Q. Last February my 84-year-old mother had pain in her lower back due to a car accident. The doctor prescribed tramadol (Ultram). She took it for several months. It helped with the pain, but we did not realize that the problems she had were side effects that the drug was causing.

The most serious one was shortness of breath. The doctor prescribed an inhaler, and was about to refer her to a pulmonologist. Other adverse reactions included confusion, lack of appetite, depression, anxiety and very high blood pressure (we took her to the emergency room in April for blood pressure of over 200 with shortness of breath).

They did not find anything, but prescribed more blood pressure medicine. Around July she stopped taking the tramadol and she soon realized that she was no longer short of breath. Gradually she was back to her old self, with purpose, less anxiety, and able to breath well.

Perhaps the doctor should have realized that the shortness of breath was due to the tramadol. Perhaps I should have read the sheet that came with the medicine. I wonder if any other patients have had a similar experience.

A. Tramadol (brand names Ultram & Ultracet) is a complicated medication that was first approved by the FDA in 1995. It is a moderately powerful prescription pain reliever that has some “weak” opioid activity. That means it acts a bit like a narcotic. It was supposed to be safer than most pain relievers, which is why it is not categorized as “controlled” substance (the way Vicodin, Oxycontin or hydrocodone are). Doctors could prescribe Ultram without using a DEA (Drug Enforcement Agency) number.

In the early days there was a belief that tramadol was much less likely to cause dependence than most other narcotic-like analgesics. In other words, there was not supposed to be an abuse potential (doctorspeak for the drug was generally considered non addicting). In theory, this pain reliever was supposed to have a low likelihood for producing withdrawal symptoms upon discontinuation, especially when compared to narcotics like oxycodone.

Tramadol also affects neurochemicals such as serotonin and norepinephrine. That means the drug behaves a little like antidepressants such as Zoloft (sertraline, which is an SSRI or selective serotonin reuptake inhibitor) or Effexor (venlafaxine an SNRI) in the brain, though the drug has not been approved to treat depression. More on this effect (and its complications) in a moment.

The problem with theories is that they don’t always work out the way they are supposed to. In the case of tramadol, there are a number of side effects and complications that were not necessarily anticipated.

TRAMADOL SIDE EFFECTS:

• Dizziness, unsteadiness, vertigo, coordination difficulties
• Nausea, vomiting
• Abdominal pain, indigestion, diarrhea
• Constipation
• Sleepiness, drowsiness, fatigue,
• Itching, skin rash (could be life threatening!)
• Sweating
• Dry mouth
• Anxiety, confusion, nervousness, cognitive dysfunction
• Headache
• Insomnia
• Seizures
• Respiratory depression, breathing difficulties (shortness of breath)
• Suicidal thoughts
• Low blood pressure on standing, hypertension, irregular heart rhythms
• Serotonin syndrome

Your mother’s side effects including her breathing difficulties, confusion, lack of appetite, hypertensive episode and depression could all have been tied to tramadol. The drug can trigger something called serotonin syndrome, especially in combination with certain other medications. You can read more about serotonin syndrome at this link. It can be potentially life threatening.

Perhaps the most disturbing and unanticipated problem with tramadol is withdrawal. Even though most health professionals thought the drug would not trigger this problem, we now know that it not only happens but can be disastrous. In addition to the narcotic-like action of tramadol, the drug also behaves a bit like antidepressants such as paroxetine, sertraline or venlafaxine. At the time it was approved, the FDA may not have realized that when such drugs are stopped suddenly, people can experience very unpleasant withdrawal symptoms. This dual action (the narcotic-like effect and the serotonin “discontinuation syndrome”) can lead to some terrible symptoms. Patients are not always warned about this problem.

TRAMADOL WITHDRAWAL SYMPTOMS:

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

Here are just two of many stories we have received about this complication:

“I had surgery on my shoulder for a partial rotator cuff tear and manipulation of my frozen shoulder at the same time. The doctor ordered for PT to begin very next day. I was taking tramadol, but starting to feel strange so I stopped taking it abruptly.

“By midnight I was having cold chills and the sweats all night long. By the next morning I was vomiting. In addition to sweating profusely and cold chills I had severe anxiety. I was ended up in ER that afternoon. Apparently, I was having withrawal from tramadol. It was a horrible experience. I do not want to ever experience the “withdrawl” symptoms again.”
Keiko


“I took tramadol for just over 30 days prior to having a hip replacement. I then took the pills for a week after surgery. Then I stopped.

