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Tramadol Withdrawal Symptoms & Tramadol Withdrawal Timeline

Tramadol is prescription opioid used to relieve pain. It is marketed under several trade names, including Ultram. Tramadol is a somewhat novel opioid analgesic medication in that it also has pharmacologic activity as a monoamine reuptake inhibitor in addition to its more conventional opioid agonist activity.1   When tramadol was first introduced in 1995, it was an unscheduled drug, as it was originally thought to be less addictive than other types of opioids.1 However, reports of abuse began to surface, and the FDA eventually issued updated warnings about the potential for abuse and tramadol addiction.

Tramadol is often diverted and misused for non-medical purposes.1 At certain doses, tramadol can elicit an increase in dopamine release which can reinforce repeated use.2 Like many other prescription opioids, people may be more likely to get addicted to tramadol when they take more tramadol than prescribed, take it in a way it was not prescribed, or take it to get high.2

Tramadol dependence may develop with repeated use, which may lead to withdrawal when drug use is decreased or stopped.2 Due to its novel mechanism of action as a norepinephrine and serotonin reuptake inhibitor, tramadol is associated with a somewhat atypical range of opioid withdrawal symptoms. Similar with other more typical opioid agonists, tramadol withdrawal can include flu-like symptoms, restlessness, and drug cravings; however, a less common withdrawal syndrome may include additional symptoms such as panic or anxiety, confusion, paranoia, hallucinations, as well as numbness and tingling in the arms and legs.1

If you or your loved one has developed an issue with tramadol, you may wonder how to stop using it, but worry about what withdrawal from tramadol may be like. In this article, we discuss tramadol withdrawal symptoms, a general timeline, and how to get help through tramadol addiction treatment.


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Tramadol Dependence and Withdrawal

With the continued use of tramadol, dependence may develop, which means that a person needs tramadol to feel normal, as their body has gotten used to its effects.2 Once a person becomes physically dependent on tramadol, they are at risk of experiencing withdrawal symptoms if drug use is reduced or stopped.3

Because withdrawal may be uncomfortable and may even be associated with certain complications, opioid withdrawal without medical support may not be recommended.4 Ideally, medical detox performed in a professional drug detox setting with medications for opioid withdrawal management as well as close monitoring by a treatment team can keep people more comfortable and safe as they stop using tramadol.


What Happens During Tramadol Withdrawal?

When you go through withdrawal from tramadol, you experience a set of symptoms that result as the body adapts to the absence of a substance on which it has become reliant to feel normal.5

Withdrawal occurs in part due to functional changes in a part of the brain called the locus coeruleus. The locus coeruleus produces a neurochemical called noradrenaline, which regulates alertness, blood pressure, and breathing. However, when a person uses an opioid like tramadol, its mu opioid receptor activation leads to a suppression of noradrenaline activity, which can lead to some of the typical effects of opioid intoxication, including sleepiness, lower blood pressure, and slowed breathing.

Over time as a person keeps taking opioids, the brain upregulates noradrenaline activity to offset the effects of opioids. At this point, should a person stop taking opioids like tramadol, the now unchecked hyperactive noradrenaline activity can lead to sensations typical of withdrawal, such as anxiety, tremors, muscle cramps, and gastrointestinal issues like diarrhea.6

Suddenly quitting tramadol or other opioids after a sustained period of compulsive misuse or after significant dependence has otherwise developed—which some people call going cold turkey—may not be a good idea, as the sudden cessation of opioids can result in severely unpleasant symptoms.3

The fear of withdrawal symptoms can be a major barrier for many people being able to stop using opioids.4 However, medical detox programs have helped many manage tramadol withdrawal safely and comfortably.4


Symptoms of Tramadol Withdrawal

Acute tramadol withdrawal will often be similar to the withdrawal experienced in association with other types of opioids.7 Symptom severity may vary from one person to another based on the amount of tramadol having been consistently used, the duration of such use, and the corresponding level of physical dependence.3,7

Although the withdrawal experience is unique for everyone, some common tramadol withdrawal symptoms include: 1, 7, 8

  • Restlessness.
  • Fever.
  • Sweating.
  • Chills.
  • Goosebumps.
  • Yawning.
  • Teary eyes.
  • Runny nose.
  • Dilated pupils.
  • Bone and muscle pain.
  • Abdominal cramping.
  • Nausea and vomiting.
  • Diarrhea.
  • Anxiety.
  • Insomnia.
  • Irritability.

For the majority of people, tramadol withdrawal is similar to experiencing the flu.1 However, in an estimated 10% of cases, tramadol withdrawal may be somewhat atypical and include symptoms such as numbness of the extremities, extreme anxiety, panic attacks, confusion, hallucinations, and paranoia.1

At times, some people may experience certain medical complications in association with opioid withdrawal. For example, pre-existing cardiac illnesses could potentially be acutely worsened because of heightened autonomic nervous system activity in opioid withdrawal. In other cases, severe gastrointestinal distress could lead to diarrhea and/or vomiting that could lead to pronounced dehydration and electrolyte disturbances.7

Though the likelihood of serious medical complications is relatively low, a program of supervised detox and medically managed withdrawal may be the ideal setting to keep a person as safe and comfortable as possible while withdrawing from tramadol.4


How Long Will Tramadol Withdrawal Symptoms Last?

Tramadol is a relatively short-acting opioid, so symptoms of withdrawal might begin as early as 8-24 hours after the last use of tramadol.2,7

While no two people will have exactly the same experience, as a short-acting opioid, the tramadol withdrawal timeline could last for around 7-10 days before symptoms largely resolve.7 The character and severity of opioid withdrawal symptoms often change as withdrawal progresses.7


Treating Tramadol Withdrawal Symptoms

Symptoms of tramadol withdrawal can be intense and highly unpleasant.7 There is no need to suffer needlessly with these symptoms of withdrawal and try to do a detox from tramadol at home on your own. Going through a managed tramadol withdrawal can help control cravings and better prevent relapse by helping to manage the intensity of withdrawal symptoms.4

A professional detox program can offer you the environment to go through withdrawal safely and comfortably. Medications may be used during a drug detox program to help ease symptoms and manage cravings.3 Medications to manage opioid withdrawal include the full opioid agonist methadone, partial opioid agonist buprenorphine, and non-opioid adrenergic receptor agonist medications like clonidine and lofexidine. Both methadone and buprenorphine bind to and activate opioid receptors in the brain to help ease withdrawal symptoms and cravings.7,8

It is important to understand that detox is often the first step for tramadol dependence and addiction. After detoxing, many people seek continued care through rehab programs that include inpatient and outpatient treatment. Group and individual therapy are often part of substance abuse programs.


Sources

  1. Drug Enforcement Administration. (2020). Tramadol.
  2. National Institute on Drug Abuse. (2021). Prescription opioids drugfacts.
  3. Pergolizzi, Jr., J.V., Raffa, R.B., & Rosenblatt, M.H. (2020). Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. Journal of Clinical Pharmacy and Therapeutics, 45(5): 892-903.
  4. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment. Treatment improvement protocol (TIP) series, no. 45.
  5. Gupta M., Gokarakonda S. B., & Attia, F.N. Withdrawal syndromes. [Updated 2021 Oct 21]. In: StatPearls [Internet]. Treasure Island (FL):
  6. Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect, 1(1): 13-20.
  7. Substance Abuse and Mental Health Services Administration. (2020). TIP 63: Medications for opioid use disorder.
  8. National Institute on Drug Abuse. (2022). Medications for Opioid Overdose, Withdrawal, and Addiction.

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