Interesting read. .
Apparently liver failure could happen after an acute overdose of tramadol, but this site says generally normal therapeutic doses aren't very harmful to the liver.
This was last updated in April 2020.
"In some situations, acute liver failure after tramadol overdose may be related to acetaminophen taken separately or in combination with tramadol. Clinically apparent idiosyncratic liver injury with recommended doses of tramadol has not been reported."
"The minor enzyme elevations that occur with tramadol use are usually mild, asymptomatic and self-limited, resolving even with continuation of therapy. Cases of acute liver failure due to tramadol overdose require intensive medical management and can be fatal. In acute overdoses, there may be interaction with other agents capable of causing liver injury (particularly acetaminophen)."
It sounds like a lot of people who may have had liver issues after using tramadol may have been using incredibly high doses and taking drugs that interacted with the liver as well.
I swear I read awhile back ago too that tramadol was a recommended opioid for people with renal failure or kidney problems, since it is not metabolized in the kidneys. I could be wrong however though, it's been a long time.
I will have to do some more digging on this topic. As for my anecdotal report,
I survived 400-600mg doses for quite a long time, without any damage that i'm aware of. I do recall some times looking like my eyes were jaundice after taking a hefty dose of tramadol. So I would not be surprised honestly if it did have some impact on the liver, but probably nothing compared to some one who drinks every day. Which I also use to do a lot of.
I use to take high dose tramadol, smoke lots of meth, do dirty street heroin, drink vodka and drink dxm. I'm surprised my organs still function at all.