaceutical regulations.

New ZealandPrescription onlyClass C

Misuse of Drugs Act 1975³⁶³⁷³⁸

Tramadol is listed as a Class C controlled drug in Part 2 of Schedule 3 to the Misuse of Drugs Act 1975. It is therefore supplied through New Zealand's controlled-drug prescription regime. As a controlled opioid, a tramadol prescription is limited to an amount reasonably required for one month of treatment.

PhilippinesAvailable without prescription

Available for purchase at major pharmacy chains without prescription in urban areas.

PortugalPrescription medication

Officially requires prescription though enforcement varies. Personal drug possession has been decriminalized since 2001, applying to small quantities for personal use.

RwandaAvailable without prescription

Widely available over-the-counter. Sold as Tramasec brand (tramadol HCl 50mg capsules) manufactured in India.

South AfricaSchedule 5

Classified as a Schedule 5 controlled substance for prescribed medical use only. Sale and possession without prescription is decriminalized and treated as a misdemeanor rather than a criminal offense.

Sri LankaPrescription-only

Difficult to obtain without proper prescription. Available through strict government-run medical stores with drugs imported from India.

SwitzerlandAbgabekategorie A

Listed as a Category A pharmaceutical requiring a medical prescription. Available through licensed pharmacies with valid prescription only.

TurkeyGreen prescription

Classified as a 'green prescription' medication indicating controlled status. Illegal to sell or possess without a valid medical prescription.

United Arab EmiratesStrictly controlled

Highly regulated with severe penalties. Only specialist surgeons can prescribe a maximum 4-week supply, with government review of each prescription. Possession without prescription can result in 4 years imprisonment. Tramadol is the strongest opioid available as morphine and codeine are banned.

References

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Citations

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Tramadol

2-[(Dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol

Ultram, Tramal, Ralivia, ConZip, Qdolo

Psychoactive Class

Opioid Depressant

Chemical Class

Phenylpropylaminopentane

Dosage & Duration

Dosage

Threshold~25 mg

Light50-100 mg

Moderate100-150 mg

Strong150-200 mg

Heavy200+ mg

Bioavailability

75%

Duration

Onset30-90 minutes

Peak2-4 hours

Offset2-4 hours

After Effects1-24 hours

Total6-8 hours

Half-life

5-6 hours

Subjective Effects

Effects vary widely by individual, dose, and context.

Physical

Constipation Cough suppression Difficulty urinating Nausea Sedation Pupil constriction Salivation

Cognitive

The physical effects of tramadol can be broken down into three components which progressively intensify proportional to dosage.

Anxiety suppression Compulsive redosing

Forked from Subjective Effect Documentation

by Josie KinsAugust 2015.

Reagent Testing

Loading reagent data

Expected colorimetric results are being prepared.

Pharmacology

Pharmacodynamics

Pharmacokinetics

Interactions

Dangerous

Highest risk

These combinations are considered extremely harmful and should always be avoided. Reactions to these drugs taken in combination are highly unpredictable and have a potential to cause death.

AlcoholAmphetaminesAMTBenzodiazepinesCocaineDiphenhydramineDXMGHB/GBLKetamineLithiumMAOIsMDMAMephedroneMXEOpioidsPCPSSRIs

Unsafe

Avoid

There is considerable risk of physical harm when taking these combinations, they should be avoided where possible.

2C-T-x compounds2C-x compounds5-MeO-xxT tryptaminesDMTDOx compoundsLSDMescalineNBOMe compoundsPregabalinPsilocybin mushrooms

Caution

Use caution

Nitrous oxide

TripSit

Tolerance

Full Tolerance

Baseline Reset

1-2 weeks in the absence of further consumption

Half Tolerance

3-7 days

Cross Tolerance

Opioids

Harm Potential

Addiction & Dependence

Psychological

Moderate

Physical

Moderate

Toxicity

Central Nervous System

Cardiovascular

Acute cardiovascular effects include hypotension in susceptible individuals and mild QTc prolongation at higher doses; serious cardiac events are rare at typical doses.¹⁰

Endocrine

Chronic opioid use may influence the hypothalamic-pituitary-adrenal and gonadal axes, with potential increases in serum prolactin and decreases in cortisol and testosterone.

