Finding a loose white pill marked AN 627 can be worrying, especially if you don’t know who it belongs to or whether it came from a pharmacy. A wrong identification can lead to a dangerous dose or drug combination. Tramadol can cause seizures, extreme sleepiness, and slow breathing.
A legitimate white, round pill with “AN” above “627” contains immediate-release tramadol hydrochloride 50 mg. The tablet is unscored, film-coated, 9 mm wide, and plain on the back. It is used in adults for severe acute pain when other treatments are inadequate. Check it against labeled pharmacy packaging before taking it because appearance alone cannot confirm what a loose pill contains or where it came from.
What is the AN 627 pill?
The AN 627 pill is tramadol hydrochloride 50 mg. It is an immediate-release opioid pain medicine manufactured by Amneal Pharmaceuticals of NY LLC and distributed by Amneal Pharmaceuticals LLC.
“AN” appears above “627” on one side of the tablet. The other side is plain.
| Identification detail | Information |
|---|---|
| Imprint | AN above 627 |
| Active ingredient | Tramadol hydrochloride |
| Strength | 50 mg |
| Color | White |
| Shape | Round |
| Size | 9 mm |
| Coating | Film-coated |
| Score line | None |
| Back of tablet | Plain |
| Release type | Immediate release |
| Drug class | Opioid analgesic |
| Legal status | Prescription only |
| Controlled substance | Schedule IV |
| Manufacturer | Amneal Pharmaceuticals of NY LLC |
| Distributor | Amneal Pharmaceuticals LLC |
| Original Amneal NDC product code | 65162-627; package-specific and repackager NDCs may differ |
A visual match can support pill identification. It cannot confirm what a loose tablet contains or whether it came from a licensed pharmacy. Counterfeit tablets may copy the appearance and markings of prescription medicines.
Is AN 627 an opioid or narcotic?
Yes. Tramadol is an opioid pain medicine and may also be called a narcotic. It acts on opioid receptors in the brain and spinal cord.
Tramadol is a Schedule IV controlled substance in the United States. It can cause misuse, physical dependence, addiction, overdose, and death.
Is AN 627 immediate release?
Yes. AN 627 contains immediate-release tramadol.
Extended-release tramadol uses different tablets and dosing instructions. Check the imprint and prescription label before taking any tramadol product.
What is tramadol 50 mg used for?
AN 627 is used in adults for short-term treatment of acute pain severe enough to require an opioid. A prescriber may consider it when other pain treatments are inadequate or cannot be used.
It may be prescribed after an injury, dental procedure, or surgery. The dose and treatment length depend on the cause of the pain, the patient’s health, other medicines, and previous opioid use.
AN 627 is not oxycodone, an anti-inflammatory medicine, or a muscle relaxant. It does not treat swelling or muscle spasms directly.
How does AN 627 relieve pain?
Tramadol’s full pain-relieving action is not completely understood. It binds to mu-opioid receptors and weakly slows the reuptake of the brain chemicals norepinephrine and serotonin.
The liver converts some tramadol into an active substance called O-desmethyltramadol, or M1. M1 has stronger opioid activity than tramadol itself.
Some people have a CYP2D6 gene difference that converts tramadol into M1 faster than expected. This can produce dangerously high opioid effects and serious breathing problems, even when a prescribed dose is taken. People known to be CYP2D6 ultra-rapid metabolizers should not use tramadol.
Other people produce less M1 and may receive less pain relief. Genetics, other medicines, age, and liver or kidney health can all change how a person responds to tramadol.
AN 627 dosage and directions
Take tramadol exactly as written on your prescription label. Your dose depends on your pain, age, medical history, liver and kidney function, other medicines, and past opioid use.
A prescriber may use a gradual starting plan when rapid pain relief is not required. This plan can begin at 25 mg per day and increase in small steps. AN 627 is an unscored 50 mg tablet, so splitting it may not produce equal 25 mg doses. A liquid formulation or another dosing method may be needed. Follow the directions given by your prescriber and pharmacist.
