Which of the following is NOT a known side effect associated with Tramadol (Ultram)?

• A. Dizziness
• B. Dry mouth
• C. Mydriasis
• D. Nausea

Answer: (C)

Tramadol works as a weak opioid receptor agonist and also inhibits serotonin and norepinephrine reuptake, so its common adverse effects follow that mix. Dizziness happens because of central nervous system depression and impaired balance. Dry mouth is a frequent, straightforward side effect due to reduced salivation. Nausea is a well-known GI and central nervous system effect of opioids and related drugs. In contrast, pupil dilation is not typical for tramadol; opioids usually cause pupil constriction (miosis). So dilation of the pupils would not be expected as a tramadol-associated side effect. If you ever see mydriasis, look for other causes or drugs interacting with tramadol rather than tramadol itself.