Coping With Tramadol Withdrawal Symptoms

Symptoms of tramadol withdrawal

Verywell / Gary Ferster  

Tramadol is a synthetic opioid. Unlike other synthetic opioids you may have heard about, like fentanyl, tramadol is far weaker than a traditional opioid. Its effects are mild enough that doctors often consider it a safer alternative to other opioid painkillers.

But in recent years, many reports of tramadol-related emergency room visits have been reported. More and more doctors are reporting tramadol-dependent patients. And the list of potential tramadol withdrawal symptoms has continued to grow.

Tramadol Withdrawal

Tramadol use is on the rise. According to government statistics, tramadol prescriptions increased by 88% in just five years, from 23.3 million in 2008 to 43.8 million in 2013. Given this increased use, more and more people are finding themselves in trouble.

Between 2005 and 2011, the number of tramadol-related emergency room visits involving abuse or misuse increased by 250%.

Tramadol can cause tolerance and dependence whether you are abusing it or taking it therapeutically. When you become physically dependent on a drug, you experience withdrawal symptoms when you stop taking it.

In most cases, tramadol withdrawal symptoms will be less intense than those that occur with other opioids, like heroin and oxycodone. Tramadol’s effects on the opioid receptors are comparatively mild, so it will be easier for your brain to adjust to its absence.

How Tramadol Withdrawal Works

An important study published in 2011 established, for the first time, that it is possible for humans to become physically dependent on tramadol. This is true even when taking it as directed by a doctor.

When someone is physically dependent on a drug, they will experience withdrawal symptoms when they stop or reduce their dose.

Tramadol works like an opioid, which means that many of its withdrawal symptoms resemble those of other opioid withdrawal syndromes. But unlike traditional opioids, tramadol has a significant effect on several of the brain’s other neurotransmitters, including serotonin.

Because of this, you may experience additional withdrawal symptoms, including those more commonly associated with antidepressant withdrawal.

Signs and Symptoms of Tramadol Withdrawal

You can expect to feel flu-ish and sick to your stomach during tramadol withdrawal. You may sweat and have chills. You might have trouble sleeping and feel much more irritated and aggravated than usual. You might also experience varying degrees of anxiety and depression.

When withdrawing from tramadol, you may experience any of the following symptoms:

  • Abdominal cramps
  • Aches and pains in the muscles or joints
  • Agitation
  • Anxiety
  • Chills
  • Confusion or delirium
  • Diarrhea
  • Fast breathing
  • Gooseflesh
  • Loss of appetite
  • Increased blood pressure or heart rate
  • Irritability
  • Nausea or vomiting
  • Panic, paranoia, or panic attacks
  • Restless leg syndrome
  • Sweating
  • Runny nose, sneezing, or coughing
  • Trouble falling or staying asleep

Everyone’s withdrawal experience is different. It is impossible to predict precisely when your symptoms will start, how long they will last, or how severe they will be.

Factors That Impact Tramadol Withdrawal

Things that can influence your withdrawal experience include the duration of your drug use, how much you use, and how often you use. Other factors that can influence your withdrawal include:

  • Your health
  • Your age
  • Genetics
  • Your mental health
  • Your other drug use
  • Your history of substance abuse

Your withdrawal experience will also depend on the factors that led you to become dependent on tramadol in the first place, such as your level of pain and history of substance abuse. An opioid use disorder (addiction) presents additional complications.

How long does tramadol withdrawal last?

In a typical healthy adult, tramadol withdrawal begins one to two days after the last dose, peaks after day three, and subsides within one to two weeks.

Coping With Withdrawal from Tramadol

If you’ve been taking tramadol for pain and found that reducing or stopping your dose causes uncomfortable symptoms, there are steps you can take to treat or avoid them, but you will need the help of a doctor.

Gradual Tapering

A tramadol taper is the simplest and most reliable way of preventing withdrawal before it begins. Tapering tramadol means that you take gradually smaller doses over the course of two or three weeks.

There is no universal taper schedule that can tell you when to reduce your dose or by how much, so it is best done with the help of a doctor. Studies have shown that psychosocial approaches in conjunction with pharmacological interventions may improve outcomes as well.

When done right, a taper should provide a smooth transition off of tramadol.

Medications

Several case studies have found that benzodiazepines, like clonazepam or lorazepam, can help reduce tramadol withdrawal symptoms. This is particularly true in cases where anxiety, agitation, or restlessness is present.

