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. Natalie

    Hi, so I’ve been on Tramadol for about a year now. First prescription dosage was 100 mg twice times a day, then six months later 50 mg two pills three times a day. When it was originally prescribed I specifically asked my physician for a pain med that is non addictive due to a family(mother) history of substance abuse and addiction.
    Despite the prescribe dose on the label my physician and I talked about using it on an “as needed” approach.

    I was in horrific organ pain for my chronic illnesses, yes plural, and soon discovered that Tramadol didn’t work as an “as needed” medication. It only works when you take it consistently. So I started taking it as prescribed. After a few weeks I began to realize that I was dependent upon the surge of energy and focus I got while on it. At first I thought it was because I wasn’t in pain anymore…and because I wasn’t in pain I decide to return to the as needed dose my physician and I had originally planned.

    A day after my last consistent dose I started to fill tingles in my hands and legs. I was working out on an elliptical at the gym and my legs fell asleep. I told my doctor who referred me to a neurologist. The neurologist found nothing wrong with me.

    A few months later one of my chronic illnesses flared and I was in pain again. Started to take the tramadol at 50mg twice a day for a few months. My flare subsided, and with it my pain. Like before, I decided to go off of tramadol, as I didn’t need it anymore. Like clockwork, a day after I took my last dose I started to get nerve tingles and brain zaps, but by this time I had also realized the correlation between my high energy and optimistic attitude and tramadol. I liked being overly happy and pleasant. I enjoyed life and felt productive. And then it the tingling nerves and sense of sadness hit. It dawned on me that it was all related to the tramadol.

    I didn’t mind continuing the medication at the time. I was going through a lot of life changes and knew that the Tramadol was helping me deal. I got off my antidepressant, citalopram, because I didn’t want serotonin syndrome. I continued taking 50 mg two pills twice a day. Then 50 mg two pills three times a day…then 50 mg pills on top of that whenever I felt exhausted. I did this for three months until my husband and I talked about conceiving. I had done my research on Tramadol throughout my abuse and knew I could no longer take it. My mom had drank alcohol while pregnant with me and now lives with the guilt of the chronic problems she gave me. I will never do that to my children.

    With my husbands help and support we cut me down to 4 pills twice a day for 4 days, then 2 pills twice a day for 3 days. At two pills my pain flared. I went back to 4 and we talked to my new primary care physician.

    He honestly was no help. He bad mouthed my old doctor for even prescribing them to me, despite the fact that I took on all the responsibility for abusing them. So my husband and I recollected and decided to taper off slower aid the withdrawal symptoms with prescription medications I already had. We got down to 1 pill a day(50 mg) and I stopped. I started my citalopram to help with the serotonin symptoms, took 1 pill of nighttime Tylenol for insomnia, swam in our above ground pool when my nerve tingles got really bad and sweated out the anxiety and depression by upping my endorphins during runs and work outs. I had a few pain episodes and used Tylenol for it, but I finally got through it after two weeks.
    It is by no means easy to get off. But I’m also not one to let a substance, or well anyone or thing honestly, control me. My husbands support was definitely essential, but most importantly my own honesty with my self, and my desire to start a family. It’s been four weeks since my last dose and I feel great.

  2. Marion

    I am so glad I Googled information this morning. I stopped 2 of my 4 -100 mg pills about a month stopping 1 then staying on that dose for 1 week and then the other. So 3 days ago I decided okay I’m kust going to stop the other 2 at once really wanting to get off it asap. WRONG. I have been so sick that I am going to try 1 pill today if necessary and I hope not go back to the 2 and check with my doctor tomorrow. Be careful everyone and please do seek your doctors advice on what they can do to make this easier as this way is intolerable. Bless you.

  3. Katie
    United Kingdom

    I came off Tramadol on the 18th June and experienced some of the symptoms. But the worst of all for me are the pains in my legs as if I have not sat down for hours on end and lack of energy, and weird sensations in my stomach.
    Anyone else had these symptoms ??

