A bottle of tramadol

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. luke
    s.c
    Reply

    I have been taking tramadol 50mg. for about 5-6 years now and I take 2 a day & sometimes can get by only taking only 1 per day and I do this because I have really got used to depending on them to get thru each day since i broke my right hip from a fall off a roof and still have the screws inside me from repairing the hip bone and along with other lower back problems & shoulder surgery from some years back.

    Before starting taking tramadol, I talked to my doctor as I felt I was starting to drink more than I ever had before because I was only a 6 pack every other week if that at all type of guy but was now because of the pain drinking every or other day 6-12 beers and not knowing why I felt the need to drink. anyway once i started taking tramadol 1 a day that seemed to take away any want for alcohol & in 5 years may have only drank 2-3 times and don’t miss it at all.

    The drug really works for me and I never abuse it or take more than 2 a day but I still wish I could get off of it because of some side effects I have as not being able to sleep very well & have found that you might not want to take this drug less than 3-4 hours before going to bed.

    It seems to be a double edged sword for me as if i take it at bedtime i’m pain free for 4 or 5 hours but will not be able to sleep & wide awake & if i don’t take it at bedtime i’m tired but in pain and don’t sleep very well. the drug does help with depression for me. the side effects i don’t like as it seems to take away ones will to do some things that you did before but that could just be that i’m getting older & my health is not as good as it was.

    So, I guess one would have to weigh out the good and bad as to if one feels that they would be better off without it and being in pain or taking only 1-2 a day & feeling able to manage there pain. i know from reading other peoples side effects the they seem to differ from one to the other. I myself have low blood pressure & have not had any problems with heart rate increasing while taking this medication but that could depend on what other meds. someone might be taking along with it.

    Alieve is about the only other drug I take with tramadol & have not had any problems so far. i have read of some people taking 5-10 pills a day and i guess i could understand why they feel bad if that’s the way they over take there meds. as that’s what happens when you abuse anything as drugs or alcohol and need more & more and it will do more damage to one’s body than help manage pain the way it should be used.

  2. Bill
    Houston
    Reply

    I was on Tramadol for 6 years for herniated disks and disk degenerative disease. My back fused normally after a few years of PT and diet control but I stayed on the substance due to its amazing energy and its anti-depressive/anti-anxiety properties. I have recently decided to get off the drug and went down in 1/3 dosages per week (taking 150 mg/day) at my own discretion.

    You should not go off this medication cold turkey though. It can cause extreme anxiety issues. I winded up once though when a doctor lost my prescription twice in the same week. Over all, I have had the will power to stay on 3 pills a day during this time and not abused this (although being on it can be viewed as such).

    YES, side effects can be different to everyone on it. YES, it is still a drug that needs to be respected for what it can do to relieve pain as well as potential abuse in using it.

  3. Chuks
    Nigeria
    Reply

    I experienced very serious itching last night after i took tramadol.

  4. Kim
    Tx
    Reply

    I have pretty bad sciatica, so I was referred to a pain management doctor. We discussed several options to help with the pain. I had 2 steroid injections that only lasted about 3 months and were very expensive. I did not want things like Lyrica or Gabapentin that he suggested. In the past I’ve had some issues with hydrocodone, like nausea and dizziness, so I didn’t want to take that either. I’ve taken Tramadol before and knew it was effective on pain. (I’ve had several surgeries). So we decided to do Tramadol, the 37.5 dose, because the 50 really knocks me out ( prescribed from my surgery).

    I had been taking them, working up to 3 a day over 6 months time. During that time I had a foot surgery and took 50’s again for 2 weeks then back to the 37.5. I was feeling worse and worse. Anxiety, general overall aches and pains, blurred vision, brain fog, high blood pressure, that nervous feeling, depression, just in a general funk mood! I wasn’t quite sure what was the culprit due to the fact I take thyroid meds and estrogen from a complete hysterectomy 6 months prior. So I had my thyroid checked. It was Ok. I went to my obgyn, and he said this did not seem to be related to the hysterectomy, but offered to prescribe me Lexapro. I filled it, but needed to change my Tramadol to hydrocodone because tramadol and Lexapro have negative interactions. After much reading about Lexapro, the side effects and withdrawal afterward, I opted not to take it.

    But meanwhile, I have been taking the hydrocodone. Ironically, I felt immediately better, aside from my sciatica. All those symptoms went away. I dug around online about symptoms of Tramadol, and BINGO. I’m so sure all these issues I was having were caused by Tramadol.

