stressed out woman pulling her hair

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 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). 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.

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!

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  1. Lyn C.

    After nine years of taking Tramal SR. to cover nerve damage from transflap mastectomy breast reconstruction I have to come off. The side effects of prolonged use are horrific and even fatal. Muscle spasms, brochospams, panic attacks, chest pain, irritable bowel syndrome. I am half way off and really struggling but determined to get there. I am 72 years old, which possibly doesn’t help, but I have a positive outlook and have always been relatively fit and energetic.

    I have dropped the dosage very gradually using Tramal in drop form, and having the doses spread out over the full day to cope with the slow release. My naturopath is wonderful helping me with supplements to soften the journey. I have had to resort to using Valium, just 2.5mg, especially in the early days to ease the muscle spasms and difficulty breathing. Sometimes it was so bad I needed three doses of valium in one day. As the drops reduce that need lessens dramatically. I have periods where there are no spasms for four days, but when the spasms return, I know it is time to reduce the drops a little more.

    However the withdrawal brings up other difficulties. My body is in a dilemma. Now the original burning pain from the breast reconstruction has returned as it is no longer masked. Also I have incredible pain in my legs,and have to get off my feet often. Also I have insomnia which I have never had before.

    At this moment I estimate it will be another eight weeks until I am off the Tramal completely…
    So I am hoping that withdrawal symptoms will slowly go. I am planning to go on SAMe to help me with the nerve pain, when free of this confounded drug.
    My advice is to avoid Tramal completely unless it is very short time use.

  2. Ann
    Bolton, England

    I’m trying slowly to come off tramadol, been on then for quite a few years, was on 400mg a day. I’m now down to 150 a day and am feeling the side effects, restlessness and unable to sleep. I can’t wait to have a proper nights sleep again, it’s awful, I’m so tired. I will never go on these again.

  3. Ty

    I took Tramadol for a few injuries including a knee injury and got addicted. Tramadol was supposed to be weaker but it made me higher than codiene-based pills ever did. When I noticed this addiction I went cold turkey and had a 1 week ordeal where I was violent and jittery non-stop, but I informed my family ahead of time that I was going cold turkey. Still, no one expected it to be that bad. Eventually I had to use some older codiene pills I had from a prior surgery to help me the last few days but within two weeks I was symptom free and pill-free. I was prescribed Tramadol for long-term pain relief because it was supposed to be non-addictive compared to Vicodin and other pain relievers. Took 3 years to get over the knee pain finally, but if I do get it hurting from working too hard I take an Aleve every now and then since that is the best over the counter pain killer for me.

  4. Walt
    So. Oregon Coast

    My VA doctor has had me on 400 mg daily for 4yrs for my peherial naturopathy. He said I could stop cold turkey because there no withdrawal symptoms. Was he ever wrong. I am on day three and have most of the symptoms people describe. Jerky legs, brain zaps flu symptoms, not able to sleep at night but fall asleep for a few minutes all day long, nervous tremors plus the original pain the tramadol was stopping. I have decided the pain fron the neuropathy was easier to endure than the side effects of tramadol. Day three and counting.

  5. S D
    New zealand

    My story is a little different.

    I’ve been diagnosed with chronic kidney stones (have had 4 in the previous year including 2 surgeries). I haven’t been without at least 1 kidney stone in this time.

    For about 11 months I was on 400mg per day (2x50mg 4 times a day) and must say tramadol is an amazing pain killer that does its job well. 4 weeks ago I decided to wean myself off as ive had concerns about my liver with long term use of this opioid.

    Long story short, I went from 400mg to 300mg for 1 week, then 200mg for a week, finally 50mg for a week and then stopped. I experienced 2 days of severe RLS which was eased with a small codiene Rx from doc. These and the odd brain zaps were all I experienced and none of it happened during the weaning process.

    I guess everyone is different. Just wanted to share.

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