While tramadol can technically be taken while breastfeeding, it comes with some noteworthy caveats. While research has shownthat only small amounts of tramadol and its active metabolite, O-desmethyltramadol, end up in breast milk, there are risks associated with its use. 

In fact, a tragic incident involving the death of an eight-month-old breastfed baby, whose mother was addicted to tramadol, has sparked caution in the medical community. It's important to note that it hasn't been definitively proven that the breastfeeding exposure to tramadol was the sole cause of the infant's death.

Due to this concern, both the U.S. Food and Drug Administration (FDA) and the drug's manufacturer advise against using tramadol while breastfeeding. If a mother does decide to use this medication, it's crucial to closely monitor the baby for any signs of increased sleepiness, difficulty breastfeeding, breathing difficulties, or limpness, and to seek immediate medical attention if these symptoms occur.

So, while tramadol can be taken while breastfeeding, it should be approached with extreme caution and ideally under the guidance of a healthcare professional. It's always best to consider safer alternatives whenever possible.