After gradual dose increases, the general adult range is 50 to 100 mg every 4 to 6 hours as needed. The usual maximum is 400 mg in 24 hours. Your prescription may set a lower dose or longer interval.
| Patient group | Dose limit or adjustment |
|---|---|
| Most adults after dose adjustment | 50 to 100 mg every 4 to 6 hours as prescribed |
| General adult maximum | 400 mg per day |
| Adults older than 75 | Maximum 300 mg per day |
| Severe kidney impairment with creatinine clearance below 30 mL/min | The dosing interval is increased to 12 hours, with a maximum of 200 mg per day. A prescriber must choose the individual dose. |
| Severe liver impairment | 50 mg every 12 hours |
These are general label limits. Your prescription provides the dose meant for you. Taking extra tablets can cause seizures, breathing problems, coma, or death.
How should you take tramadol?
Tramadol can be taken with or without food. Food does not meaningfully change how the tablet is absorbed.
Follow these safety steps:
- Take only the amount written on your prescription label.
- Keep the required time between doses.
- Do not combine it with another tramadol product.
- Do not share it with another person.
- Avoid alcohol during treatment.
- Wait until you know how it affects you before driving.
- Contact your prescriber if the medicine does not control your pain.
How long can you take AN 627?
When an immediate-release opioid is needed for acute pain after an injury or procedure, treatment often lasts only a few days. Use tramadol for the shortest time prescribed.
Treatment that continues beyond a few days should be reviewed regularly for pain relief, side effects, misuse, and overdose risk. Do not continue taking leftover tablets for a new pain condition without speaking with a healthcare professional.
What should you do if you miss a dose?
Take your next dose at the usual time. Do not take an extra dose or 2 doses together to replace the missed one.
Contact your pharmacist if your directions are unclear or you take tramadol on a fixed schedule.
Can you split or crush an AN 627 tablet?
AN 627 has no score line. Swallow the tablet whole unless your pharmacist or prescriber gives you different instructions. Splitting an unscored tablet may produce unequal doses.
Do not crush, chew, or dissolve AN 627 unless your pharmacist or prescriber confirms that it is appropriate. Never snort, inject, or misuse tramadol. These actions can cause overdose, seizures, and death.
How long does AN 627 take to work?
Pain relief usually begins within about 1 hour and reaches its strongest point in about 2 to 3 hours.
Tramadol has an average elimination half-life of about 6.3 hours. Its M1 metabolite has an average half-life of about 7.4 hours. A half-life measures how long the body takes to remove half of a substance.
Kidney disease, liver disease, older age, genetics, dose size, and other medicines can extend these times. Pain relief may wear off before the drug has fully left the body.
How long do the effects last?
Immediate-release tramadol is commonly prescribed every 4 to 6 hours as needed. The length of pain relief differs based on the dose, type of pain, metabolism, and previous opioid use.
Do not take the next dose early when pain returns. Contact your prescriber if the medicine wears off too soon.
How long does tramadol stay in your system?
Most tramadol leaves the body over several half-lives. The full time differs from one person to another.
Drug-test results depend on the test used, the dose, how often the medicine was taken, and kidney or liver function. Many basic opiate screens do not automatically test for tramadol. A test designed to detect tramadol may find it. Ask the testing laboratory which substances its panel includes.
Common AN 627 side effects
The most frequently reported side effects include:
- Dizziness
- Nausea
- Constipation
- Headache
- Sleepiness
- Vomiting
- Itching
- Tiredness
- Sweating
- Dry mouth
- Abdominal discomfort
Dizziness and sleepiness can raise the risk of falls and driving accidents. Stand up slowly and avoid driving until you know how the medicine affects you.
Constipation can become severe during opioid treatment. Ask your healthcare professional about fluids, dietary fiber, physical activity, or a suitable constipation medicine.
Contact your prescriber if a side effect is severe, continues, or becomes worse.
