Coping With Tramadol Withdrawal Symptoms

Table of ContentsView AllTable of ContentsTramadol WithdrawalHow Tramadol Withdrawal WorksSymptomsCoping TipsWarningsLong-Term TreatmentResources

Table of ContentsView All

View All

Table of Contents

Tramadol Withdrawal

How Tramadol Withdrawal Works

Symptoms

Coping Tips

Warnings

Long-Term Treatment

Resources

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.

One 2020 study found that while tramadol prescription rates are high, misuse of oral tramadol has remained stable and is relatively low compared to other prescription substances.

However, rising tramadol prescribing rates may be contributing to increased dependence and misuse.

Tramadol can cause tolerance and dependence whether you are misusing 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.

When someone isphysically 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, includingserotonin.

Because of this, you may experience additional withdrawal symptoms, including those more commonly associated withantidepressant 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:

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 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.

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.

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.

It is important to note that benzodiazepines can be habit-forming and should not be used long-term. They should also never be taken at the same time as opioid medications.

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 treatingopioid withdrawal.

What Are Benzodiazepines?

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 ortraumatic brain injurymay 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 calledserotonin 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:

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

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.

What Is Addiction?

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-based12-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 theirwebsite. You can find a meeting near you with theirsearchable directory.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

Precautions to Prevent Tramadol Drug Interactions and Overdose

18 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Library of Medicine.Compound Summary: Tramadol. Pub Chem.Bush DM.Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Mediation Tramadol.The CBHSQ Report. Substance Abuse and Mental Health Services Administration.Bigal LM, Bibeau K, Dunbar S.Tramadol prescription over a 4-year period in the USA.Curr Pain Headache Rep. 2019;23(10):76. doi:10.1007/s11916-019-0777-xReines SA, Goldmann B, Harnett M, Lu L.Misuse of tramadol in the United States: An analysis of the National Survey of Drug Use and Health 2002-2017.Subst Abuse. 2020;14:1178221820930006. doi:10.1177/1178221820930006Substance Abuse and Mental Health Services Administration.Emergency department visits for drug misuse or abuse involving the pain medication tramadol.U.S. National Library of Medicine.Opiate and opioid withdrawal.Lanier RK, Lofwall MR, Mintzer MZ, Bigelow GE, Strain EC.Physical dependence potential of daily tramadol dosing in humans.Psychopharmacology (Berl). 2010;211(4):457-66. doi:10.1007/s00213-010-1919-3Dunn KE, Tompkins DA, Bigelow GE, Strain EC.Efficacy of tramadol extended-release for opioid withdrawal: A randomized clinical trial.JAMA Psychiatry. 2017;74(9):885-893. doi:10.1001/jamapsychiatry.2017.1838Talih F, Ghossoub E.Moxonidine for tramadol withdrawal symptoms during detoxification.BMJ Case Rep.2015. doi:10.1136/bcr-2015-210444Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification.Cochrane Database Syst Rev.2011;(9):CD005031. doi:10.1002/14651858.CD005031.pub4Park YM, Park HK, Kim L, Lee HJ, Kang SG.Acute-withdrawal restless legs syndrome following abrupt cessation of short-term tramadol.Psychiatry Investig. 2014;11(2):204-6. doi:10.4306/pi.2014.11.2.204Beyaz SG, Sonbahar T, Bayar F, Erdem AF.Seizures associated with low-dose tramadol for chronic pain treatment.Anesth Essays Res. 2016;10(2):376-8. doi:10.4103/0259-1162.177181Guerriero F.Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults.World J Clin Cases. 2017;5(3):73. doi:10.12998/wjcc.v5.i3.73Takeshita J, Litzinger MH.Serotonin syndrome associated with tramadol.Prim Care Companion J Clin Psychiatry. 2009;11(5):273. doi:10.4088/PCC.08l00690Simon LV, Keenaghan M.Serotonin Syndrome. StatPearls. National Institutes of Health.World Health Organization.Tramadol: Update Review Report Agenda item 6.1. Expert Committee on Drug Dependence Thirty‐sixth Meeting. Geneva.Substance Abuse and Mental Health Services Administration.Mental health and substance use disorders.Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Drugs and Alcohol Group, ed.Cochrane Database of Systematic Reviews. Published online September 7, 2011.doi:10.1002/14651858.CD005031.pub4

