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WADA issues further tramadol guidance for players, support teams and medical personnel

WADA issues further tramadol guidance for players, support teams and medical personnel

Following publication of the World Anti-Doping Agency [WADA] Prohibited List for 2024, which includes the banning of well-known pain-killer tramadol from in-competition use, further guidance has been provided to assist players, support teams and medical personnel with the upcoming changes.

WADA has issued fact sheets for both players and medical personnel to help prepare them for the 2024 season. These fact sheets have been distributed to medical personnel and the relevant tour bodies, but can be summarised by the following five key points:

1. From 1 January 1 2024,  tramadol will be added to the S7 (narcotics) category of the WADA Prohibited List . This means it will be banned in competition only.

2. Tramadol is an opioid that is used to treat moderate to severe pain. Recent scientific research has suggested that it can also have performance-enhancing effects. Moreover, it is highly addictive, which poses a health risk to athletes.

3. If a player’s physician prescribes tramadol to use incompetition to treat a diagnosed medical condition, players must apply for a Therapeutic Use Exemption (TUE) before they start taking the medication.

4. If players use tramadol within 24 hours before the start of the in-competition period, there is a risk that a sample collected in-competition will return a positive finding.

5. If players use tramadol more than 24 hours before the in-competition period, it is unlikely, but not impossible, that an in-competition test result will be positive.

To download the fact sheets, click here (athletes’ guidance) or here (medical professionals' guidance).

The ITIA remains committed to supporting members of the tennis community – whether they are players, representatives, support staff, coaches, or medical personnel – in understanding all elements of the Tennis Anti-Doping Programme and WADA Prohibited List.

Players seeking further understanding of the WADA Prohibited List, or seeking practical support from the ITIA on anti-doping matters, can make contact with us directly via our app, through direct message on social media, or by filling out the contact form at

Tramadol & the WADA 2024 Prohibited List

Tramadol & the WADA 2024 Prohibited List


What is tramadol?

Tramadol is a synthetic opioid pain medication used to treat moderate-to-severe pain. It is sometimes used to treat pain due to sports injuries in athletes. It is in the category of “Narcotics” on the Prohibited List.

Tramadol is available in many different formulations, and is sold under many various brand names in different countries. Examples of brand names include: Tramal, Tramedo, Tramake, Zydol. Many other brand names exist and so athletes should check with their doctor or pharmacist what brands are prescribed in their own countries.

How does a substance get added to the Prohibited List?

For a substance to be placed on the Prohibited List it must meet two of the three following criteria:

  • It has the potential to enhance or enhances performance
  • It represents and actual or potential health risk to the athlete
  • It violates the spirit of sport

Which criteria does tramadol meet?

Recent studies have confirmed the potential to enhance physical performance in certain activities. Read one of the studies here: Is tramadol a performance enhancing drug?

Tramadol use has potential health risks for athletes. It can result in serious side effects, which include addiction and physical dependence, seizures and decreased alertness.

Use of tramadol for the purpose of performance enhancement is also against the spirit of sport.

When is tramadol banned?

Athletes will be prohibited to use tramadol during the in-competition period unless they have a Therapeutic Use Exemption (TUE).
What is the In-Competition period?

The in-competition period usually begins at 11:59pm on the night before competition, but always check your International Federation’s (IF) Anti-Doping Rules.

Use of tramadol for urgent or emergency treatment of pain

Sometimes tramadol is required to be prescribed and administered to athletes for the urgent or emergency treatment of pain, such as when a severe, painful injury occurs during sport. When required for urgent or emergency treatment during the in-competition period, a Retroactive TUE should be applied for. It is therefore important that your doctor keeps good medical records of tramadol administration as it will be needed for this purpose.

I’m an athlete and I sometimes take tramadol for pain: what do I need to do?

Tell your doctor that tramadol is banned in-competition in sport. Ask them to consider your treatment options and possible alternatives.

If you require tramadol for your condition, ask your doctor to support you in submitting a TUE application. This may be a “Retroactive TUE” if tramadol was needed urgently for emergency treatment.

Understand the process around TUEs and whether you need one. Make sure you follow the necessary steps and have the required medical documentation. The ITA Athlete Hub is an excellent resource for more information on these topics.

Consequences of taking prohibited substances

The consequences of a positive test for a substance on the Prohibited List can be wide-ranging, with potential serious adverse effects to your health, sanctions from competing in your sport which will impact your sporting career, social and family network and potentially your finances.

You can find two interesting webinars on the ITA YouTube channel about the consequences of doping. Check out this playlist, or watch them directly below.


The 2024 Prohibited List: Summary of Changes

The World Anti-Doping Agency (WADA) has recently released the 2024 Prohibited List (the List), which details the substances and methods that are banned within sport. Broken down into several categories, the List identifies which substances and methods are prohibited at all times, in-competition only, and within specific sports.

Following an extensive consultation period by WADA, the 2024 List was published on 27 September 2023. This gives athletes and their support personnel sufficient time to make themselves aware of the changes, review any medications they use, and apply for a Therapeutic Use Exemption (TUE) if required before the updated List comes into effect on 01 January 2024.

The below sections summarise the major changes to the List for 2024. Please consult the 2024 Summary of Major Modifications and Explanatory Notes document for the full list of modifications.


Tramadol will be prohibited in-competition under Section 7 Narcotics.

UKAD will shortly be releasing a position statement for athletes and doctors on how to comply with the new tramadol regulations. This document will include the timeframes for when an athlete should submit a TUE for the use of tramadol, the factors to consider when making such an application, and scenarios whereby a TUE is unlikely to be granted.

Removal of plasmapheresis as a prohibited method

The donation of plasma or plasma components by plasmapheresis will no longer be prohibited when performed in a registered collection centre.


Tramazoline has been added to Section 6 Stimulants as an example of an imidazoline derivative which is permitted when administered by dermatological, nasal, ophthalmic, or otic routes. It is prohibited by any other route of administration.

Additional Examples

Several new examples of prohibited substances have been added to various categories of the List. Please note that these are not new substances being added to the 2024 List for the first time but are additional examples of substances that are already prohibited.

Monitoring Program

WADA has also published the 2024 Monitoring Program which lists substances (not on the Prohibited List) that are currently being monitored for potential misuse by WADA.

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