Serious tramadol side effects
Some reactions require emergency treatment.
Call 911 immediately for:
- Slow, shallow, or stopped breathing
- Extreme sleepiness or inability to wake
- Collapse or loss of consciousness
- A seizure
- Blue or gray lips or fingertips
- Swelling of the face, lips, tongue, or throat
- Severe trouble breathing
- New or severe chest pain, especially with fainting or severe weakness
Breathing problems are more likely during the first 24 to 72 hours of treatment, after a dose increase, or when tramadol is combined with another sedating substance.
Serotonin syndrome
Tramadol affects serotonin. Too much serotonin can cause a medical emergency called serotonin syndrome.
Possible symptoms include:
- Agitation or confusion
- Fever
- Heavy sweating
- Fast heartbeat
- Diarrhea or vomiting
- Shaking
- Muscle stiffness
- Poor coordination
- Overactive reflexes
Seek urgent medical care if agitation or confusion occurs with fever, heavy sweating, shaking, muscle stiffness, or poor coordination after tramadol is started, its dose is raised, or another serotonin-raising medicine is added.
Call 911 if the person has a seizure, collapses, has trouble breathing, or cannot be awakened.
Seizures
Tramadol can cause seizures at a prescribed dose. The risk rises with higher doses, a seizure disorder, alcohol or drug withdrawal, head injuries, and certain antidepressants or other interacting medicines.
Call 911 if a seizure occurs.
New or worsening pain
Opioids can sometimes increase sensitivity to pain. This is called opioid-induced hyperalgesia.
Contact your prescriber if your pain becomes worse, spreads to a new area, or begins after light touch. Do not take extra tablets to manage these symptoms.
Low sodium or low blood sugar
Tramadol has been linked to dangerously low sodium levels. Most reported cases occurred in women older than 65 during the first week of treatment.
Contact a healthcare professional promptly for confusion, unusual weakness, headache, or balance problems.
Low blood sugar has also occurred, especially in people with diabetes, kidney problems, or older age. Symptoms may include shaking, sweating, weakness, confusion, hunger, and a fast heartbeat.
If you have diabetes and these symptoms occur, check your blood sugar if possible and follow the treatment plan given by your healthcare professional. Seek urgent help if the person becomes severely confused, faints, or cannot swallow safely.
Low adrenal hormone levels
Opioids can rarely cause adrenal insufficiency, especially after treatment lasting longer than 1 month.
Symptoms may include ongoing nausea, vomiting, poor appetite, unusual weakness, dizziness, and low blood pressure. Contact your healthcare professional if these symptoms occur together.
Swallowing problems
Opioids can change how the esophagus moves. This condition is called opioid-induced esophageal dysfunction.
Contact your prescriber if swallowing becomes difficult, food feels stuck, or food or liquid repeatedly comes back up. Seek urgent care for chest pain or an inability to swallow.
Drugs and substances that interact with tramadol
Tell your doctor and pharmacist about every prescription medicine, over-the-counter product, vitamin, supplement, and substance you use. Some interactions change tramadol levels. Others increase sedation, seizures, serotonin syndrome, or breathing problems.
