The effect of tramadol on blood glucose concentrations: a systematic review

Expert Rev Clin Pharmacol. 2020 May;13(5):531-543. doi: 10.1080/17512433.2020.1756773. Epub 2020 May 12.


Introduction: Studies comprehensively summarizing the impact of tramadol use on glucose homeostasis are very sparse. Thus, the present study was performed to collect and summarize the latest information about this issue in a systematic way.

Areas covered: An exhaustive literature search was carried out using relevant keywords. Web of Sciences, PubMed, Scopus, and Google scholar were interrogated until 30 June 2019. Case-control, cohort, cross-sectional, clinical trial, case report, and animal studies that focused on the objective of the study were retrieved. This review summarizes the results of 761 papers on glycemic changes due to tramadol exposure. Thirty-six publications reported hypoglycemia and 17 hyperglycemia during tramadol use. Twenty-two studies either reported normal blood glucose concentrations, or did not observe any difference in the blood glucose levels following tramadol use. Finally, hypoglycemia was reported in diabetic individuals exposed to tramadol in 12 studies.

Expert opinion: The data suggest that primarily hypoglycemia but some degree of hyperglycemia has been reported with tramadol use. Importantly, all studies on tramadol use in diabetes reported hypoglycemia. Tramadol-induced hypoglycemia may be severe in some cases. The risk of alterations in glucose homeostasis accompanying tramadol exposure indicates time importance of careful blood glucose monitoring during tramadol use.

Keywords: Tramadol; blood glucose level; hyperglycemia; hypoglycemia; poisoning.

Publication types

  • Systematic Review

MeSH terms

  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Animals
  • Blood Glucose / analysis
  • Blood Glucose / drug effects*
  • Humans
  • Hyperglycemia / chemically induced
  • Hypoglycemia / chemically induced
  • Tramadol / administration & dosage
  • Tramadol / adverse effects*


  • Analgesics, Opioid
  • Blood Glucose
  • Tramadol