Tramadol Withdrawal

Does tramadol cause withdrawal symptoms?

It is common to experience withdrawal symptoms when stopping tramadol (Ultram), especially if the medication is stopped abruptly after a prolonged period of use. Because of this, it is advised to gradually decrease tramadol (Ultram) use, to reduce the risk of withdrawal symptoms.^[1]

Tramadol (Ultram) causes a feeling of euphoria or ‘high’, which contributes to its risk of misuse and abuse. Stopping any medication can cause withdrawal symptoms and as tramadol (Ultram) has the potential for dependence, tolerance, and addiction to develop, withdrawal symptoms tend to be more likely and more severe.^[2]

If tramadol (Ultram) is used regularly, in high doses, and for a prolonged period, whether under prescription or not, it is common for a physical dependence to develop. This means that the person needs to repeatedly use the drug in order to feel stable or normal, and without it will experience physical and emotional effects.^[3] 

Tramadol (Ultram) is an opioid and causes similar withdrawal symptoms to other opioid medications. However, unlike other opioids, it also affects the activity and levels of serotonin and norepinephrine.^[2][4] These are neurotransmitters involved in the regulation of several functions including mood, sleep, appetite, energy, and pain.

Various types of antidepressants also impact these neurotransmitters. As such, when tramadol (Ultram) is stopped, atypical symptoms similar to antidepressant withdrawal may occur alongside typical opioid withdrawal symptoms.^[5]

Tramadol withdrawal symptoms

It is common to experience withdrawal symptoms when stopping tramadol (Ultram), particularly when the medication is stopped abruptly. These symptoms can be mild and may reduce within a short time without the need for intervention, or they may be more severe and long-lasting.

Common withdrawal symptoms

Common tramadol (Ultram) withdrawal symptoms include:^[1][2][3][5]

• Stomach pain
• Nausea
• Vomiting
• Diarrhea
• Muscle and joint pain
• Restlessness
• Shaking
• Sweating
• Fatigue
• Flu-like symptoms
• Trouble sleeping
• Mood changes
• Agitation
• Aggression

• Low mood
• Anxiety
• Cravings

Severe withdrawal symptoms

In some cases, rare or severe withdrawal symptoms can occur, sometimes persisting for a long time in cases of post-acute withdrawal syndrome (PAWS).

Rare or severe tramadol (Ultram) withdrawal symptoms can include:^[1][2][5]

• Depersonalization
• Derealization
• Paranoia
• Hallucinations
• Psychosis
• Confusion
• Severe anxiety
• Panic attacks
• Numbness and tingling in the hands and feet
• Ringing in the ears
• Persistent vomiting or diarrhea

Tramadol withdrawal timeline

It is common for withdrawal symptoms to begin within the first three days of stopping or reducing tramadol (Ultram). Withdrawal symptoms might start more slowly or not at all if the dose is reduced gradually.^[3][4]

The first withdrawal symptoms to occur are often flu-like symptoms, sweating, and changes in sleep and mood. Gastrointestinal symptoms are likely to occur slightly later in the withdrawal process.^[3]

In some cases, these symptoms will be mild or moderate and will be alleviated within ten days.^[4][5] However, in some cases, withdrawal symptoms can be more severe and long-lasting. 

There is a higher risk of severe withdrawal symptoms if the individual has taken tramadol (Ultram) for a prolonged period and in high doses, has a history of mental illness, or uses other substances.^[6]

Tramadol cessation timeline

When reducing tramadol (Ultram) use, a safe cessation timeline will vary for each person. Factors that can influence cessation include the duration of use, daily dosage, the condition being treated (if prescribed), physical and mental health conditions, and the severity of withdrawal symptoms that occur with each dosage reduction.^[4]

When tapering off tramadol (Ultram), it is recommended to make dosage reductions of no higher than 10% every 1-4 weeks. This may not always be possible depending on the tablet strengths available, so reductions may need to be slightly larger, although can be implemented more slowly.^[6][7]

A recommended daily tramadol (Ultram) dose is 50-100mg every 4-6 hours, up to a maximum of 400mg per day.^[1] If someone is taking 100mg four times per day, a cessation timeline may include:^[6]

• Reduction 1: 350mg per day, in three 100mg doses and one 50mg dose
• Reduction 2: 300mg per day, in two 100mg doses and two 50mg doses
• Reduction 3: 250mg per day, in one 100mg dose and three 50mg doses
• Reduction 4: 200mg per day, in four 50mg doses
• Reduction 5: 150mg per day, in three 50mg doses
• Reduction 6: 100mg per day, in two 50mg doses
• Reduction 7: 50mg per day, in one 50mg dose
• Reduction 8: Complete cessation

Each reduction can occur in a timeframe that is suitable for the individual. It could take several days or several weeks to move on to the next dosage reduction, depending on withdrawal symptoms. If severe or intolerable withdrawal symptoms occur, cessation can be paused or slowed until they are alleviated.

It is important to note that during this time, suddenly increasing tramadol (Ultram) doses can create a significant risk of overdose.^[7] This can cause severe heart and breathing issues, seizures, coma, or even death.^[1] It is crucial to follow the cessation instructions given by the prescribing doctor.

Tramadol detox treatment

For some people, stopping tramadol (Ultram) might involve a few months of gradual dose reductions with no need for any further intervention. However, for others, particularly those with substance use disorders, ending tramadol (Ultram) use might require ongoing professional support.

It may be necessary to detox from the medication in an inpatient facility, such as a hospital or rehab center. In these facilities, professionals can monitor the individual’s symptoms and provide support, psychological interventions, and medication to help manage withdrawal symptoms.^[4]

Various medications can be used to help with opioid detox. This includes:^[3][4][8]

• Buprenorphine or methadone: These medications are opioid agonists, so they affect the same receptors as tramadol (Ultram). This helps to reduce withdrawal symptoms and cravings but does not produce a ‘high’. Buprenorphine and methadone can be used short-term to reduce withdrawal symptoms or long-term as a maintenance treatment for opioid dependence.
• Lofexidine or clonidine: These medications are non-opioids, so they do not reduce the cravings that occur during tramadol (Ultram) withdrawal. They are used to reduce withdrawal symptoms such as gastrointestinal issues, flu-like symptoms, pain, and anxiety.

For some people, particularly those with substance use disorder or co-occurring mental health conditions, it may be helpful to utilize ongoing treatment and support following tramadol (Ultram) detox. This could include psychotherapy, support groups such as Narcotics Anonymous, and medication.^[4][7]