| Medicine or substance | Possible risk |
|---|---|
| Alcohol | Severe sleepiness, breathing problems, coma, or death |
| Benzodiazepines such as alprazolam or diazepam | Heavy sedation and respiratory depression |
| Other opioids | Overdose and breathing problems |
| Gabapentin or pregabalin | Increased sedation and breathing risk |
| Sleep medicines, sedating antihistamines, and other central nervous system depressants | Severe sleepiness, poor alertness, and slowed breathing |
| SSRIs, SNRIs, and tricyclic antidepressants | Serotonin syndrome and seizures |
| Triptan migraine medicines | Serotonin syndrome |
| Cyclobenzaprine or metaxalone | Serotonin syndrome, severe sleepiness, or slowed breathing |
| MAO inhibitors | Serious toxicity, serotonin syndrome, or respiratory depression |
| Fluoxetine, paroxetine, bupropion, or quinidine | Reduced pain relief, withdrawal, seizures, serotonin syndrome, or breathing problems as tramadol and M1 levels change |
| Erythromycin, ketoconazole, or ritonavir | Higher tramadol levels, seizures, serotonin syndrome, or breathing problems |
| Carbamazepine, phenytoin, or rifampin | Reduced pain control or withdrawal; stopping them may raise tramadol levels |
| Buprenorphine, butorphanol, nalbuphine, or pentazocine | Reduced pain relief or sudden withdrawal symptoms |
| St. John’s wort or tryptophan supplements | Higher serotonin syndrome risk |
| Warfarin | Changes in blood-clotting test results |
| Digoxin | Possible digoxin toxicity |
Tramadol must not be used with an MAO inhibitor or within 14 days after stopping one. Examples include phenelzine and tranylcypromine. Linezolid and intravenous methylene blue also have MAO-inhibiting activity and can cause serious interactions.
Do not stop an antidepressant, seizure medicine, or other prescription medicine on your own. Ask your prescriber or pharmacist to check the combination.
Who should not take AN 627?
Tramadol should not be taken by:
- Children younger than 12
- Patients younger than 18 following tonsil or adenoid surgery
- People with serious respiratory depression
- People with acute or severe asthma outside a monitored medical setting
- People with a known or suspected bowel blockage
- Anyone with an allergy to tramadol, another opioid, or any tablet ingredient
- Anyone currently taking an MAO inhibitor
- Anyone who stopped an MAO inhibitor within the past 14 days
Tramadol should be avoided in adolescents aged 12 to 18 who have risk factors for slow breathing unless a clinician decides the benefits outweigh the risks. These risk factors include recent surgery, obstructive sleep apnea, obesity, severe lung disease, a neuromuscular condition, or another medicine that slows breathing.
Conditions that require medical review
Tell your prescriber before taking tramadol if you have:
- A seizure disorder
- A head injury or brain condition
- Asthma, sleep apnea, or another breathing problem
- Kidney or liver disease
- Low blood pressure or poor circulation
- Low sodium
- Diabetes
- Urination problems
- Pancreas or gallbladder disease
- Depression or suicidal thoughts
- A personal or family history of substance misuse
- A previous opioid overdose
Adults older than 75 may clear tramadol more slowly and experience more side effects. Their total daily dose should not exceed 300 mg.
Pregnancy and breastfeeding
Tell your prescriber if you are pregnant, planning a pregnancy, or think you may be pregnant. Prolonged opioid use during pregnancy can cause neonatal opioid withdrawal syndrome after birth.
Possible signs in a newborn include irritability, tremors, poor sleep, vomiting, diarrhea, a high-pitched cry, and trouble gaining weight. The newborn may need hospital treatment.
Tramadol is not recommended during or immediately before labor when another pain treatment is appropriate. It crosses the placenta and may slow a newborn’s breathing.
Breastfeeding is not recommended during tramadol treatment. Tramadol and M1 can pass into breast milk and may cause dangerous sleepiness or breathing problems in an infant.
Can AN 627 cause dependence or addiction?
Yes. Tramadol can cause tolerance, physical dependence, misuse, and opioid use disorder. These terms have different meanings.
| Term | Meaning |
|---|---|
| Tolerance | The same dose produces less effect after repeated use |
| Physical dependence | The body develops withdrawal symptoms when the medicine is reduced or stopped |
| Misuse | The medicine is taken in a way that differs from the prescription |
| Opioid use disorder | Opioid use becomes difficult to control and continues despite harm |
Possible signs of a developing problem include strong cravings, taking more than prescribed, running out early, trying to obtain pills from several sources, and continuing to use tramadol despite problems at home, work, or school.
Physical dependence can occur during prescribed treatment. It does not prove that a person has opioid use disorder.