Other drugs used to treat tramadol withdrawal include the hypertension medications clonidine and moxonidine. These drugs have a history of successfully being used off-label in treating opioid withdrawal.

Warnings About Tramadol Withdrawal

Some people are at greater risk of a complicated withdrawal. Some factors that may contribute to complications when you quit taking tramadol include:

Impact of Other Medications or Substances

While some people are solely dependent on tramadol, many people take it in combination with other substances.

Among the thousands of people who visit the ER each year for problems related to tramadol abuse, about 71% report using one or more other drugs. The majority of these people combine tramadol with another painkiller or sedative.

When people use several therapeutic or illicit drugs at the same time, they can develop multiple physical dependencies. If you have been combining or alternating your tramadol dose with another painkiller, like hydrocodone, your opioid dependence may be more severe.

Increased Seizure Risk

If you have become physically dependent on anti-anxiety medications (benzodiazepines) you are at risk of dangerous withdrawal complications, including seizures and delirium. 

Tramadol is also associated with seizure activity. Seizures can occur in people both with and without a history of seizures. People with a history of seizures or traumatic brain injury may be at increased risk during tramadol withdrawal.

Tramadol has been shown to lower the seizure threshold, making seizures more likely to occur. Your risk is also increased if you take other medications that lower the seizure threshold, such as antipsychotics.

Risk for Older Adults

People over the age of 65 are also at increased risk of withdrawal complications. Older adults metabolize tramadol slower than younger people. This means that the drug has more powerful effects. In older adults, withdrawal may start later than normal and be more severe. 

Individual Factors

While it is not common, some people do appear to be more sensitive to tramadol withdrawal than others.

If you or someone you love is experiencing confusion, hallucinations, delusions, or severe agitation, you should bring them to the nearest emergency room.

Serotonin Syndrome

One other thing to be aware of is tramadol’s association with a dangerous condition called serotonin syndrome. Serotonin syndrome is unlikely to occur during withdrawal unless you relapse and take an unusually high dose.

Serotonin syndrome typically occurs when you combine tramadol with one or more medications that affect your body’s serotonin levels, such as antidepressants, MAOIs, migraine medications, or illicit drugs.

Symptoms of serotonin syndrome, which can be deadly without treatment, include:

  • Dilated pupils
  • Heavy sweating
  • Rapid heart rate
  • Twitching or rigid muscles

Long-Term Treatment

If you developed a physical dependence on tramadol because you spent several months or years taking a therapeutic dose for your pain, you probably won’t need any additional treatment. A taper should be enough to help you quit as long as you have a plan to handle your pain in the future.

If you misuse or abuse tramadol, then you have a longer road ahead of you.

Misuse vs. Abuse

  • Tramadol misuse means taking it in any way other than prescribed by your doctor, including taking larger or more frequent doses than you’re supposed to or mixing it with other medications.
  • Tramadol abuse is when you use it to get high, use it to intensify the high of another drug, or use it to treat opioid withdrawal symptoms.

A substance use disorder (addiction) is a complex disease with physical and psychological symptoms. The physical symptoms are your withdrawal symptoms, while the psychological symptoms are the thoughts, feelings, and behaviors surrounding your drug use.

Long-Term Treatment Options

Depending on your circumstances, medication may mean a slow tramadol taper or the addition of opioid maintenance medications like buprenorphine or methadone.

Some people work one-on-one with a drug counselor or psychiatrist who can prescribe medication. Others prefer the abstinence-based 12-step model. All of these methods have been shown to encourage long-term sobriety.

Research shows that a combination of medication and counseling is the best approach to opioid addiction.

In the long term, many people chose the convenience of a free 12-step group, like Narcotics Anonymous. These social support groups are offered every day around the country. At meetings, you swap stories with people who have been where you are. Through acceptance and participation, these groups give you the strength to stay clean and rebuild your life after addiction.

Resources for Tramadol Withdrawal

To find more information about Narcotics Anonymous check out their website. You can find a meeting near you with their searchable directory.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

Pain makes us desperate. When we’re in pain, it’s hard to think straight, let alone plan for the future, but you have to protect yourself from the opioid epidemic sweeping this country.

It’s easy to think of tramadol as harmless compared to other opioids, but it is not harmless. Getting help right away will make all the difference in the world. Take this opportunity to nip your problem in the bud and secure a better future for yourself and your family.

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Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Corinne O’Keefe Osborn
Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology.