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.

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  1. Pamela
    Merrill, WI
    Reply

    I have been taking Tramadol for chronic back pain since August 2015. It would sometimes make me itchy but was never an issue. About a week ago, I broke out in anew itchy rash on both arms, my upper chest, shoulders and upper back. I couldn’t imagine what was causing it. No new soaps, detergents, meds or foods. It would kind of subside by morning but then would flare up again in the evening, which is when I usually take the Tramadol more often, especially when I’m at work and my back hurts so bad from standing. On Saturday, I was off so decided to try not taking any Tramadol and the rash didn’t flare up, but now today when I was back at work, I took it twice during my shift and now here is am, rashy and itching like crazy!

  2. tim
    Chicago
    Reply

    It’s been two weeks, and two days since my last dose. I only took it for about 6 weeks, about 4-5 50mg tablets at once at night. I stopped cold turkey the 5th of jan and today the 22nd I’m still having substantial stomach cramps. Is this a normal symptom of a lengthy withdrawal? Just a side note I’ve never taken this devil drug before this.

  3. vivian
    colron
    Reply

    This drug tramadol has destroyed my social life withdrawals are torture. I wish I had never taken this. Your tolerance becomes higher. I need help desperately…

    • Georgia
      Austin Texas
      Reply

      Vivian I am in the same boat. I am actually considering going to rehab over this! It has destroyed my social life as well and I am looking for hope somewhere. Just want you to know you are not alone and we will figure this out!

    • Margie
      easthampton, Mass.
      Reply

      You can try acupuncture and Chinese herbs. They have helped me incredibly when I had horrible side effects from a heart medication. It takes a little while sometimes, but really works. I now go straight to the acupuncturist whenever certain symptoms of my health issues return. These symptoms include shortness of breath and heart palpitations, and Chinese herbs can also treat a host of other symptoms. I suggest looking into it- you can research it online, and most likely find an acupuncturist in your area who is also into herbs. Good luck! I know how awful it can be to be withdrawing from a drug- I did that too, before I knew that acupuncture and herbs could help so much.

    • Barb
      Tacoma
      Reply

      I am trying to wean myself off this horrible drug. I’m very depressed and my anxiety is through the roof. I am scared. I have an appointment with a rehab facility today. I hate this drug.

    • Jenny
      Lee on Solent
      Reply

      I have been taking Tramadol for years for rheumatoid arthritis and joint replacement. After my hip replacement I thought it was time to come off the Tramadol. I cut down the afternoon dose from 2 to 1 and then took the usual 2 at bedtime. I had the most awful night with shakes “live feelings”all over. I eventually got some sleep after 3am
      Do I continue with the reduction and hope things get better or keep on taking full dose with no effects.

  4. DÉISE
    Munster, Ireland
    Reply

    Hi…I had been taking tramadol for 2 years and stopped taking them on Dec 17th 2015 post L4/5 right side decompression surgery. I took 2x50mgs x 3 times a day… and if I was going out at night I took 2x50mgs extra to get through the social function. I quit cold turkey as my surgery went really well and I am anti tablets. I have very few side effects. I’m a little short tempered but have a strange feeling beneath both my knees. It’s been 15 days so fingers crossed things go well and I can say I’m tramadol free!!

  5. Diane
    Ohio
    Reply

    My mother-in-law is 87 and broke her pelvis. The doctor prescribed tramadol and it has resulted in paranoia and confusion, pronounced anxiety, and forgetfulness. We have asked repeatedly, since the treatment started 10 days ago, for a different dosage or better yet, different medication. The doctor has indicated this is the medication with the least side effects. I find that hard to believe.

  6. Lee
    California
    Reply

    I went off Ultram after 40 years. No real problems except lack of sleep and headaches, can anyone tell me if this could be due to going off drug?
    Many thanks
    Lee

  7. Reanna
    ?
    Reply

    I have been taking Ultram for approximately 6-8 months now. I can’t remember exactly. I take 100mg of the morning and 50mg in the afternoon, but not always 50mg in the afternoon. Some days I do not even take the 50mg in the afternoon. Recently, like the past two weeks, I have been waking up with my legs feeling very weak and I feel funny. I know poor description, but I have no other description I feel almost like I am dehydrated after a drunk in my legs. After taking the 100mg of Ultram in the morning, I feel better and I will feel better for several hours. Then approximately 6-7 hours after taking the 100mg of Ultram, I get very shaky, pretty much all over, but a lot in both shoulders and I feel my heart pounding. I can check my heart rate and it is not elevated, but Ican just feel it pounding. I hands will even feel tingly at times. It is the strangest feeling in the world. I feel so nervous and jittery. Is this a reaction to me coming down off the Ultram from the morning dose? It never did this before int he past 6 months, so I don’t understand why it would start now all of a sudden. Anyone have any ideas if this sounds like it’s the Ultram doing this? My plan is to take an Ultram every time I feel this way and if it fixes it,I guess I can attribute the Ultram to the cause. Anyone had anything similar? It is very strange.

    • Ann
      Michigan
      Reply

      Ultram hasn’t been out for 40 years. maybe 18-20 years, but not 40. Maybe you are thinking of another drug.

  8. Tamara Lang
    Pittsburgh
    Reply

    Thank you for this post. I know its older but this medicine is terrible. Prescibed tramadol for chronic pain in 2005, it worked welll until 2010 when I began college. Prescibed 300 mg x a day w adderall didnt mix and i have been weaning off (foctor supervised) for 18 months. After taking a psychopharmacology course did it click. The sweating, trembling, muscle tightening, ankle swelling, and more. I have been on celexa, trazodone, and klonopin for 19 years. In the beginning, before the adderall i was warned by rx that cekexa + tramdol carries a risk for seizures. I at the time, uneducated coorelated “seizures” w epilepsy. Over the years the sweating, and muscular tightening to something medical. It was my idea to cut the dose. I thought my mood was okay enough not to be on so much medication. The initial cut was 300 mg 18 months ago. I have been miserable, agitated, panicked, socially dysfunctional, its very hard. Down to 50 mg, these miserable symtoms are helped with the klonopin, but the dose needs doubled to fet through it. I see my doc on Monday and I am praying she will increase the klonopin temporarily. Diarehha, severe stomach pains, trouble breathing are all apart of this misery. Feel so much better until klonopin wears off. If anyone is prescribed this medicine, it will help the mood. However, it does not mix with imitrex, 800 mg ibuprofen, cekexa, trazodone, and adderall as it pertains to me. Im lucky im alive, to be honest. But to progress in academics it has to go. Good luck to anyone trying to wean of these. Never should be prescribed at 600 mg er with my medications.

  9. Michelle Nicholai
    MI
    Reply

    I have been off tramadol since the previous Friday, 5 full days now. I had a terrible withdrawl time Saturday night. I decided to take a small dose of Tylenol 3 to help take edge off. I am now out of those since Monday. I can’t eat, my heart is racing, legs jello, no energy, chills, fever… No sleep at night! I try to take some Tylenol pm to help me sleep or Benadryl but it doesn’t help. Then I got to thinking I’m on meridian which may not be helping. I now have diarrhea as well…. How much longer????

    • Brian
      Boston
      Reply

      I took my first dose of tramadol Halloween day and boy was it a trick far from a treat. It barely took away my back pain and the weakness and diahrrea were relentless. I guess it’s just not a good drug for me
      Brian C

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