Tramadol withdrawal symptoms
Stopping tramadol suddenly after regular use may cause:
- Restlessness
- Anxiety or irritability
- Sweating and chills
- Runny nose or watery eyes
- Yawning
- Muscle or joint pain
- Trouble sleeping
- Stomach cramps
- Nausea, vomiting, or diarrhea
- Increased heart rate or blood pressure
Your prescriber can create a gradual dose-reduction plan. The rate depends on your dose, treatment length, health, and response to each reduction.
AN 627 overdose symptoms
A tramadol overdose may cause:
- Very slow or stopped breathing
- Extreme sleepiness
- Stupor or coma
- Limp muscles
- Cold or clammy skin
- Pinpoint pupils
- Slow heartbeat
- Low blood pressure
- Seizures
- Unusual snoring or a blocked airway
Overdose can occur after taking too much tramadol or combining it with alcohol, benzodiazepines, other opioids, sleeping medicines, or other sedatives.
What should you do during a suspected overdose?
- Call 911 immediately.
- Give naloxone if it is available.
- Follow the naloxone package directions for another dose if the person does not respond.
- Follow the 911 dispatcher’s instructions. Give rescue breaths or CPR if the person is not breathing normally and you are trained.
- Place an unconscious person who is breathing on their side to reduce choking risk.
- Stay with the person until emergency responders arrive.
Several naloxone nasal sprays are available without a prescription in the United States. Keep naloxone where family members or caregivers can find it quickly, and make sure they know how to use it.
Naloxone can reverse opioid-related breathing problems. Its effect is temporary, and tramadol can remain in the body longer. A tramadol overdose may also cause seizures that naloxone does not treat.
Call 911 even if the person wakes after receiving naloxone.
Rarely, an opioid overdose can cause a serious brain injury called toxic leukoencephalopathy. Symptoms may appear hours, days, or weeks after the person seems to recover. Any new problem with alertness, thinking, balance, speech, or movement after an overdose needs urgent medical care.
For an accidental dose without emergency symptoms, contact Poison Control online or call 1-800-222-1222. Do not make the person vomit unless Poison Control or another healthcare professional tells you to do so.
Call 911 if the person collapses, has a seizure, cannot breathe normally, or cannot be awakened.
What should you do if you find a loose AN 627 pill?
Check the complete imprint, color, shape, size, score line, and both sides. Compare these details with the prescription label and original pharmacy packaging.
A pharmacist can compare the tablet’s imprint and physical details with trusted identification records and your prescription label. A visual check cannot confirm what a loose tablet contains or rule out a counterfeit.
Do not take or share a loose tablet when its source is unknown. Counterfeit medicines may contain the wrong ingredient, an incorrect amount, or a harmful substance.
Changes in a tablet’s color, shape, texture, packaging, or markings need a pharmacist’s review. Buy prescription medicine only through a licensed pharmacy.
If a child may have swallowed the pill, call Poison Control immediately, even if the child appears well. Accidental tramadol ingestion can be fatal.
Safe storage and disposal
Store tramadol in a tight, labeled container at 68°F to 77°F. Brief temperature changes between 59°F and 86°F are permitted.
Keep it locked, out of sight, and away from children, pets, visitors, and anyone who may misuse it. Count the remaining tablets when misuse or theft is a concern.
Use a drug take-back program for expired or unwanted tablets. If no take-back option is available, follow these disposal steps:
- Mix the tablets without crushing them with dirt, used coffee grounds, or cat litter.
- Place the mixture in a sealed bag or container.
- Put the sealed container in the household trash.
- Remove personal information from the empty prescription bottle.
