Tramadol — a synthetic opioid — generally starts to relieve pain within an hour in its fast-acting forms, which are used for short-term pain management.

Fast-acting forms include:

• Drops
• Injections
• Some formulations of tablets and capsules

With slow-release or extended-release (ER) forms, the drug may take longer to start because it’s gradually released over 12 or 24 hours, but pain relief lasts longer. Slow-release tramadol is used to help with long-term pain. Slow-release forms include some formulations of tablets and capsules.

How quickly it takes the pain relieving effect to kick in can be affected by whether tramadol is combined with another pain relieving medication, such as a nonsteroidal anti-inflammatory drug. Tramadol should not be taken with other opioid medications.

When you take tramadol and it is absorbed into the bloodstream, you get a gradual onset of pain relief, that then reaches a peak, before the pain relieving effect tapers off.

• Fast-acting tramadol peaks in your system after 2 to 3 hours, and typically lasts around 6 hours. It’s taken every 4 to 6 hours as needed for pain.
• The extended-release version peaks at 10 to 12 hours, but generally provides lasting pain relief for up to 24 hours. It’s taken once daily.

Does taking tramadol with food change how fast it works?

Whether food will affect how fast tramadol works depends on which form of tramadol you are taking.

• Tramadol conventional tablets: food does not significantly change how fast or how much tramadol is absorbed.
• Tramadol extended-release capsules: food does not significantly change how fast or how much tramadol is absorbed.
• Tramadol extended-release tablets: by taking it with a high fat meal lowers the peak plasma concentration (by about 28%), amount of absorption (by about 16%) and slows the time to peak concentrations (by approximately 3 hours). This will mean that when you take it with a high fat meal that it could take longer to start working and you may find you do not get as much pain relief, when compared to taking it with a low fat meal or empty stomach.
• Fixed combination with acetaminophen: food slows the time to peak plasma concentration by half to one hour.

Tamadol should be taken in its original form. It cannot be split, chewed or crushed. It also shouldn’t be dissolved.

Tramadol dose

• For fast-acting tramadol, the recommended limit is 400 mg per day. A starting dose is 25 mg or 50 mg. After titration, 50 mg to 100 mg may be taken as needed for pain relief every 4 to 6 hours.
• For extended-release tramadol, the recommended limit is 300 mg per day. It’s taken once daily and comes in three different strengths: 100 mg, 200 mg and 300 mg.

When you first start taking tramadol, a lower dose is prescribed and then slowly raised every few days until the optimal dose is found. People who have kidney disease, liver disease or are over 75 years old may need to take lower doses of tramadol.

When you’re in pain, it can be hard to wait for a medication to take effect, but it’s very important not to take more tramadol than prescribed.