Abstract: To compare the prescribing and usage pattern of all dosage forms of tramadol and to assess the type and frequency of tramadol-induced adverse drug reactions. All insured prescriptions which were collected in special software called Rx Analyst in the National Committee of Rational Drug Use were reviewed for prescriptions included at least one dosage form of tramadol. Data related to dispensing of tramadol were obtained from the official databank of national regulatory authority. All registered tramadol forms that induced adverse drug reactions in the database of Iranian Adverse Drug Reaction Monitoring Center were analyzed. The study period for all mentioned data was defined from 2006 to 2010. There were 291, 940 dosage forms of tramadol in 336, 610, 664 insured prescriptions in comparison to 1, 474, 680, 760 number of all dosage forms which dispensed from wholesaler to retail pharmacies during five years in the study. There were 461 different adverse reactions occurred in 249 patients. The most reported reactions included convulsion (73 items), nausea (56 items) and vomiting (47 items). We detected three death suspected to be induced by tramadol. Assessment of the trend of adverse reactions showed that the total number of reports was reduced from 89 cases in 2006 to 21 in 2010. There is a gap between number of tramadol prescribed and dispensed in the country that may be related to self-medication of this medicine. This has important value for priority setting in implementing interventions for promoting rational use of tramadol.