18 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Library of Medicine.Compound Summary: Tramadol. Pub Chem.Bush DM.Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Mediation Tramadol.The CBHSQ Report. Substance Abuse and Mental Health Services Administration.Bigal LM, Bibeau K, Dunbar S.Tramadol prescription over a 4-year period in the USA.Curr Pain Headache Rep. 2019;23(10):76. doi:10.1007/s11916-019-0777-xReines SA, Goldmann B, Harnett M, Lu L.Misuse of tramadol in the United States: An analysis of the National Survey of Drug Use and Health 2002-2017.Subst Abuse. 2020;14:1178221820930006. doi:10.1177/1178221820930006Substance Abuse and Mental Health Services Administration.Emergency department visits for drug misuse or abuse involving the pain medication tramadol.U.S. National Library of Medicine.Opiate and opioid withdrawal.Lanier RK, Lofwall MR, Mintzer MZ, Bigelow GE, Strain EC.Physical dependence potential of daily tramadol dosing in humans.Psychopharmacology (Berl). 2010;211(4):457-66. doi:10.1007/s00213-010-1919-3Dunn KE, Tompkins DA, Bigelow GE, Strain EC.Efficacy of tramadol extended-release for opioid withdrawal: A randomized clinical trial.JAMA Psychiatry. 2017;74(9):885-893. doi:10.1001/jamapsychiatry.2017.1838Talih F, Ghossoub E.Moxonidine for tramadol withdrawal symptoms during detoxification.BMJ Case Rep.2015. doi:10.1136/bcr-2015-210444Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification.Cochrane Database Syst Rev.2011;(9):CD005031. doi:10.1002/14651858.CD005031.pub4Park YM, Park HK, Kim L, Lee HJ, Kang SG.Acute-withdrawal restless legs syndrome following abrupt cessation of short-term tramadol.Psychiatry Investig. 2014;11(2):204-6. doi:10.4306/pi.2014.11.2.204Beyaz SG, Sonbahar T, Bayar F, Erdem AF.Seizures associated with low-dose tramadol for chronic pain treatment.Anesth Essays Res. 2016;10(2):376-8. doi:10.4103/0259-1162.177181Guerriero F.Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults.World J Clin Cases. 2017;5(3):73. doi:10.12998/wjcc.v5.i3.73Takeshita J, Litzinger MH.Serotonin syndrome associated with tramadol.Prim Care Companion J Clin Psychiatry. 2009;11(5):273. doi:10.4088/PCC.08l00690Simon LV, Keenaghan M.Serotonin Syndrome. StatPearls. National Institutes of Health.World Health Organization.Tramadol: Update Review Report Agenda item 6.1. Expert Committee on Drug Dependence Thirty‐sixth Meeting. Geneva.Substance Abuse and Mental Health Services Administration.Mental health and substance use disorders.Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Drugs and Alcohol Group, ed.Cochrane Database of Systematic Reviews. Published online September 7, 2011.doi:10.1002/14651858.CD005031.pub4

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Library of Medicine.Compound Summary: Tramadol. Pub Chem.Bush DM.Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Mediation Tramadol.The CBHSQ Report. Substance Abuse and Mental Health Services Administration.Bigal LM, Bibeau K, Dunbar S.Tramadol prescription over a 4-year period in the USA.Curr Pain Headache Rep. 2019;23(10):76. doi:10.1007/s11916-019-0777-xReines SA, Goldmann B, Harnett M, Lu L.Misuse of tramadol in the United States: An analysis of the National Survey of Drug Use and Health 2002-2017.Subst Abuse. 2020;14:1178221820930006. doi:10.1177/1178221820930006Substance Abuse and Mental Health Services Administration.Emergency department visits for drug misuse or abuse involving the pain medication tramadol.U.S. National Library of Medicine.Opiate and opioid withdrawal.Lanier RK, Lofwall MR, Mintzer MZ, Bigelow GE, Strain EC.Physical dependence potential of daily tramadol dosing in humans.Psychopharmacology (Berl). 2010;211(4):457-66. doi:10.1007/s00213-010-1919-3Dunn KE, Tompkins DA, Bigelow GE, Strain EC.Efficacy of tramadol extended-release for opioid withdrawal: A randomized clinical trial.JAMA Psychiatry. 2017;74(9):885-893. doi:10.1001/jamapsychiatry.2017.1838Talih F, Ghossoub E.Moxonidine for tramadol withdrawal symptoms during detoxification.BMJ Case Rep.2015. doi:10.1136/bcr-2015-210444Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification.Cochrane Database Syst Rev.2011;(9):CD005031. doi:10.1002/14651858.CD005031.pub4Park YM, Park HK, Kim L, Lee HJ, Kang SG.Acute-withdrawal restless legs syndrome following abrupt cessation of short-term tramadol.Psychiatry Investig. 2014;11(2):204-6. doi:10.4306/pi.2014.11.2.204Beyaz SG, Sonbahar T, Bayar F, Erdem AF.Seizures associated with low-dose tramadol for chronic pain treatment.Anesth Essays Res. 2016;10(2):376-8. doi:10.4103/0259-1162.177181Guerriero F.Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults.World J Clin Cases. 2017;5(3):73. doi:10.12998/wjcc.v5.i3.73Takeshita J, Litzinger MH.Serotonin syndrome associated with tramadol.Prim Care Companion J Clin Psychiatry. 2009;11(5):273. doi:10.4088/PCC.08l00690Simon LV, Keenaghan M.Serotonin Syndrome. StatPearls. National Institutes of Health.World Health Organization.Tramadol: Update Review Report Agenda item 6.1. Expert Committee on Drug Dependence Thirty‐sixth Meeting. Geneva.Substance Abuse and Mental Health Services Administration.Mental health and substance use disorders.Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Drugs and Alcohol Group, ed.Cochrane Database of Systematic Reviews. Published online September 7, 2011.doi:10.1002/14651858.CD005031.pub4

