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. AcornIntoOak
    Oregon
    Reply

    I would like to add into this discussion the symptoms that came up that prompted tapering off of Tramadol, as well as the withdrawal process I’ve been navigating.

    I began Tramadol in 2008 for extreme pain due to numerous factors: I fell down a mountain in Java and within six weeks of that contracted severe Dengue fever on top of having a painful form of muscular dystrophy, adenomyosis, homocystenuria, an immune disorder and fibromyalgia. At the time I began it I had been bedridden for two years and mostly paralysed from my ribs down. So many other pain treatments had been tried to little effect.

    Then the Tramadol was tried and holy cow! It worked a dream! In less than a year I was back to college and working. A bit more than that and I was fully ambulatory again. I took 2 50mg tablets 4-5 times a day and for the next six years all went well.

    Then in late 2013 the adenomyosis and endometriosis required extensive abdominal surgery, further melanomas turned up and then the cold and flu season got me really run down which triggered a relapse of the muscular dystrophy in February 2014. This time the paralysis was waist down and limited use of the upper body. I tell you all of this because it’s important to know that my situation is super complicated and would cause drugs to react differently with me than most people but later developments may serve as a warning to others so that they can work with their doctor to rule it out before things get too bad.

    What happened next was in late July. I slowly started having odd memory problems. I would completely lose periods of activity within a few days of doing them. Here and there at first. Considering everything else going on we thought it was the stress of it all catching up to me. Then in September there were clear signs that something wrong was happening with my brain. I’d get lost and confused in familiar places and activities, I would startle very easily, get disoriented at the drop of a hat and lose words while trying to talk. Early Alzheimer’s was suspected after brain and spine scans didn’t show any new problems, and tapering off each of my medications to be off of them for 3 days each hadn’t shown any changes.

    I had successfully completed months of physical, speech and cognitive therapy by November and found my pain levels had diminished enough that I was taking half the doses of Tramadol by then and the cognitive therapy had apparently begun working well because the brain issues were lessened too. Things were better but hadn’t reached normal, yet it seemed like it was somewhat possible for the future. I couldn’t write anymore nor read much but life had improved and I did have some independence.

    Then Christmas night we took down our tree in prep for a trip the next day and I managed to badly hurt my knee and back in the process. I took my full doses of Tramadol on each time for the next 12 hours. The next day I had my worst brain episode yet. I was shopping for the trip with my spouse and completely lost my sense of place, activity and why we were there for a good ten minutes–I felt like a lost child. My spouse had to sit with me and talk to me like I was five, reassuring me that everything was as planned and that he would make sure I was okay. I was fraught with anxiety and uncertainty about everything around me. And on the drive home, every time a car would turn abruptly or change lanes quickly I would gasp audibly. It was very unnerving, especially since we were about to leave for a lengthy drive for the holiday. It was then that two and two came together. I had been taking lower doses when the brain issues began to ease up and they came back with a vengeance when I returned to full doses.

    The next week we started the taper off of Tramadol, as we had done many times over the years to check for dependency, but this time instead of the standard 3 days we planned 7 days free of it. I had never had withdrawal before, only steady increases of pain that I just tried to zone out and away from during the three days. Same thing happened this time.

    That is until we got to the night of day 5. At first it was severe headache with fever, not clearly withdrawal, could have just been a cold but that night I had horrendously sad and gory dreams on top of it. Pain levels had increased to the point of being breath taking from time to time but nothing I couldn’t manage with steady concentration or distraction. Then the sudden stabs of pain behind my right eye told me this wasn’t a cold. The next day, chest pains added in and occasional difficulty breathing along with stabbing pains in my brain. Then I found myself crying over sappy songs or commercials–totally atypical behavior from me. (Thought it was some hormonal swing but have since read here that many of you have this symptom too).

    Then the deep horrendous all over body pain started. On some days I took five long hot epsom salt baths. They helped while in them but within an hour the benefit faded. The leg pains and shock sensations began next and nearly brought me to tears all night long.

    But it was that next day when I woke up that I knew that it was the Tramadol. That day I got my brain back. Not fully, but in a very noticeable amount! That was also the day I was supposed to start back on the Tramadol.

    It is now 9 days since I have had any. Sometimes the bone pains are excruciating–but this is the shocking part for me–sometimes I have almost no pain at all! And my brain is nearly back to the way it was years ago. I thought I was just getting older, all the slowing, but it wasn’t anything other than the Tramadol. Tonight the stabbing pains in my legs and hips did bring me to tears, knocked the breath right out of me at least two dozen times over the course of the night, but each one lasted not much more than a minute with tolerable pain in between and as I write this it has all dropped down near a 3 with nary an aspirin.

    I still have a ways to go before all the side effects and withdrawal symptoms are gone but there is a positive and whole life out there just a few clicks down the road that was completely inaccessible just a few months ago.

    I don’t know what changed with how my body processed or responded to the Tramadol. It was a wonder for me when all else had failed, but somewhere along the way it became the problem. I hope this information could alert someone ahead of time if they start having odd brain problems, before it becomes dangerously limiting for them.

  2. Lyn C.
    Australia
    Reply

    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.

  3. Ann
    Bolton, England
    Reply

    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.

  4. Ty
    US
    Reply

    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.

  5. Walt
    So. Oregon Coast
    Reply

    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.

  6. S D
    New zealand
    Reply

    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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