man in agony

Tramadol is becoming a mainstay in the treatment of pain, especially now that opioids have come under such scrutiny. But the FDA warns that this medication can interact with many other drugs to trigger a potentially life-threatening reaction called serotonin syndrome. Tremors from tramadol could be an early warning sign that this reader is poised for a dangerous adverse reaction.

Q. I have been on tramadol (50mg 3 times a day) for a couple of years due to back pain. I had surgery on my back last November and suffered complications.

For a while I was taking a double dose of tramadol and now my tremors are so bad I can hardly type. This email was almost impossible.

In addition to tramadol (my regular dose), I am taking bupropion SR and escitalopram. I have trouble sleeping and cannot get more than three hours sleep at a time. I’ve been taking mirtazapine or alprazolam to help me sleep.

Last night I took both to try to get a solid night’s sleep but I woke with a horrible headache. I almost passed out when I tried to stand up.

Does this sound possibly like serotonin syndrome? My job is clerical in nature and if I cannot type due to tremors, I’m unable to do my job.

A. You are taking three drugs (tramadol, escitalopram and mirtazapine) that can affect the brain chemical serotonin. The combination might well lead to excess amounts of this neurotransmitter. That could trigger serotonin syndrome.

Serotonin Syndrome and Tremors from Tramadol:

Symptoms of serotonin syndrome include agitation, tremor, confusion, uncontrollable muscle contractions, incoordination, rapid pulse, nausea, vomiting, diarrhea, and elevated blood pressure. In extreme cases people may experience hallucinations or fall into a coma.

Please note that tremors from tramadol could be an early warning signal that serotonin syndrome is close at hand. The FDA warns that when tramadol is combined with certain other medications:

“a potentially life-threatening serotonin syndrome may occur with concomitant use of serotonergic drugs such as SSRIs, SNRIs, TCAs, MAOIs, and triptans.”

The FDA loves its alphabet soup of drugs. In essence, the FDA is referring to antidepressant drugs and migraine medicines with those acronyms.

Mirtazapine (Remeron) and escitalopram (Lexapro) are both antidepressants and would fall within the FDA’s warnings.

Other Side Effects Besides Tremor from Tramadol:

  • Dizziness, vertigo, sleepiness, speech disorders
  • Digestive discomfort, heartburn, nausea, vomiting, constipation
  • Headache, agitation, nervousness, anxiety, agitation, tremor, spasticity, hallucinations
  • Incoordination, hyper reflexes, seizures

Stories from Readers:

Anne from New Zealand shared this story about tramadol:

“My partner takes tramadol and sometimes takes large doses. When he does he gets muscles spasms, chronic itching, paranoia, can’t hear well, can’t speak well, has difficulty urinating, doesn’t sleep for 24 to 36 hours and makes strange sounds like he has tourettes. He also has conversations with himself in babble talk. He has had at least 2 seizures.”

Charlotte in Plano, TX offers this tramadol interaction report:

“My husband took tramadol after a lithotripsy procedure to break up a kidney stone. He was on sertraline along with other drugs to treat his Alzheimers disease. After just one dose he became so agitated (including extreme paranoia and terrifying hallucinations) that I was advised to take him to the emergency room.

“It took both my son and me along with a tech to control him from ripping out tubes, etc., and leaving. It took three injections of both Valium and some other sedative that we were told would put him out within 10-15 minutes. His eyes never closed. We finally brought him home where the nightmare began of his getting out of bed and falling numerous times.

“I was told that he was allergic to the tramadol. Neither the prescribing physician nor the hospital staff connected the dots between the sertraline and tramadol.”

Stopping Tramadol is No Easy Matter:

Do NOT stop any of your medications suddenly, especially tramadol. The withdrawal can be terrifying.

Over 500 people have commented on tramadol side effects and withdrawal at this link. When Stephen in Sebring, Florida stopped tramadol he experienced anxiety, irritability, shivering, headaches, sleeping difficulties, nightmares, flu-like symptoms, hallucinations, unusual thoughts and aggressiveness.

Another visitor didn’t get his tramadol refill over a weekend and experienced:

“Tremors, shivers, shakes, restless legs and sweating so bad my bed would be drenched and I couldn’t sleep at all. My body hurt worse than any flu and I was so sick I couldn’t eat for days.”