  4. Shelly

    I want to be as helpful as I can and also seek help from others. Ok, I have been on Ultracet (Tramadol with Acetaminophen) for over a year due to injury, then surgery for that injury, the 7 months of painful physical therapy that followed and then another injury. It helped the pain, kept me focused and optomistic about my recovery, gave me energy, confidence, an overall feeling of “WOW!” Due to the nature of my surgery, I was unable to drive so I had to walk everywhere, something I’d never done nor enjoyed, but I did. I lost 20 lbs. and looked and felt great. Bought new clothes for my new body and was just really digging life. Then prescribing Dr. gave me less and less refills. I purchased online from non-US pharmacies. Quite expensive, but hey, I looked good, I felt great. Got to do what you got to do. Took 75mg three times a day.

    Then suddenly the Ultracet became unavailable, so I switched to straight Tramadol. Wasn’t long before the awsomeness decreased. A steady downhill until last Sunday night when I slipped into a horrendous panic attack. Shaking, hot flashes, chills, profuse sweating, nervousness, a constant feeling of pending doom, Stared at the ceiling until 2am and then was awake at 6am. The next morning I was ok for a little while, then by the afternoon it happened again while out with my teenager. From a parking lot of a shopping plaza I called my primary care physician and he was able to see me right away. My blood pressure had skyrocketed and that made me more upset. I was always perfect my whole life. I didn’t take any Tramadol at all that day and haven’t since the episode that evening before. Today is Friday, day 5 of complete cold turkey and still feel slightly anxious, but very lethargic, not motivated, no interest in taking walks. Just sitting here on the internet hoping to find ways to feel better. I am terrified of trying a weaning process after being off of it completely for 5 days now. I also learned that Tramadol causes an elevation of Serotonin which can cause Serotonin Syndrome which can be serious and cause the same symptoms as withdrawal. So why would I want to go back to the Tramadol? I do need help though, Any suggestions on feeling better quicker are appreciated. I cannot tell anyone I know about this. I am ashamed.

  5. Karma
    Rhode Island

    I have experienced all of the above when trying to get off Tramadol. I have been taking 100 mg three times a day now, for the past 5 years for my back pain. Over the past 3 weeks I have weaned myself a quarter of a tab at a time – so instead of taking 2 50 mg tabs 3 times a day, I was now at 1 and 3/4 tabs 3 times a day, I stayed on the new dose about 3 to 4 days until the withdrawal symptoms weren’t quite as bad anymore and I had a feeling that my body had adjusted a little to the new dose. Last week I had reduced to 1/4 of one pill 3 times a day, then went to 1/4 of a pill twice a day. I took my last quarter pill 3 days ago. I do have slight brain zaps, nausea, and most of the other listed withdrawal symptoms, the worst one is I cant sleep and have awful restless leg syndrome lying awake in bed. I knew this would happen, but I was so ready to get off, and I know this might last another month or two before my body has fully adjusted to being off Tramadol. I am thinking I should have reduced even slower than I did. Maybe stayed on a certain dosage for a week each. But I have lost patience with the nausea and all the other symptoms, and just want to get it over with. Yes it does help that I am not working and have no other responsibilities than myself and my hubby, I don’t see how anyone can do this having to deal with work and kids every day. It should be illegal to prescribe this medication! I am shaking my head in disbelief on how this drug got approved by the FDA. The doctors ( at least my own doctor ) are clueless.

  6. Joni

    It’s good to know I’m not the only one experiencing this!
    Was put on Tramadol 3yrs ago for pain relief due to Fibromyalgia & severe menstruation pain. I started off on 50mg 3 times a day & it did seem to work but not for long so they upped my dose to 100mg twice a day plus 50mg 3 times a day. Again it worked but not for long so they took me off the 50mg & increased my 100mg & told me to take as much as needed including taking 2 400mg ibuprofen with every Tramadol capsule.
    Fast forward & I tell them it has stopped working they insist I come in to see them to discuss an even higher dosage. I refuse so they then refuse to renew the Tramadol prescription unless I come in to see them.

    Instead I took this opportunity to take myself off of them thinking I wouldn’t have any symptoms. Like hell I don’t! Didn’t even realise it could be withdrawal symptoms until last night after suffering for the last two weeks with what I thought were flu symptoms combined with a fibromyalgia flare up. How wrong could I be! I’ve had a migraine for the better part of a week I’ve had no energy & no urge to do anything the entire time.
    They never told me this shit would happen.

    I have an autistic son who needs me & a hubby who works long hours to provide for us.
    I can’t go back now knowing what it does to people but I’m suffering.
    I’m so glad I found this site.

