stressed out woman pulling her hair

Doctors love tramadol (Ultram, Ultracet) because it is perceived as safer than narcotics like hydrocodone (Lortab, Norco, Vicodin, etc.) or oxycodone (Oxycontin, Percocet, etc). Many prescribers are unaware of the withdrawal reaction that can occur when people try to stop tramadol suddenly.

There is a sanitized term for this extremely disorienting condition: “discontinuation syndrome.” It does not begin to describe what some people go through when trying to stop tramadol. At last count there are over 300 comments about this problem with this article. SomeĀ are truly hair raising. To read them all, click on the box at the bottom of this page labeled “Older Comments.” But first, the question that started this thread:

Q. I have been taking Ultracet (tramadol) for several years for back pain. I was taking 100 mg three times a day as prescribed. The pain is better and I tried stopping the tramadol and had a terrible reaction.

I went to my internist who advised that I stop taking the tramadol over a period of time. I am now taking 50 mg three times a day but cannot get any lower than that without experiencing nerve twitches in my legs and intense jitteriness that interferes with my sleep.

Have you heard of similar problems and do you know of any way to alleviate the withdrawal symptoms without getting hooked on another medication?

A. Tramadol (Ultram, Ultracet, Rybix ODT, Ryzolt) is a strong pain reliever that was originally thought to have opioid-like activity without the same potential to cause addiction as morphine or similar narcotics. To quote the “experts,” tramadol was thought to have a “low potential for abuse.” In other words, it wasn’t supposed to cause physical dependence or produce a “withdrawal syndrome.”

It turns out the drug is a lot more complicated than many experts first believed. In addition to its analgesic action via opioid receptors in the brain, tramadol exerts a profound effect on other neurochemistry. That means that brain chemicals like serotonin and norepinephrine are profoundly impacted by tramadol. Sudden discontinuation can bring on a host of symptoms including:

Tramadol Withdrawal:

  • Anxiety, mood swings, irritability
  • Brain zaps (shock-like sensations), tingling
  • Sweating, chills, goose bumps, shivering
  • Tremors
  • Headaches
  • Insomnia, sleeping difficulties, nightmares
  • Flu-like symptoms
  • Nausea, diarrhea, loss of appetite
  • Depression
  • Hallucinations, unusual thoughts
  • Aggresiveness

Some of these symptoms may persist longer than many health professionals realize and there is no one-size-fits-all tapering program. People vary greatly in the way their bodies adapt and recover. It may take several months to gradually wean yourself from tramadol. You should not attempt this on your own. A health professional who understands the complexity of the drug may be essential.

Many of the withdrawal symptoms associated with tramadol are reminiscent of those linked to sudden discontinuation of antidepressants like sertraline (Zoloft), paroxetine (Paxil) or venlafaxine (Effexor). Symptoms can include dizziness that will not quit, brain “zaps” or “shivers” that are a bit like electrical shock-like sensations, sweating, insomnia, headaches and difficulty concentrating. Read stories from readers who tried to get off antidepressants like duloxetine (Cymbalta) at this link.

The FDA has not provided physicians with clear guidelines on how to phase off such drugs. We frequently see recommendations like “gradual withdrawal,” but no one bothers to provide clear instructions about what that really means. We’re really sorry that we don’t have any great insight on this process either. Readers have shared their own solutions at this link.

Although many people can relieve their acute or chronic pain with tramadol, here are some symptoms to be aware of while taking this medication.

Tramadol Side Effects:

  • Nausea, vomiting, indigestion, diarrhea
  • Constipation
  • Headache
  • Drowsiness, dizziness, fatigue
  • Restless legs
  • itching
  • Dry mouth
  • Sweating, flushing
  • Loss of appetite
  • Difficulty sleeping, insomnia
  • Skin rash
  • Serotonin syndrome

Please note serotonin syndrome above. This can be a life-threatening situation and can be precipitated if tramadol is combined with other medications such as “triptans” prescribed for migraine headaches or antidepressants that affect serotonin. ALWAYS check with a pharmacist about the drug interactions before combining tramadol with any other medication. To learn more about serotonin syndrome, click here and here!

Share your own tramadol story below and please vote on this article at the top of the page.

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  1. David
    Boston MA
    Reply

    Took Tramadol (100 to 300 mgs/day) for fibromyalgia pain/associated depression for seven, consecutive years. Worked like a charm; pain suppression with no soporific side effect and several nootropic effects (increased alertness, focus, fatigue suppression, and appetite suppression). Tramadol was a godsend (for me).

    I would still be taking it, but, due to rescheduling by FDA/DEA, prescriptions must now be renewed monthly (written Rx and mandatory office visit/ evaluation). The insurance company was unhappy that they now had to pay for 12 office visits/ yr. Dr./ insurance company decided to wean me off “opiate” due to increased regulatory scrutiny, “off label” Rx, and associated costs. I was forced to wean/ withdraw from Tramadol and have been “Tramadol-free” for 3 months.

    My withdrawal symptoms were relatively mild compared to some of the comments reviewed, but they have been protracted. Since I was gradually weaned, I did not experience the “zaps”, but have experienced the loss of the nootropic effects and, most profoundly, the targeted pain suppression effect. I have also experienced chronic coughing, intermittent sneezing, and emotional disinhibition (e.g. rapid onset anger when frustrated, impatience, crying, etc.). This is not “normal” behavior for me. These symptoms have persisted for a disturbing long time (12 weeks and counting).

    I am now forced to live with chronic pain/ depression because of regulatory forces beyond my control. Dr. has attempted alternatives with no success to date. The “alternatives” (Lyrica, Effexor, Cymbalta) have not been effective and also have associated withdrawal attributes; but as long as they are not scheduled as “narcotics”, he is not reticent to prescribe them. I am dismayed that the regulatory pendulum is preventing me from receiving the one medication that I have found entirely effective.

  2. Aaron
    Colorado
    Reply

    I was taking tramadol 50mg for a week stopped taking them cause I have had opioid addictions in the past and it was giving me similar experiences like nodding out and vomiting I stopped taking them and felt like I worked out for 50days straight and also was heavily angry and depressed to the point I actually lost my job because I was agrees I’ve to a fellow employee. Horrible withdrawl I’d rather deal with pain then ever have to take those nasty things again.

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