You can read more about this reaction here. That is why it is so important not to stop any of the meds abruptly!

Tramadol Side Effects and Withdrawal are Daunting

Please consult your doctor and pharmacist and ask them to check for drug interactions. They may be able to design a gradual taper for your medications so that you will no longer suffer tremors from tramadol.

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  1. Lilprince

    I am nigerian, i started taking tramadol seven years back during when i was in secondary school, now i want to quit because of headache, diarreah, light heartrate, less sleep and sweating in the night i sometimes suffer nasal congestion and i can’t afford it because am schooling what shall i have to do?

  2. Smith

    Please get off tramadol! My boyfriend is currently in hospital fighting for his life. After six years of taking it he started having reactions so traumatic it looked as if he had taken bath salts. He has now developed serotonin syndrome and is feeling and acting like a schizophrenic. My heart breaks for him. I hope he will be okay.

  3. Lonnie

    I suffer from severe endometriosis and sciatic pains/general neuropathy brought on by the disease. The only thing that really helped with the pain was oxycodone, but I could only obtain it whenever I had laproscopic surgeries every few years, so of course my supply did not last.

    After practically begging my GP for something stronger than an NSAID (which I try to avoid because of my bleeding problems) she finally caved and prescribed me some Tramadol. It’s pretty weak and only seems effective if I don’t take it very often. I also take Escitalopram 5mg daily and never noticed an interaction even when I added a small dose of Xanax every now and then for my anxiety.

    Recently I suffered from an infection in my lower body and was in severe pain for about a week. I was taking 50mg of Tramadol every day during that time, and I noticed that not only was it not working as effectively as usual, but it was actually making my schizophrenic symptoms worse (increased anxiety, dissociation, paranoia, agitation). To make things worse, I began to have trouble sleeping because the nerves in my limbs felt weak, and they would start jerking immediately right as I was drifting off.

    I stopped taking it immediately, and the spasms steadily began to go away over the next few nights.

    I’m in pain every day of my life, but I guess this is one drug I’m going to have to take sparingly after all.

  4. Steve

    I have recently been given tramadol for leg, knee,neck , back elbow and foot pains. I am large, but also take statins for familia hypercholestlemia with CAD. This is working better, by far, than the hydro codons ever did. I take warfarin so I am limited on pain killers. I hated taking the hydro codons because it kept me up all night and barely worked!!! Tramadol works ,OVERWHELLMINGLY, good for me. I have hard time sleeping with it also, but at least walking is easier. If side effects start I will have to quit. Still working full time with extra jobs on top!! Gotta pay bills!!!

    • S.R Nicole
      Smokey Mountain's of Tennessee

      I took just one Tramadol and it messed my whole body up. I had tremors, confusion, couldn’t sleep and stomach ache so bad, it was unbelievable! I will never take it again!

  5. Rick
    Portland, OR

    Tramadol works very well for me. I alternate a two 50mg tablet dose with one hydrocodone 5/325 tablet about twice a day. 2 Tramadols give me as much back pain relief as one hydrocodone. I do occasionally have some shakiness and it’s hard to write or hold a cup, but it isn’t always a problem and might be from something else. No other problems that I’ve noticed.

    My doc says 2 at a time is OK as long as I don’t exceed 4 tramadols in a day.

  6. Carol
    Troutman, NC

    Was prescribed Tramadol to try prior to my knee replacement and have now added it to my allergy list. I only took 50mg and withing 20 minutes or so experienced decreased respirations and decreased heart rate and felt awful.

  7. HelenM

    I have taken tramadol, and hydrocodone, in fairly low doses for years. I have scoliosis, spinal stenosis, fibromyalgia and neuropathy over my whole body. A few years ago I was reading about low dose naltrexone for fibro and thought I might like to try it. However, you could not take any opioids for you would be thrown into withdrawal. Tramadol was said to be OK. Not for me! I weaned off the hydrocodone without difficulty and tried the LDN. Thought it was the worse fibro attack I have ever had! Did some more research and found sites where it was said that you could not take tramadol while taking LDN. So then I set about weaning off the tramadol. I got down to half a 50mg pill and could not go any lower. My neuropathy and fibro present with all over burning; trying to get off the tramadol intensified that burning beyond belief, extending it to areas that had not yet been burning. I tried more than once, then just gave up. When I began the initial weaning I was taking a 50mg tramadol and 325/10mg hydro twice a day. I now take one of each a day, divided in half; natural factors limit my dosage anyway: lyphedema and opioid constipation. I feel I am a responsible pain medication user and that is very important to me. If the pain and burning were gone, I would be glad to give up the medications