  7. karen

    Started this weekend,hate it but it’s time. Suffer from back pain but started med due severe menstrual cramps. I’ve done this before,it’s not fun but it’s doable. Diphenhydramine helps a bit,for a no prescription choice. I’ve treated my symptoms as I would a cold. As adults I truly believe we should conduct ourselves as such and not look to place blame on others. All medications have side effects and should be approached with caution. Every thing,just about, has the potential for dependency; caffeine,sugar,nicotine,alcohol,the list goes on; and are perfectly legal. Approach a problem,seek solutions,choose what suits you and be patient and determined. No one needs government in their lives. Good luck all.

  8. Azman

    Been on medication for back pain for nearly 1yrs and been on tram 2×50 mg 3 times daily. Tks for this site that I have get to know abt tram withdrawal and it’s consequences. Worried to go thru so I taper from 6 to 1 within a week intend to CT after this with 2 x50mg left. Is codeine phosphate 60 or nurofen any help for the detox to mild down? Hope anyone knew it may be able to help out as these are the only sub that with me but few. God Bless.

  9. Sheryl

    I am so glad that I found this website! I have been taking Tramadol since about 2002. I ruptured a disc in my neck lifting weights and ended up having to have it repaired surgically. I was prescribed Tramadol 50 mg as needed up to 400 mg per day. I started out taking 50 mg 3 times per day and it worked great. The doctor that originally prescribed it said it was a very mild pain reliever with no side effects. Fast forward a few years and I started having severe knee pain. I was diagnosed with severe osteoarthritis and had my first knee surgery in 2005 at the age of 45. Between 2005 and 2015 I have had both knees replaced and one hip. I have arthritic pain in my other hip, both shoulders and my lower back. I have taken the Tramadol along with Diclofenac all these years and the combination has worked well to relieve my pain and allow me to live a normal, productive life. I am up to 350 mg of Tramadol per day now. I have asked both my orthopedic and internal medicine doctors numerous times if I need to come off the Tramadol and they both told me it was fine to take it as long as my blood work is good (checked every 6 months). The reason I looked up withdrawal symptoms on the Internet is because like many of you I have always been able to get my Tramadol prescription filled a little early. I called my doctor last week and asked for a refill because my prescription will run out before my next 6-month appointment (in 2 weeks). Well, I got a call back from his nurse saying it was too soon and that I must be taking too many pills if I am almost out. I was furious! First of all I am not completely out and secondly I thought this stuff was safe to take long term! I have never taken more than prescribed. So it got me to thinking that maybe I should try to stop taking it. I took only 50mg on Thursday and Friday and today I am feeling like crap(day 3). I ended up taking 100 mg today just to be able to function! The thing I notice the most is the feeling of doom and gloom. I also have the hot/cold feeling that is miserable. My feet are freezing but my upper body is sweating profusely. I do also have some tingling in my lower legs but I’m used to that after 2 knee replacements (the last one was just 4 months ago). I am so angry at my doctor!! I moved up my appointment to next Wednesday and he is going to get a piece of my mind. I am also going to tell him to read the posts on this website and maybe he will think twice before prescribing this highly addictive drug in the future! No doubt I will have to have his help to get off this stuff. I work full time and can’t afford to miss work while trying to detox! I feel stupid for not being more proactive about my health. But when several different doctors tell you over and over that a drug is safe you believe them. The more I think about it the Tramadol may be causing problems such as my lack of energy and being irritable. I blamed most of that on menopause and have been getting hormone replacements trying to deal with those issues. Hopefully getting off the Tramadol will improve my health overall! Again, I am so glad that I found this website because it has given me plenty of information to throw at my doctor next week. Good luck to all of you that are going through this nightmare!

  10. Anastasia


    I am not easily addicted to anything, quit smoking easily, quit antidepressants easily, etc. but I’ve only taken Tramadol two days, and today I’m off it and I couldn’t get out of bed!
    My fluffy black kitten who I love so much now irritates me more than anything, everything irritates me. I’m so ready to punch something.

    However, everytime I get any hyped up emotion my whole brain hurts. When I calm down my headaches stop for the moment but it still feels really weird and uncomfortable; all I want to do is down a couple more pills.
    I’ve hidden them from myself and I’ve taken a Lisinopril to help with high blood pressure which seems to be helping me calm a bit. Tramadol feels good for 8-12 hrs and then messes you up twice as long.