    I think short-term Tramadol is OK for pain, but since I’d been on it for several months it was actually causing way more severe symptoms. The hydrocodone I’m currently taking is half of a 5/325 2 times a day. So we shall see how this does with time. I also use a compounded pain cream to help, it works well but is pretty pricey and not covered by insurance. It’s expensive to be in pain management! Appointments every 2-3 months, mandatory drug tests, etc. so I hope to get away from the pills, if the cream works by itself. I don’t think I have to go as often or mess with the drug tests. I will discuss this with my pain management doctor on my next visit in 2 months.

    In a nutshell, I for me Tramadol is OK for short courses, but long term it’s going to cause symptoms! I suppose they all do. But I am not sure all doctors are aware of the symptoms I was describing and connecting it to Tramadol. My pain doctor might have, but I didn’t see him, and of course my obgyn probably wouldn’t. He was a bit hesitant to prescribe the Lexapro but I suppose he was trying to offer up something that could help with the depression and anxiety. But he did not explain the drug to me. I researched that on my own. Thank god for the web!

  5. ed
    Afghanistan
    Reply

    My brother has these weird thoughts. He thinks someone is following him and there is a conspiracy going on behind his back. He can’t differentiate between reality and imagination. He told me that he had 6 Tramadol tabs in two days consecutively. And now I don’t know what to do with him, I took him to a doctor a few days ago and we had his brain CT scanned, and the doctor said there is no problem with him, and he still thinks something is wrong and people are following him. Please if you have experience in this regard or to what doctor I should take him share it with me. Thanks

  6. Estella. R. T.
    MI
    Reply

    I have a major problem with my legs jumping at night this runs in my family no doctor can figure out what to do for me now I was tested for restless leg syndrome it was negative tried everything out for rls nothing worked so one doctor tried me on tramodol oh my goodness it worked so I didn’t have to loose any more sleep or fall on my face from my legs jumping from underneath of me now they are saying it has a narcotic in it so I can’t get it so here I go again living with my legs jumping again so I only get 1 maybe 2 hours of sleep at night can’t stand to do my dishes without holding myself hoping not to fall again I’m almost 56 years old I’ve been taking tramodol for 18 years with NO SIDE effects what so ever no shortness of breath no high or low blood pressure nothing and without this medication I Fallon Dall off my bed from my legs jumping very bad so I ask what kind of proof is there of these side effects my Grandmother GOD rest her soul fell down her stairs broke her hip twice from her legs jumping while walking downstairs and falling back then they had no treamodol so I pray I don’t fall with a sharp knife or something so how can I get my tramodol back I only take 1 during the day and 1 or 2 at night so please give me my tramodol back before I fall and break my hip or worse

  7. Jim
    Missoula, Montana
    Reply

    FDA protocols for testing of many drugs’ efficacy & safety continue to be increasingly watered-down by illicit influences of Big Pharma (both via congressional lobbyists and via revolving–door industry personnel inside FDA.)
    This longtime, faux-free-market trend of illicit corporate influence over legit government oversight, one that’s easily documented over the past decades, is now very likely to drastically worsen with the the anti-Enlightenment principles of the incoming Trump administration.
    Caveat Emptor….!

  8. julian
    Missouri
    Reply

    Gabapentin saved my life – from tramadol withdrawals. Just make sure to stop taking the Gabapentin once the withdrawals have gone away.

  9. Carol
    Az.
    Reply

    I stopped taking tramadol and gabapentin 3 days ago, wow how uncomfortable. I never miss work but today I absolutely must…. I’m having zaps of electricity like going through my arms legs and my brain I’m trying to rest and hopefully be ready for work again in 2 days… Drinking lots of water and walking every morning…ugh, never again Drs. Don’t tell this part of the quick fix(back pain) alieve will have to do

  10. Lindsay H.
    Halifax, UK
    Reply

    HI, doing well, apart from, headache, sweats, diarrhoea, lack of sleep, down to 100 mg slow release a day, not had to use extra 50mg to keep going, apart from the headache I am coping really well, I did drop suddenly by 100mg each time so above was expected, but think (fingers crossed) I am coming through the worst, I am dreading going down to 50mg a day, in a couple of weeks but determined to. I am in constant pain, but liveable with at moment, when totally free of Tramadol I will look into other stuff.

  11. HoustonGal
    TX
    Reply

    I have been taking generic Tramadol for over three years, along with muscle relaxer Tizanadine, for pain resulting fron spinal arthritis, degenerative spine, spondylitus, and numerous food allergies that cause muscle/joint pain.

    I would like to share some info that can drastically reduce pain. Stop eating all starchy foods! Starch causes inflammation which causes pain. It is difficult, but after 2 months, starch free, you will have decreased your pain to very a manageable level.

