Tramadol and xanax are both centrally acting drugs that target the brain. Both have potential for abuse and can be dangerous if not taken as directed.

As with any medication, it is important to understand the risks of taking these substances together before combining them.

How Does Xanax Work?

Xanax is a benzodiazepine. People typically use benzodiazepines like Xanax for anxiety disorders, panic attacks, or other related conditions. Benzodiazepines bind to receptors in the brain and cause sedation.

The specific receptors that Xanax targets are the GABA receptors. GABA is the brain chemical that has a calming effect. People with anxiety disorders often have lower levels of GABA receptors.

Therefore, when Xanax binds to GABA receptors, it boosts the calming effect. Benzodiazepines also have anticonvulsant properties. This means that they can be used to treat seizure disorders.

Xanax has FDA approval as an adjunctive treatment for seizures in children and adults. However, many people take Xanax off-label to treat generalized anxiety disorder (GAD).

How Does Tramadol Work?

Tramadol is an opioid, meaning it works by binding to opioid receptors in the brain. These receptors cause the release of neurotransmitters like serotonin, norepinephrine, and dopamine.

These chemicals control mood, hunger, sleep, and pain. The most well-known opioid is morphine.

Tramadol works on two opioid receptors: Mu and norepinephrine. Tramadol is a serotonin reuptake inhibitor (SRI). It targets the serotonin receptors in the brain.

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SSRIs are often prescribed for depression. Tramadol also works on norepinephrine receptors, causing a rise in serotonin. This combination is why Tramadol is often used to treat pain, anxiety, and depression.

What Happens When You Mix Xanax and Tramadol?

Mixing Xanax and Tramadol can cause an overdose or increase the potential for addiction. Xanax and Tramadol both cause sedation.

However, Xanax is a benzodiazepine and Tramadol is an opioid. Combining these drugs increases the risk of adverse effects.

When you mix Xanax and Tramadol, you may experience the following effects: 

Respiratory depression

  • Tramadol can decrease the rate of respiration. Combining the drugs can cause respiratory depression, which can be lethal.

Respiratory arrest

  • Tramadol can cause respiratory arrest. Combining the drugs can increase the risk of death.


  • Tramadol causes seizure risk. Combining the drugs can increase the risk of seizure.

Cardiac arrest

  • Tramadol can cause cardiac arrest. Concomitant use of Xanax can increase the risk of cardiac arrest.

How to Avoid the Mixing Mistakes

If you are on a benzodiazepine and you find that you need to take an opioid, then you should reduce your benzodiazepine dose as much as possible before taking the opioid.

There are several steps you can take to reduce the risk of mixing errors:

  • Always take benzodiazepines as directed. If you take too much Xanax, or take it with other drugs, you are at a high risk of adverse side effects and overdose.
  • Never take opioids as directed. The prescribed dose of opioids is only enough to treat pain. Taking more opioids can increase your risk of adverse side effects and overdose.
  • Avoid taking Xanax and Tramadol together. If you need to take both medications, then you should reduce your dosage of Xanax.
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Final Words

Xanax and Tramadol are both addictive medications that can be dangerous when taken together. Xanax is a benzodiazepine that treats conditions like anxiety and seizures. Tramadol is an opioid that treats pain, depression, and anxiety.

Combining these drugs can cause serious adverse effects and even death. If you are taking these drugs, always follow the directions and avoid taking them together.


David with lots of experience and knowledge in medications that are utilized to treat a wide range of medical conditions. Before David dispenses a medication to a patient, he will go over the side effects, dosage recommendation and contraindications.