Gastrointestinal

Tramadol causes reduced gut motility and increased smooth muscle tone, resulting in constipation; this effect develops more slowly to tolerance than other opioid effects.

Hepatic

Caution is advised in patients with liver impairment due to hepatic metabolism of tramadol to its active metabolite.

Renal

Caution is advised in patients with kidney failure due to renal elimination of tramadol and its metabolites.

Psychosis Risk

Seizure Risk

History & Culture

Legality

International

1961 Single Convention: not internationally scheduled.

1971 Convention on Psychotropic Substances: not internationally scheduled.

1988 Convention: not listed as a controlled precursor.

By Country

United StatesPrescription onlySchedule IV

21 CFR 1308.14⁴⁹

AustraliaPrescription onlySchedule 4

Therapeutic Goods (Poisons Standard—June 2026) Instrument 2026¹⁵

Classified as a Prescription-Only Medicine since 2001 under the Poisons Standard. Requires a valid prescription to obtain legally.

BelarusPrescription-only (Category B)

Classified under Category B pharmaceutical regulations requiring a valid prescription for legal possession.

BrazilPrescription onlyLista A2

Portaria SVS/MS nº 344/1998¹⁹²⁰

Classified under List A2 as a narcotic substance by ANVISA (Agência Nacional de Vigilância Sanitária). Requires prescription and is subject to controlled substance regulations.

CanadaPrescription onlySchedule I

Controlled Drugs and Substances Act and Narcotic Control Regulations²¹²²²³

ColombiaAvailable without prescription

Can be purchased over-the-counter at drug stores along with other opioid-containing medications.

DenmarkPrescription onlyListe B

Bekendtgørelse om euforiserende stoffer²⁷²⁸

EthiopiaAvailable without prescription

Regularly sold over-the-counter at fair-sized pharmacies, particularly in Addis Ababa. Official regulatory status unclear but practical availability is unrestricted.

GermanyPrescription onlyAnlage 1

Arzneimittelverschreibungsverordnung³¹

Regulated as a prescription medication according to Anlage 1 AMVV (Arzneimittelverschreibungsverordnung).³² Not classified as a narcotic under the BtMG but requires medical authorization.

IndonesiaAvailable without prescription

Reportedly available over-the-counter from pharmacies without prescription, though pricing may vary for tourists versus locals.

IrelandPrescription onlyPart A / Part B

Medicinal Products (Prescription and Control of Supply) Regulations 2003 (S.I. No. 540/2003)³³

Regulated under S.I. No. 540/2003. Legal to possess and use only with a valid prescription from a licensed medical practitioner.

JapanControlled import

Requires a simplified license to import for personal use, with a maximum 60-day supply permitted. Subject to customs inspection and possible review for reclassification.

LithuaniaControlled narcoticCitation needed

Controlled as a narcotic substance grouped with other opiates. Requires a specialized prescription form to acquire legally, rather than a standard prescription.

MexicoPrescription-only

Officially marked for prescription-sale only though enforcement varies by pharmacy. Possession without proper prescription can result in detention, arrest, or demands for bribes.

NorwayPrescription-only (not scheduled)

Requires a prescription but is not classified as a scheduled narcotic substance. Available through pharmacies with medical authorization.

PolandPrescription-only (not scheduled)

Not scheduled as a narcotic substance but classified as a prescription-only medication. Legal possession requires valid medical prescription.

RomaniaPrescription-only

Requires valid medical prescription for legal possession and use. Available through licensed pharmacies.

SingaporeControlled (poison legislation)

Not available over-the-counter. Controlled under poison legislation rather than drug control laws. Requires prescription for legal access.

SpainPrescription onlyPrescripción médica

Real Decreto Legislativo 1/2015³⁹⁴⁰

SwedenSchedule III (controlled)Citation needed

ThailandAvailable without prescription

As of May 2014, tramadol in 50mg and 100mg oral forms is available from pharmacies without prescription. Sold under the brand name Tramagesic.

