Tramadol Withdrawal Symptoms, Timeline, and Treatment

Tramadol Withdrawal Symptoms, Timeline, and Treatment Addiction Coping and Recovery Print How Long Does Withdrawal From Tramadol Last? By Corinne O’Keefe Osborn linkedin Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology. Learn about our editorial policy Corinne O’Keefe Osborn Medically reviewed by Medically reviewed by Steven Gans, MD on January 31, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on January 31, 2019 More in Addiction Coping and Recovery Methods and Support Overcoming Addiction Personal Stories Alcohol Use Addictive Behaviors Drug Use Nicotine Use In This Article Table of Contents Expand Overview Signs and Symptoms Coping and Relief Warnings Long-Term Treatment Resources View All Back To Top 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 think of it as a safer alternative to stronger painkillers.?? But in recent years, reports of tramadol-related emergency room visits have begun to pile up. More and more doctors are reporting tramadol-dependent patients. And the list of potential tramadol withdrawal symptoms has continued to grow. Overview Tramadol use is on the rise. According to government statistics, prescriptions for tramadol increased 88 percent in just five years, from 23.3 million in 2008 to 43.8 million in 2013.?? With all that tramadol floating around, 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 percent. Regardless of whether you are abusing it or taking it therapeutically, tramadol can cause tolerance and dependence. When you become physically dependent on a drug, you experience withdrawal symptoms when you stop taking it.?? During tramadol withdrawal, you can expect to feel flu-ish and sick to your stomach. You may sweat and have the 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. Tramadol withdrawal symptoms typically begin within one or two days of your last dose and usually resolve in about a week. In most cases, the symptoms of tramadol withdrawal are going to be less intense than those that occur with other opioids, like heroin and oxycodone. Tramadol’s effects on the opioid receptors are comparatively mild, which means that it will be easier for your brain to adjust to its absence. 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. Signs and Symptoms 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, it means 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. When withdrawing from tramadol, you may experience any of the following symptoms:?? SweatingChillsIrritabilityAnxietyDiarrheaNausea or vomitingLoss of appetitePanic, paranoia, or panic attacksAches and pains in the muscles or jointsTrouble falling or staying asleepRunny nose, sneezing, or coughingGoosefleshAbdominal crampsRestless leg syndromeConfusion or deliriumHallucinations (seeing, hearing, or feeling things that aren’t there)AgitationPsychosisIncreased blood pressure or heart rateFast breathing Everyone’s withdrawal experience is different. It is impossible to predict exactly when your symptoms will start, how long they will last, or how severe they will be. 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 healthYour ageGeneticsYour mental healthYour other drug useYour history with substance abuse 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 and Relief 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. 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. 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 that have been used to treat tramadol withdrawal include the hypertension medications clonidine and moxonidine. These drugs have a history of success being used off-label in the treatment of opioid withdrawal.?? Warnings Some people are at greater risk of a complicated withdrawal. 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 percent 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. 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 are taking other medications that lower the seizure threshold, such as antipsychotics. 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.   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, then you should bring them to the nearest emergency room. 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 also 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 rapid heart rate, dilated pupils, twitching or rigid muscles, and heavy sweating.?? 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, then 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.?? But if you are among the many people who misuse or abuse tramadol, then you have a longer road ahead of you. 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 that has both 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.?? Research shows that a combination of medication and counseling is the best approach to opioid addiction. Depending on your circumstances, medication may mean a slow tramadol taper or the addition of opioid maintenance medications like buprenorphine or methadone.?? Some people choose to work one-on-one with a drug counselor or psychiatrist who can prescribe medication. Whereas others prefer the abstinence-based 12-step model. All of these methods have been shown to encourage long-term sobriety. 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 a process of acceptance and participation, these groups give you the strength to stay clean and rebuild your life after addiction. Resources To find more information about Narcotics Anonymous check out their website. You can find a meeting near you with their searchable directory. To find a psychiatrist or psychologist who specializes in opioid use disorders, you can use this searchable directory from the Substance Abuse and Mental Health Services Administration (SAMHSA) or call SAMHSA’s national helpline at 1-800-662-HELP (4357). 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. Precautions to Prevent Tramadol Drug Interactions and Overdose