Raw research findings for this medication. Mostly single studies, not curated or confirmed robust.
Tramadol is an opioid pain medicine for moderate to fairly severe pain. It works in two ways: its main breakdown product acts on the body's opioid receptors, and tramadol itself also raises serotonin and noradrenaline in the nerves that carry pain signals. It is sold as Ultram and ConZip, among other names.
Much of tramadol's pain relief comes from O-desmethyltramadol, which the liver enzyme CYP2D6 makes from it. People with two non-working CYP2D6 copies (poor metabolizers, about 5 to 10 in 100 people of European ancestry) make little of it and may get less relief; people with extra working copies (ultrarapid metabolizers) make more of it faster, with a higher chance of opioid side effects. CPIC and DPWG have published guidelines on CYP2D6 and tramadol, and the US drug label warns about ultrarapid metabolizers. Studies have also looked at the opioid receptor gene OPRM1, the transporter ABCB1 and others, with weaker evidence.
Clinical guidelines that name a gene for Tramadol. They sort people into groups by the gene copies they carry.
CPIC guideline: CYP2D6. CYP2D6 activity score 0 to 6 or more. Strong. 2021.
DPWG guideline: CYP2D6. CYP2D6 activity score 0 to 6 or more. 2022.
US FDA: CYP2D6. CYP2D6 activity score 2.5 to 6 or more.
Every published finding on gene variants and Tramadol. Upload your DNA file to see which of these rows apply to you.
PharmGKB weighs all studies of a variant and rates how strong the evidence is, from 1A (strongest) to 4.
CYP2D6 CYP2D6*1, CYP2D6*1xN, CYP2D6*2, CYP2D6*3, CYP2D6*4, CYP2D6*5, CYP2D6*6, CYP2D6*9, CYP2D6*10, CYP2D6*17, CYP2D6*41: Level 1A · replicated. Metabolism/PK. 29.
CYP2D6 CYP2D6*1, CYP2D6*3, CYP2D6*4, CYP2D6*5, CYP2D6*6, CYP2D6*10, CYP2D6*17: Level 1A · replicated. Efficacy: Pain, Pain, Postoperative. 13.
CYP2D6 CYP2D6*1, CYP2D6*1xN, CYP2D6*2, CYP2D6*2xN: Level 1A · replicated. Toxicity: Cardiotoxicity, Drug Toxicity. 3.
CYP2D6 CYP2D6*1, CYP2D6*3, CYP2D6*4, CYP2D6*5, CYP2D6*6, CYP2D6*10: Level 2A · replicated. Dosage: Pain. 8.
Studies of how quickly the body processes this medication.
Studies of how well it worked in people carrying a variant.
Studies of how much of the drug people needed or tolerated.
Studies that do not fall into the groups above.
Study findings and evidence levels: PharmGKB (CC BY-SA 4.0). Guidelines: CPIC and DPWG, as bundled in PharmCAT. Most studies were done mainly in people of European ancestry.
More drugs from the same category
Not a prescribing recommendation. This page is educational information about pharmacogenomic research and clinical guidelines - it is not medical or dosing advice, and not a prediction of how any medication will work for you. Never start, stop, or change a medication or dose based on it; talk to your doctor or pharmacist, who can order clinical-grade testing if appropriate.
Content updated September 2026.
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