“The withdrawal for me was worse than recovery from the surgery. I had flu like symptoms and was depressed (something I had never experienced). It took about 3 weeks to feel somewhat normal. I would never take this drug again!”
Lorraine

 

GENERIC TRAMADOL PROBLEMS:

In addition to the side effect issues and the withdrawal symptoms associated with sudden discontinuation of tramadol, there is also the generic drug concern. We have heard from a number of people that not all generic versions of tramadol are created equal:

“I was taking the generic version of Ultram (tramadol) for several years when my pharmacy suddenly changed manufacturers (and did not point it out to me before I left the pharmacy with it).

“I gave them the benefit of the doubt, but within 24 hours of taking the other generic, I knew something was terribly wrong. All of my pain symptoms returned overnight, accompanied by extreme anxiety.

“I had to jump through hoops with the pharmacy but managed to get my doctor to write the script as DAW [dispense as written] and within an hour of taking the “Ultram,” I felt completely different. The anxiety disappeared along with the lower back and leg pain.”
P.J.B.


“When my doctor prescribed Ultram for my neurologic pain, it worked for the first time and I was nearly pain free for a few hours. Then the pharmacy changed to the generic tramadol and I never had total pain relief for any length of time.”

Jim

 

The bottom line on tramadol appears to be:

• Tramadol can ease pain somewhat, but has a number of serious side effects (see above)
• Tramadol should not be discontinued abruptly. It can trigger terrible withdrawal symptoms for some people.
• The FDA has not provided physicians with clear guidelines on how to help patients phase off such drugs. We frequently see recommendations like “gradual withdrawal,” but no one bothers to provide clear instructions about what that really means.
• Do not assume that all generic tramadol formulations are identical to Ultram or each other.

If you experience any side effects, withdrawal symptoms or complications with a generic version of tramadol, contact your physician and pharmacist and request the help you deserve.

Share your own story or comment below.

 

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  1. Wendy
    Nevada
    Reply

    My daughter has rheumatoid Arthritis and severe back issues. She has been going to a pain management doctor for two years. The first thing he put her on was Tramadol 50mg three times a day. She is all of 98 pounds. She has also been prescribed other meds as well. She is 24 always avoided illegal drugs, stopped being friends with people who were using. Lost friends to overdose etc.. Her primary care prescribed Cymbalta for depression and possible pain relief she was on it 60 days when she began having issues. Then she had a seizure in the shower. She realized her “issues” were absence seizures. She had an appointment with her pain doctor and they decided to “wean” her off tramadol but she wasn’t really giving direction on how to go about it. She had two more seizures and was told not to drive or be alone. finally after a week she got through to the doctor and the doctor told her to stop the tramadol immediately. She might experience some discomfort but the seizures should stop. Well the “discomfort” was full on withdrawal symptoms fever chills muscle spasms nausea extreme pain anger and lashing out the works. The doctor called in new prescriptions to help with the withdrawal symptoms which basically knock her out. I live 500 miles from her but my 74 year old mother stepped in to stay with her. This medication was touted as not being addictive and minimal opiate withdrawal symptoms. That is completely wrong do not take this medicine without completely researching your options. My daughter feels like she would rather go through having her appendix removed and having mono (which nearly killed her, again due to a medical professional) at the same time than dealing with the withdrawals from this supposed safe drug.

  2. bruce s
    bingen Wa.
    Reply

    I have osteoarthritis, degen discs, no cartiledge in my neck, bone on bone, bad spondy low back, uneven leg length, 4 herniated discs and more, but that is nuff, been taking tramadol hcl. Is that same as ultram? 3 years using this trash, some relief until last fall 2013, I pushed a neck vert. I could feel it manually, went to my pain clinic, saw a PA., gave me more tram, I said I needed a good chiro or osteo to realign my neck. She did not know any in this area. Later, too late, her supervising MD. did know of a good chiro that he used often but too late for me. Meantime the PA. upped my dose from 100mg to 300 mg a day, pretty soon I am hooked and still in pain.
    Now a year later I am withdrawing (my choice) and same clinic seems clueless as to schedule a gradual taper. Last visit they cut back 33% on it….too rapid….Why do I know more than the doctors from looking at a few web sites on withdrawal? Best site …reduce 10% a week, not 10 mg a week, an easy mistake to make but a bad one. As said the clinic: Columbia Pain Management, seems pretty ignorant on a subject that they should know very well.
    I’m not doing well and resent the heck out of these idiots malpractice……So, I’m on my own despite many calls asking for help. Oh just talked to the clinic and they will see me in a week.