    Doing this has allowed me to keep my tramadol intake to 2 tablets daily, 50mgs, occassionally three. Just one serving of beans, potatoes or other starch and BAM, back to bed for 2 days or more. Try it, it takes about a month of abstinence to see a real difference.

  12. Suzanna
    Wales
    Reply

    On tramadol for nearly a year for headaches..built up a tolerance drs very slow to pick up…new dr came to practice and immediately set up a withdrawl taper..all the usual withdrawls hit…rls,insomnia,cramps,nausea but eased after about 3weeks…then the anxiety and severe depression..what a hateful tablet..get whatever help you need peeps..time and keep strong.xx

  13. Mummy loves bub
    Uk
    Reply

    l took tramadol for costocorhinits for over a year then l fell pregnant and l had to quit cold turkey l was in so much pain and discomfort l vowed never to take it again until a few months back when l had issues with my back it took away the pain but suddenly l started getting naseaus all the time and l even threw up in a super market that’s when l knew it was time to stop l wld rather deal with the pain than this and once again queue withdrawal symptoms the worst is body aches n pains ,the chills ,itching ,restless legs and insomnia lm on day 8 soldiering on some of the symptoms are better still feverish but getting there and hopefully this time l stay off it for good .

  14. Lindsay
    Halifax, UK
    Reply

    I agree the thought of withdrawl is horrible, but you have to try, I am determined to get down to as low as possible if not off completely. I take,them for, arthritis in spine, and also a Chiari type 1 malfunction, so as long as I can cope with pain, keep mobile and the headaches are controllable I will persevere, keep us updated and so will I, it does help me to know that someone else is trying to stop this medication, I don’t feel totally alone, as my family do not understand what I go through when I am,late taking my dose, so trying to cut down is very daunting, waiting for the withdrawal symptoms to hit and being able to cope with them. Good luck and stay positive

  15. Lindsay
    Halifax, UK
    Reply

    Hi, went to docs on Saturday and she agreed to reduce my 159mg SR down to 100mg SR, not sure if I was supposed to swap one 150mg for a 100mg, but I stopped both 150mg for the 100mg, it is now Tuesday and I am full of cold, but had this before changing, so I am hoping that it is the cold that is the problem, I am down 100mg a day and I feel ok so far, unless it is not the cold, then I am having hot sweats, headache, not sleeping, but not had the dizziness and nausea I usually get when I,miss a dose. Back at docs in 3 weeks, for blood test and decide whether to stay at same level for a while of reduce again, I can cope with how i am feeling so if continues like this happy to go down, I have still been able to work, although I feel slower and lethargic, but that could be the cold. Pressing on regardless, will update again in a few weeks unless something happens.

    • Susie
      Tucson, AZ
      Reply

      I’ve been on tramadol for almost two years and thought it was a wonder drug! No problems while on it. I could actually function. But now my dr gave me choice of tramadol or Valium. I chose to stay on Valium as I have muscle issues in back and neck. I’m on day three of taking 1/2 tab of tramadol and to taper a half tablet every week. I am already depressed and have on lexapro for 7 yrs or so. Dr also started me on Wellbutrin a few weeks ago. I have experience many losses this past year……. my dad, young doodle dog, last of children moving out and no job (which I lost while caring for my dad). I am a nurse but feel a mess. Asthma has been bad last three months too. Bottom line is now I’m having itching and my BP is higher than normal so taking lots of antihistamines. Maybe this isn’t the right time to start to taper off the tramadol?

  16. Samuel
    nigeria
    Reply

    I feel serious indigestion whenever I eat …I’m so scared my Tommy gets full times I eat expecially whenever I eat bread or flour generally ..all this happened after I stopped taking tramadol abruptly I feel less comfortable and I am always scared to eat now but I feel hungry time to time..someone help pls

  17. Ruth
    Colorado
    Reply

    I have taken ultram/tramadol for ? can’t remember, probly 10 years. I was on darvocet and it was taken off market. At that time, my pain Dr switched me to ultram. I’ve had spinal fusion surgery and really needed pain medication to live until the last couple years.

    Now, I truly believe 800 mg Motrin would control pain, but when I’ve tried to ease off ultram, I experience terrible depression, anxiety, sleep issues, etc. Reading this forum is so frightening. When I talk to my doctor, she seems to think I need the pain meds, and talks down the withdrawal problems.

    I don’t think I can do it. I have gone down a pill a day. I was taking five 50 mg pills, daily. Now, for the past month, four. I have had a headache almost continually. I feel I mostly need the drug for psychological reasons and that upsets me. Plan to continue down one 50 mg per month for another month, then cut scone in half and so on. It will take six months probably. I’m so scared of the withdrawals. If I even a bit past time to take a pill, I get sweaty and anxious, it’s horrible!

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