  8. Ruth
    Elkins, West Virginia

    Tramadol is useless for me. The pain relief only last for 2 hours and I have nausea and vomiting and itching and a rash. When I had osteomyelitis, six tramadol and one dilaudid provided only a little relief. Post surgery I had very little pain and had to take Phenergan and Benadryl.

    I have read your articles about Tramadol and decided to not use it anymore.

  9. Steve

    I’ve been on Tramadol 50 mg twice a day for a year for fibromyalgia pain. My only other med is zolpidem at night so I don’t have serotonin excess but you did not mention that Tramadols’s effectiveness decreases greatly over time for many people as the receptors seem to weaken. Apparently if you get off the med for a while (and do what for pain?) you may become responsive again. When I first started, it would put me to sleep and help with pain to some degree, gradually becoming less sedating but also less effective. Now it is barely effective where I used to feel it creeping into my pain areas a few hours after ingestion. We can put people on the moon but until you experience chronic pain, you don’t realize how far medical research has to go to come up with an effective, long lasting, low toxicity pain med.

  10. Charles

    Tramadol is a fantastic pain fighter, especially if you have a bleeding ulcer and can take no nsaids. I have several kinds of pain, and what is a real nightmare is when you get a vicious attack and no relief since the idiots in Washington decided to tell our doctors how to help us. I’ll bet the drug lords are loving this.

  11. mac

    I took Tramadol for a brief time for back pain, tried it on three different occasions. I experienced extreme vertigo, nausea, diarrhea, and a migraine-like headache with just one dose each of those times. I had to hold on to the wall to get myself to the bathroom without falling down and could not tolerate bright light. This lasted for days. The only other medication I took at the time was Armour Thyroid, so I doubt there was any “drug interaction.” I have experienced good pain relief with no side effects from oxycodone and the time released version, oxycontin. Everyone is different. Whenever I am asked if I’m allergic to any medications, I always respond: Tramadol.

  12. rick

    I learned first hand about serotonin syndrome and Tramadol that I had taken for a muscle spasm in my back. That night I ate very spicy food and ended up in the hospital with a mild case of anaphylactic shock. The Doctor gave me a few Valium to calm me down and that was just the start of my problems because the use of and the withdrawal effects of that combination of meds after only a few days made me suicidal as well as homicidal.

    I now can see how under the influence of certain medications can basically cause a person to lose control of their rational behaviorism’s !I suggest to anyone taking this medication to be very careful if you take Valium or related products!

  13. Beth
    San Dego

    I have been on Tramadrol about four or five years. The only way I can take it is take a 50mg pill and cut it into four little pieces which I take about every four hours. When I hurt my back a couple of months ago, I took an extra small piece daily. I am back to my four pieces. The comments here are very scary. I think I would like to try and get off of it. Can I do that by gradually not taking as many pieces for a certain time and keep cutting back that way?

  14. Bob
    Tampa, Fl.

    Check with your Doctor if you notice problems. I take 1 to 3, 50 milligram tablets in approx, 24 hours for: leg cramps, Arthritis, Neuropiety. Some times 1 tablet & 2 Tyinol X capsules I get relief in about 15 minutes.

  15. ML

    I take Tramadol..for my lower back pain…as needed…which is maybe one or two a week….I have noticed that when I take Tramadol….I usually wake up during the night…with anxiety attacks….or panic attacks….I absolutely hate these..!!……I also have a tendency to have thoughts of sucicide…when taking Tramadol….I thought this was a great solution to my back pain..but has turned into a nightmare…

  16. Mike
    North Carolina

    Tramadol is an outstanding pain relief product for me.I have shoulder,knee and some back pain and tramadol works better than anything I’ve ever used. It was first prescribed for me following heart bypass surgery several years ago. I don’t take nsaids due to bleeding concerns so tramadol solved that concern. The side effects described in this article certainly do not apply to me.

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