    Vicodin never left me a wreck like this.

  11. Bob
    United States

    Been on tramadol for separated hip (gotta love drunk drivers) for 4 years (100mg, 3x daily). Had a procedure that lessoned the pain, so began taking “as needed” per perscription, usually 2 in the am, then anywhere from none to 2 or 3 depending on activity. First thought I had the flu, then experienced 5 of the symptoms described above. Went back to full dosage, all went away. Due to kindey issues I can’t take anything that metabolizes in the kidney, including opiods, tylonol, asprin, ibuprofin etc. Now faced with a lifetime addiction at full dose that I don’t need for pain, or a lifetime of pain without painkillers (other than alcohol, with it’s own dangers.)

  12. Tina

    Hi just would like to tell you about a bad experience I have had, I have been on tramadol for nearly 12 years due to a bad accident I had at work, I on my own accord to decide to come off the tramadol. I was on 400mg 8 four times a day I started by stopping 1 (50mg) for 2 weeks then down to 7 a day for 2 weeks, just at the end off that 2 weeks I had a doctors appointment for another medical reason, my doctor just asked me how I was getting on with weaning of said “it was going well” he then said “I want you to come off them completely, I want you to take 5ml of morphing when you would be due to take the tramadol”

    I was really weary but thought doctor knows best, well that was on Tuesday by the Friday I started feeling really ill felt so nausea it wouldn’t go I felt like I was on a fair ride, I felt so down I could not sleep, I never felt so ill in all my life, by the Sunday evening my husband said perhaps it could be withdrawal symptoms I said no it probably the flu as thinking no way would a doctor tell you to do what he told me to do when it’s a dangerous way of doing it when you put your trust in your doctor, well a hour later I when and took just one tramadol with in 20 minutes it all went I felt like dancing on the table, so on the Monday morning I phoned the surgery and asked to talk to a doctor and to make the story short I spoke to another doctor, he replied you never go cold turkey on that sort of medication, he told me to start taking them as normal and do it the way
    you was doing it, I’m sure that the other doctor will be having a talk too, so the reason I am writing this is to let other people know never do it the way the doctor told me.

  13. sasha

    Dose off very slowly I had to do that off of xanex it took me three months to dose off xanex they actually put me on klonopin because its longer acting to fill the gaps take the total mg u are taking and take an 8th or even a 16th of the pill away by cutting it. If its cuttable. Do that for a week then try to cut down one more 8th or 16 th of a pill every week do this til u have stopped if the pill is every six hours continue taking every so hours but make sure u just cut the dose down a very small fraction. Watch for fast heartbeat and know that this works any other way I would have hallucinations and almost have a heart attack until a doctor helped me she told me to cut it in Half but that didn’t work so I did much smaller … I’m drug free except for the fact that I hurt my hip with sciatica and went to the doctor and asked for a non addictive rx and he gave me tramadol. I noticed it was addicting right away so here I am getting off I week two very slow because I had withdrawls that quickly. I cut an eighth off for three or four days now I will be cutting back a 1/4 of a pill and hopefull be off this thing in a couple weeks … Never again. How could a doctor prescribe me addicting pills when I told him not to? To a mother of a two year old. High five to him. I asked him if he knows for sure as I looked him in the eye that its not physically addicing and he said no.

  14. Gregg

    I had a life threatening disease. Not expecting to live over one year. After surgeries My organs started to fail. Regardless, 6.5 years heavy morphine use, then switched to Tramadol.

    12 years later I am ready to stop all drugs. Not sure if I can now or not. 300mg Tramadol daily 4 years.

    So far this is my experience.

    300mg. to 50mg for a week or so. Very sick!
    0 mg. for 17 days. Not much better. I am getting some sleep now, but not much.
    I never got depressed? Just felt extremely bad all the time.

    At this point I have given up on a daily feel better view. Realistically, I am thinking (hoping) 3-6 months will be a more accurate time line.

    17 days out, one day I will sleep some. The next day all withdrawal symptoms return in full force.

    I hate to paint such a gloomy picture, but the reality is (for me) it is going to take months.

    Even at 50 mg. / day you are still going to be going threw some rough times.

    If the withdrawal systems do not go away in one month. I am going to go to my doctor and see if I can get some relief. Also, I am going to talk to a lawyer about this.