AN 627 compared with commonly confused pills
| Question | Answer |
|---|---|
| Is AN 627 tramadol? | Yes. It contains tramadol hydrochloride 50 mg. |
| Is AN 627 oxycodone? | No. Oxycodone is a different opioid. |
| Does AN 627 contain acetaminophen? | No. Tramadol is its only active ingredient. |
| Is AN 627 a muscle relaxant? | No. It is an opioid pain medicine. |
| Is AN 627 extended release? | No. It is an immediate-release tablet. |
| Are AN 627 and 377 the same medicine? | Both contain tramadol hydrochloride 50 mg. AN 627 is round and 9 mm, while 377 is oval and 13 mm. Their manufacturers and inactive ingredients may differ. |
Do not use a loose pill as a substitute for your prescription. A pharmacist can compare its markings with trusted records, but appearance cannot rule out a counterfeit.
Frequently asked questions
Can you drink alcohol while taking AN 627?
No. Alcohol can increase sleepiness and slow breathing when combined with tramadol. The combination can cause overdose, coma, or death. Check cough syrups and other products for hidden alcohol.
Can you take AN 627 with ibuprofen?
Some patients may be prescribed tramadol and ibuprofen together. Ibuprofen may be unsafe for people with kidney disease, stomach ulcers, bleeding problems, or certain heart conditions. Ask your prescriber or pharmacist before combining them.
Can you take tramadol with acetaminophen?
A clinician may use tramadol with acetaminophen in some cases. AN 627 does not contain acetaminophen, but other tramadol products do. Check every medicine label to prevent an accidental acetaminophen overdose.
Does the AN 627 pill make you sleepy?
Yes. Tramadol can cause sleepiness, dizziness, and slower reactions. Avoid driving or using machinery until you know how it affects you. Severe sleepiness or difficulty waking can be an overdose warning.
Can AN 627 make you feel high?
Tramadol can cause euphoria in some people. Taking it for this effect, using more than prescribed, or mixing it with other substances increases the risk of seizures, addiction, overdose, and death.
Can tramadol cause seizures at a prescribed dose?
Yes. Seizures have occurred at recommended doses. Higher doses, seizure disorders, certain antidepressants, head injuries, and alcohol or drug withdrawal can raise the risk.
Can you stop tramadol suddenly?
Regular tramadol use can cause physical dependence. A sudden stop may bring withdrawal symptoms and uncontrolled pain. Speak with your prescriber about a gradual reduction plan.
Will AN 627 appear on a drug test?
Tramadol may appear when the testing panel specifically includes it or uses a broad confirmation method. Drug-testing panels are not standardized, so a basic opioid test may not check for tramadol.
Tell the testing provider about your prescription and ask which substances the laboratory tests.
Is naloxone effective for a tramadol overdose?
Naloxone can reverse dangerous breathing problems caused by tramadol. It may not reverse every overdose symptom, including seizures.
Give naloxone when an opioid overdose is suspected and call 911 immediately.
Is AN 627 a strong painkiller?
Tramadol is an opioid prescribed for severe pain. Its effects vary based on genetics, age, kidney or liver function, other medicines, and previous opioid use.
Serious side effects can occur even at a prescribed dose, so take only the amount written on your prescription.
Final thoughts
Small differences in a pill’s imprint, shape, size, or reverse side can change its identification. A legitimate white, round, unscored tablet marked AN 627 contains immediate-release tramadol hydrochloride 50 mg when it comes from a licensed supply. Take it only when it was dispensed for you in labeled pharmacy packaging and only at the prescribed dose. Ask a pharmacist to inspect any loose or uncertain tablet, and call 911 for slow breathing, a seizure, collapse, or inability to wake.
References
- Tramadol hydrochloride prescribing information
- Tramadol drug information
- FDA opioid pain medicine safety update
- FDA naloxone and opioid overdose information
- Poison Control
- FDA counterfeit medicine safety information
- AN 627 pill identification
- 377 pill identification
- Tramadol dosing and safety information
- Drug-testing guidance
Medical disclaimer: This article provides general health information. It does not replace medical advice, diagnosis, or treatment from a doctor, pharmacist, or other qualified healthcare professional. Never change an opioid dose or stop treatment without speaking with your prescriber.