  3. Sherry
    Palm Bay, FL
    Reply

    I have 3 discs that are degenerating in my lower back along with Fibromyalgia, two bad knees & Neuorophy!!! I was put on Tramadol a week ago, the more days I took it, the worse I began to feel! More pain, forgetfulness, dizziness, as well as some other side effects.

    I took 2 yesterday but nothing this a.m. yet, and I can already tell a major difference! I’m not in as much pain as I was over the weekend! Going to my M.D. in a little bit & going to talk to him about the side effects of Tramadol! So not happy with it!

  4. david
    United Kingdom
    Reply

    Interesting to read everyone’s experiences with tramadol here. I have been taking the drug on and off for about 6 years but the past two years it has developed to habit forming.

    Initially I was taking them for back problems however like most I am now simply taking them because I can’t get off them. I take 3×4 50mg pills every evening purely down to the fact that without them I am bored senseless. Recently I feel a lot more depressed than normal and the suicidal thoughts are creeping in. I have had every other side effect imaginable over the years. Pretty much everything on the list I have had but for me the worst issues are the itching, nausea and cloudy thoughts.

    One thing I do find positive in my situation is that this year I have been on two family holidays this year and during these times I have not taken any tramadol at all so I know from experience getting off them properly can be done.

    Tonight I will lower my dose and see how we go. I am sick of being unsociable and always making excuses not to do things. I want my life back.

    • sherry
      ohio
      Reply

      Please,please whatever you do only take small amounts of this. I have been on ultram for ten years due to disk degeneration disease and nerve damage in my arms . This honestly is the only med that gave me energy and no pain for a while. But, they never told me how addictive it is!! I am on day 5, of withdrawal,not good at all let me tell you. The problem with this pill is after A while you need more and more. I will get off these some way. Just be careful.

  5. laz
    United States
    Reply

    Regarding Tramadol toxicity and withdrawal, we recently had an experience which shouldn’t have happened. Our 8 yr. old dog had surgery and was prescribed Tramadol pre-op and post-op. We told the vet that her pre-op dose was too high because she began crying after we gave it to her so we lowered the dose to 1 pill/day instead of three! We thought she would take that into account after surgery. However she still prescribed Tramadol at 1 pill /day cut in half and given 12 hours apart (we found out later that cutting pills increases the speed of release into the system and shouldn’t be done). Well our dog was having breathing difficulties in a couple of days, vomiting and we reported it immediately. The vet seemed clueless and didn’t even suggest Tramadol as the cause, so we kept on giving it to our dog thinking she needed it to survive.

    Finally, several days later our dog had tremors on her sides before going to bed, during the night she began crying uncontrollably like she never did before the Tramadol. In the morning she was exhausted and we thought dehydrated so we brought her to the vet clinic. The vet was again clueless and missed the symptoms as being a result of adverse reactions to the Tramadol. We researched all this afterwards and found out that all the symptoms could be attributed to Tramadol adverse reaction and withdrawal. The uncontrolled crying is called emotional liability and can be caused by Tramadol overdose or withdrawal. Toward the end our dog so exhausted from crying, also had weak/no pulse in her legs and we also found that on the list related to Tramadol side effects. Again the vet didn’t make any connection and gave our dog morphine to sedate her to stop the crying which was the wrong thing to do. We found out that Tramadol should not be mixed with a narcotic and morphine is a narcotic. So our dog died and we had to speak with the vet and show her the information we found. Her words were “this is all news to me.” She was sorry but her lack of knowledge concerning Tramadol effects, dosage and withdrawal ultimately led to our dog’s untimely death. If not for the meds. I think our dog would have recovered. Sad. Avoid Tramadol! Also, vets have no accountability put on them and owners have no recourse it seems when negligent care is given. Be aware. I wish we had been.

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