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 norepinehprine 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
Insomnia, sleeping difficulties, nightmares
Flu-like symptoms
Nausea, diarrhea, loss of appetite
Hallucinations, unusual thoughts

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
Drowsiness, dizziness, fatigue
Restless legs
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!

If you found this information of interest, you may wish to subscribe to our *free* online newsletter. It offers questions and answers about drugs, home remedies, nutrition and non-drug approaches to healing; commentaries on the most pressing health issues of the day; special alerts on breaking health news as it happens and coverage of the top health headlines of the week.

It’s easy to subscribe to our free newsletter. Just click on the link below:

Sign up for our Email Newsletter

Stay informed with us, The People’s Pharmacy.

Join Over 52,000 Subscribers at The People's Pharmacy

  1. monica

    My nightmare started in January 2013. I hurt my back at work and my life has never been the same. I was told tramadol was a good alternative to narcotics. Little did I know that this is not true. I’ve tried to stop cold turkey a few times in the past with no success. My doctor has recently put me on an extended release formula for long term use. Well no thank you I’d rather stop taking this drug all together but my problem is I still have back pain. But now I’m wondering if now I do have back pain due to the meds.

    Not sure what to do. But I do notice a significant change in me such as leg pain, insomnia, I feel like I have the flu, ugh and these stupid brain zaps! I know I just need to get past this hurdle and then it will get better. It definitely helps to read all these posts and I immediately feel better and I know I can do it!

  2. mike

    I was put on tramadol for a long term foot injury in 2006.I took 300 mil per day. Got off because of stomach problems. After 1 week, of no tramadol, still nervous, anxious, mood swings and emotional things, crying over songs and tv shows, ear ringing, loud noises in my head when trying to sleep. Tramadol worked to a degree, but not worth getting hooked up into that cycle again though.

  3. In torment

    I had been on Tramadol for 8 months due to back surgery, I began to drop the dose last week and 3 days ago I attempted to stop completely. I felt so bad on the second day I had to open a capsule and pour most of the medication out just to allow my body a tiny bit to get through work.

    I have the flu like symptoms and runny nose, I get random shivers, I feel really emotional at a song or somethig on tele, which has never been me before. I almost feel hungover. All of this I can now handle and accept it as something I’m going to have to ride out. I write this led in bed at 2.52am knowing I’m up for work in less than 4 hours. The reason I’m still awake is my legs. I have never experienced such a constant annoying feeling. I can’t lie still, I thrash as my legs ache desperate to get comfortable and to get some sleep. Like another person posted I don’t feel Tramadol massively helped with my pain at all and the effects of stopping were never pointed out. I have told almost begged everyone I know never ever to take the stuff, this aftermath of torment just isn’t worth it. I feel for each and everyone of you, just ride it out

  4. AD

    The thing is, Tramadol “works” fine. It does what it is supposed to do while you are on it.
    BUT, and this is an enormously huge BUT, when you STOP taking it, is when you feel AWFUL. And, for most people, they have to stop taking it at some point – then they feel like they are going psychologically bat-shit crazy!!! And, there are the physical symptoms to boot. This is NOT a non-addictive drug.

  5. AD

    I am now 5 weeks off Tramadol. Although the horrible withdrawal stuff has passed, I am still in a state of BLAH’s. I have good moments, but nothing makes me “really happy”. I know this stage of the game will pass too. Just takes time for the chemicals in my brain to function on their own, and they will. I still feel mildly depressed alot of the time and some unexplained anxiety sometimes (that I never used to get) and my blood pressure is still higher than it normally has been for the last 20 years.
    I don’t notice a difference in myself day to day, but I can see that when I look week to week, I am getting better. Tramadol is HORRIBLE stuff. It feels fine when you are on it, but stopping in hell incarnate. Just keep reminding yourself it is just the chemicals in your brain that have to get functioning again and the only way to do that is to stop the Tramadol.

  6. Deb

    Well, I have been taking tramadol for 21 years with no side affects unless I miss doses. Same as all of you from the restless leg to the flu like symptoms, runny nose.
    But…. I have severe arthritis in my hands and I wouldn’t be able to move them without tramadol. It doesn’t take the pain completely away, but it dulls it enough to keep me moving everyday. I’m 56 and I take 50mg every 6 hours.
    I think if any pill doesn’t agree with you talk to your doctor on the steps to quit taking it, don’t do it on your own. Tramadol has never made me lethargic or buzzed like some of the pain meds out there, I actually think it works pretty good.

  7. LadyBarbie

    It’s been over a month since I had to quit Tramadol cold turkey due to moving and running out. I still have some withdrawals just not as bad. My heart still beats hard at night and my flu/cold comes and goes just not as bad. My tummy troubles come and go also. I was on Tramadol since Jan 2008. 240 pills a month. Do I miss them…Not at all. My back pain seems the same with or without them! I stopped taking the muscle relaxers also. Unless I have a bad back day.
    I never did get the leg pain/twitching with the withdrawals. But it was bad enough. I know that it was all worth it! This safe med the doctor put me on! This is the first time since 2008 that I am pain pill free. I thought my back would get so much worse. Not at all. Good luck to you all..will write again in 2 weeks…hopefully all withdrawals will be done by then!

  8. SPOOKY#1

    I was told it is not addictive too but my experience has been a little different. I have been taking them for about 10 years and just returned from the pharmacy after being denied a refill due to the DEA chaging Tramadol to a Schedule IV drug. Nice of them to cancel existing scripts for legal users.
    It’s going to be a long 48 waiting for my doctor to write a new prescription and on top of that, at 62, I’m raising my six year old granddaughter as a single parent so I have to suffer with a smile.
    I wrote down some phone numbers for her to call if anything bad happens during the wait so I think I have covered everything. Lots of hot and cold showers to help with chills and sweats. RLS is a given and last time I was off for a few days wound up sitting with my knees pulled against my chest tight just to gain some control over it so I could sleep.

What Do You Think?

Share your thoughts with others, but be mindful of protecting your own and others' privacy. Not all comments will be posted. Advice from web visitors is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. In posting a comment, you agree to our commenting policy and website terms and conditions.