    IMO it is threatening my life. No sleep is very bad for the immune system. It is throwing all my hard work on staying alive down the drain. And I am not in good shape. If I die, I want them held responsible.

    My story so far, regards.

    • Wyatt
      United States

      Ive been taking Tramadol for 3 and on. This last time almost killed me. I go days without sleeping. I stopped 2 full weeks ago and still only sleep every other night. And only with a sleeping pill. Has this ever caused permanent damage? Anyone know? I don’t even get sleepy anymore.

    • Azman

      I just posted and found that I have similar tapping method and maybe by 2 days time to detox. Anyway GREGG it’s gd to hear that u have gone past the critical stages and thumb up bro. I don’t know yet of how tram reaction on me.

  15. Leslie
    Jacksonville florida

    Thank you all so much for your posts.
    I am trying to stop the Tramadol.
    I can’t stop crying and sweating… I am in and out of the bathtub- but can’t regulate my temperature.
    I can’t sleep well and am anxious and agitated.
    I am 50 year old women who had to have a hip replacement.
    I am 2 or 3 days in, trying to stop taking this drug!
    I have been taking 50mg every 8 hours totaling 1-3 a day for about 5 months.
    The pills begin to stop working as well and I was having side effects.
    I decided to stop taking them.
    I am hanging in there but scared.

    • Matt

      I’m getting close to done tapering off myself right now, and the key for me has been to go slow.

      I’ve been on Tramadol for a dozen years due to chronic pain from a C5-C6 herniated disk in my neck. My prescription is for 400mg/day (4X100mg), but I had routinely been taking up to four times that much daily (obtaining the extra from an less than diligent online pharmacy).

      The medicine worked really well for me. I don’t know if it “stopped” my pain, but it made me care less about it. I also liked the mild euphoric feeling I got from Tramadol without ever looking or feeling loopy or inebriated, and it made time pass by faster and easier in my perception, especially at high dosage.

      I decided to stop taking it primarily because my life had started to revolve around the need to make sure I had an adequate supply, and making sure I had it with me at all times. Over the years I had occasional supply problems (prescription running out, a lost shipment, etc.), and the withdrawal symptoms were terrible until I could get more. I’ve wanted to get off the drug for a while, as I don’t like being dependent on anything. The final straw was the recent scheduling of Tramadol as a Class IV controlled substance.

      I was able to drop back to the prescribed dosage pretty quickly (over the course of about two weeks) and without any severe withdrawal symptoms. It has gotten harder and slower since then. I think the biggest risk for me is the temptation to accelerate my tapering after having some success, when I really need to do the exact opposite. I’m so eager to be done that it’s hard to take the slow road. For me, about a week at a given dosage prior to lowering it (by 1 pill/day at first, then by half a pill/day at lower dosages) seems to keep withdrawal mostly at bay.

      As of now I’m down to 75 mg/day (a pill and a half). Like I said, almost there….

      I tried to drop to a single pill a day yesterday after two days at that level, which was a mistake. The symptoms got bad. I had to go back up to 75mg/day and will be there for at least the next few days.

      All along the way I’ve focused not on avoiding all withdrawal symptoms, but on keeping them at a level I can live with. By far the worst of it for me is restless limbs, but going slow has allowed me to get at least 2-4 hours of sleep a every night (and some nights, maybe 1 out of 3, I sleep fine). I’ve also had body temp irregularities (intermittent mild, full and partial body chills and sweating), and I’m sneezing at least twice an hour. All manageable at the pace I should be and will be going. I’ve asked my wife to keep an eye on me for changes in mood or irritability, but so far so good on that front. No headaches or pain related to withdrawal, though I am having to deal with more pain from the original injury. C’est la vie.

      I’ve got about 3 weeks to go before I try to stop completely. That’s my last remaining fear– how bad will it get and for how long once this pernicious stuff is out of my system? But I’m committed and looking forward to being free of the stuff. Good luck to all who are working toward the same end– whether you do it on your own as I have or get help from professionals, the goal remains the same. We can do it!

      • Jeff

        You story has been very helpful for me. Thanks

      • Lindsay55
        Baton Rouge

        Matt thank you for posting! I am on day one and terrified I won’t make it! Very pathetic for a 55 year old woman! However I am sick of this stuff!Again thank you it helps to know I am not alone!

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