National Library of Medicine.Compound Summary: Tramadol. Pub Chem.

Bush DM.Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Mediation Tramadol.The CBHSQ Report. Substance Abuse and Mental Health Services Administration.

Bigal LM, Bibeau K, Dunbar S.Tramadol prescription over a 4-year period in the USA.Curr Pain Headache Rep. 2019;23(10):76. doi:10.1007/s11916-019-0777-x

Reines SA, Goldmann B, Harnett M, Lu L.Misuse of tramadol in the United States: An analysis of the National Survey of Drug Use and Health 2002-2017.Subst Abuse. 2020;14:1178221820930006. doi:10.1177/1178221820930006

Substance Abuse and Mental Health Services Administration.Emergency department visits for drug misuse or abuse involving the pain medication tramadol.

U.S. National Library of Medicine.Opiate and opioid withdrawal.

Lanier RK, Lofwall MR, Mintzer MZ, Bigelow GE, Strain EC.Physical dependence potential of daily tramadol dosing in humans.Psychopharmacology (Berl). 2010;211(4):457-66. doi:10.1007/s00213-010-1919-3

Dunn KE, Tompkins DA, Bigelow GE, Strain EC.Efficacy of tramadol extended-release for opioid withdrawal: A randomized clinical trial.JAMA Psychiatry. 2017;74(9):885-893. doi:10.1001/jamapsychiatry.2017.1838

Talih F, Ghossoub E.Moxonidine for tramadol withdrawal symptoms during detoxification.BMJ Case Rep.2015. doi:10.1136/bcr-2015-210444

Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification.Cochrane Database Syst Rev.2011;(9):CD005031. doi:10.1002/14651858.CD005031.pub4

Park YM, Park HK, Kim L, Lee HJ, Kang SG.Acute-withdrawal restless legs syndrome following abrupt cessation of short-term tramadol.Psychiatry Investig. 2014;11(2):204-6. doi:10.4306/pi.2014.11.2.204

Beyaz SG, Sonbahar T, Bayar F, Erdem AF.Seizures associated with low-dose tramadol for chronic pain treatment.Anesth Essays Res. 2016;10(2):376-8. doi:10.4103/0259-1162.177181

Guerriero F.Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults.World J Clin Cases. 2017;5(3):73. doi:10.12998/wjcc.v5.i3.73

Takeshita J, Litzinger MH.Serotonin syndrome associated with tramadol.Prim Care Companion J Clin Psychiatry. 2009;11(5):273. doi:10.4088/PCC.08l00690

Simon LV, Keenaghan M.Serotonin Syndrome. StatPearls. National Institutes of Health.

World Health Organization.Tramadol: Update Review Report Agenda item 6.1. Expert Committee on Drug Dependence Thirty‐sixth Meeting. Geneva.

Substance Abuse and Mental Health Services Administration.Mental health and substance use disorders.

Amato L, Minozzi S, Davoli M, Vecchi S.Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Drugs and Alcohol Group, ed.Cochrane Database of Systematic Reviews. Published online September 7, 2011.

doi:10.1002/14651858.CD005031.pub4

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