UkrainePrescription onlyTable II · List 1

Cabinet of Ministers Resolution No. 770 of 6 May 2000⁴¹⁴²⁴³

United KingdomPrescription onlyClass C · Schedule 3

Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001⁴⁵⁴⁶

ArgentinaTechnically prescription-only

Officially requires prescription but practically available over-the-counter at many pharmacies in 50mg and 100mg tablets as well as IV ampules.

AustriaPrescription onlyAnlage III

Suchtgiftverordnung¹⁶¹⁷¹⁸

Legal for medical use under the Arzneimittelgesetz (AMG). Possession or sale without a valid prescription is illegal under the Suchtmittelgesetz (SMG).

BoliviaAvailable without prescription

Available in 50mg tablets and IV ampules over-the-counter at pharmacies without prescription.

CambodiaAvailable without prescription

Available from pharmacies without prescription. Typical cost approximately $1-2 USD for 10 capsules as of 2010.

ChinaPrescription onlyCategory II

Costa RicaVariable enforcement

Available at some pharmacies without prescription though many require it. Sold in 50mg capsules and extended-release tablets up to 300mg.

EgyptControlled (prescription-only)

FrancePrescription onlySur ordonnance

Code de la santé publique; Base de données publique des médicaments²⁹³⁰

IndiaControlled substance

Classified as Schedule H (prescription-only) and brought under the Narcotic Drugs and Psychotropic Substances Act in April 2018 due to abuse concerns and links to criminal organizations.

IranPrescription-only

ItalyPrescription onlyTable I + Medicines A/D

Ministerial Decree of 29 July 2022 updating the tables under D.P.R. 309/1990³⁴³⁵

KuwaitAvailable without prescription

Available over-the-counter in 50mg and 100mg capsule forms as of 2003.

MalaysiaNot controlled

Not listed as a First Schedule drug under the Dangerous Drugs Act 1952. May still require prescription under pharmaceutical regulations.

New ZealandPrescription onlyClass C

Misuse of Drugs Act 1975³⁶³⁷³⁸

PhilippinesAvailable without prescription

Available for purchase at major pharmacy chains without prescription in urban areas.

PortugalPrescription medication

Officially requires prescription though enforcement varies. Personal drug possession has been decriminalized since 2001, applying to small quantities for personal use.

RwandaAvailable without prescription

Widely available over-the-counter. Sold as Tramasec brand (tramadol HCl 50mg capsules) manufactured in India.

South AfricaSchedule 5

Sri LankaPrescription-only

Difficult to obtain without proper prescription. Available through strict government-run medical stores with drugs imported from India.

SwitzerlandAbgabekategorie A

Listed as a Category A pharmaceutical requiring a medical prescription. Available through licensed pharmacies with valid prescription only.

TurkeyGreen prescription

Classified as a 'green prescription' medication indicating controlled status. Illegal to sell or possess without a valid medical prescription.

United Arab EmiratesStrictly controlled

References

Source Pages

Citations

Suggest an edit

Spotted a mistake, an outdated claim, or something missing from the Tramadol article? Send the editors a private note. Feedback lands in a moderation queue and is never shown on the site.

Tramadol

Contents

Dosage & Duration

Dosage

Duration

Subjective Effects

Physical

Cognitive

Reagent Testing

Pharmacology

Pharmacodynamics

Pharmacokinetics

Interactions

Dangerous

Unsafe

Caution

Tolerance

Harm Potential

Addiction & Dependence

Psychological

Physical

Toxicity

Psychosis Risk

Seizure Risk

History & Culture

Legality

International

By Country

References

Source Pages

Citations

Further Reading

Suggest an edit

Tramadol

Contents

Dosage & Duration

Dosage

Duration

Subjective Effects

Physical

Cognitive

Reagent Testing

Pharmacology

Pharmacodynamics

Pharmacokinetics

Interactions

Dangerous

Unsafe

Caution

Tolerance

Harm Potential

Addiction & Dependence

Psychological

Physical

Toxicity

Psychosis Risk

Seizure Risk

History & Culture

Legality

International

By Country

References

Source Pages

Citations

Further Reading

Suggest an edit