The People's Perspective on Medicine

Stopping Ultracet (Tramadol + Acetaminophen) Led to Withdrawal

Because of the opioid epidemic many physicians have stopped prescribing drugs like hydrocodone. Is tramadol safer? Stopping Ultracet can be challenging.
Tramadol

Almost everyone has heard about the opioid epidemic. According to the National Institute on Drug Abuse, “Every day, more than 130 people in the United States die after overdosing on opioids.”  What has not made headlines, however, are the potential problems with alternate pain medicines. Many doctors are now prescribing tramadol, a key ingredient in the brand name pain reliever, Ultracet. This reader says that stopping Ultracet was challenging.

How Should You Stop Ultracet?

Q. I started taking Ultracet about a year ago. This medicine contains tramadol and acetaminophen.

I began with just one a day. In less than a month, I was taking five pills a day. Now I want to get off this medication. Should I start by tapering the dosage? Or just stop it altogether?

Three days have passed since I took my last tablet. I haven’t slept during that time and I’m feeling anxious and sweaty. If these symptoms don’t increase, I will be able to continue without medication. But if they get worse, I wouldn’t know what to do!

A. When tramadol was first introduced, the maker presented it as an alternative to narcotic pain relievers. It has since become clear that some people can become dependent on tramadol. Stopping Ultracet suddenly can be challenging. Sadly, neither the FDA nor the manufacturer give clear guidelines about how to taper off Ultracet or tramadol. 

What’s the Story on Tramadol?

This drug has some opioid activity, but it also affects neurotransmitters such as serotonin and norepineprine. That means it can trigger a “discontinuation syndrome” similar to one people might experience if they abruptly stopped drugs like sertraline (Zoloft) or venlafaxine (Effexor).

Discontinuing tramadol suddenly can lead to withdrawal symptoms such as anxiety, insomnia, sweating, nausea, pain, tremors or diarrhea. A few people report panic attacks or “brain zaps.”

The Double Whammy:

Because tramadol has both weak opioid action as well as antidepressant-like neurochemistry, there could be a dual effect. Stopping Ultracet suddenly could lead to side effects such as those our reader reported.

You can learn more about tramadol side effects and withdrawal at this link

Stories from Other Readers:

This person has had a tough time:

“My doctor first prescribed Ultram/Ultracet for my fibromyalgia about 25 years ago, when I was in my late 40s.. I took 20 mg 2 x a day so I could continue to work. The feeling when I was late with a dose was awful.

“After a few years I weaned off it very slowly and went back to work part time. Then as I got older, and arthritis and old injuries began to slow me down with more pain, I went back on it (50 mg 2 x a day). After two years and trouble sleeping the doctor increased the dose to 3 x a day.

“Now I am retired and downsized. I have been weaning myself off SLOWLY for about 5 weeks by cutting pills. I am now down to about 1/3 of the 50mg pill 3 x a day and I’m paying close attention to how I feel. Only my husband believes how bad stopping Ultracet has been. All symptoms are true, and unbelievably bad.

“In a few weeks, I will be seeing a new doctor. Hopefully, I will be done with this by then. I am eating only organic food and getting on a good schedule. I hope pain management will not be the monster it has been.

“My knees are shot, I have had spinal surgery, two shoulder surgeries, a broken ankle, etc. I am 71, I hope to get to a good place for the rest of my life.

“This all got started because my doctor told me to “take more to feel good.” I got almost no encouragement to wean off. My doctor told me,’good luck; you are brave.’ That may have been only because I had been his patient for 25 years, and I was a medical professional too.”

Tresa shared this story:

“I was on medication for depression for 2 years. Last year I fought through the withdrawal symptoms and stopped the medications completely. Recently I had a miscarriage and last week I had a hip surgery. Mostly I was on tramadol injections and when I came home they gave me 2 painkillers. One of them was Ultracet.

“I stopped it whenever I felt my pain was bearable. After a day, I had severe panic attacks. I had suicidal thoughts and sleepless nights. I was scared to death that my husband would leave me (for no reason). As a result, I cried all night.

“I was confused about what was causing all this. It is just by chance I went through the comments on the PeoplesPharmacy.com website and now I know these are withdrawal symptoms. It will be difficult at first, but I will have to do taper off this drug properly. Otherwise I will end up in that hopeless place again.

“I will be stopping Ultracet little by little. It’s difficult, but it’s possible.”

C.S. is scared and confused after stopping Ultracet:

“I’m on day 28 of Ultracet withdrawal. I was doing better after 2 weeks of hell. Cold turkey. No other choice. Now it’s like withdrawals are starting all over again. No sleep. Heart palpitations, nausea, anxiety and twitchiness 24/7 the past three days. What the hell is going on?”

Doctors are advised to reduce the dose gradually to avoid such problems. But what does “gradually” mean? Is it a week, a month, six months or longer? Without guidance many patients feel like C.S. We suspect that many people can be successful with a six-week taper, but some may need to reduce the dose even more gradually.

Share your own experience with Ultracet or tramadol in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I’m a lucky one. I’ve used tramadol for 15 years for arthritis pain — prescription has always been 50mg 3x a day but I only take one a day to supplement 2000 mg acetaminophen per day — rarely, 2 a day. Twice in the 15 years I have had to stop taking tramadol — once when I went on a depression med for a short time and then a 6 month respite for a blood clot. (meds did not mesh). Neither time did I experience withdrawal symptoms. I am thankful for my tramadol.

Endless trauma and grief around pain and pain killers. If only the Rockefellers had not sent Abraham Flexner around the country in 1923 to get rid of the natural healing schools and hospitals, we would still be enjoying the benefits of homeopathy, and using Arnica and other homeopathic preparations for pain, and probably would all be healthier, happier, and be able to retain more of our income for things other than pharmaceuticals.

I have taken half a Tramadol (50 mg) three times a day, with a 500 mg Tylenol since I quit NSAIDs. This controls my arthritis hand pain with the occasional use of a topical NSAID. I also have taken lorazepam for many years (1/2, 3x a day). I am concerned that the doctor may no longer be able to prescribe both because of FDA recommendations at some point. I also take SAMe, 400 mg twice a day, which I believe has helped with pain and mood.

I took tramadol after a knee replacement. For me, it was a perfect pain med because it didn’t make me sick or cause hallucinations, which had been my reaction to other pain meds in the past. I took 6 pills a day (don’t remember how many mg. each pill contained).

However, stopping it was a challenge. The doctor’s nurse told me to simply cut one pill a day every 2-3 days. Cutting one pill caused severe anxiety and panic, so I immediately went back to the full dose for a few more days. Then I cut back very slowly — half a tab at a time and I would go at least 4 days on the slightly lower dose before reducing it again. If I cut part of a morning dose, I’d make the next reduction to a late afternoon dose to balance out the levels in my system. I continued to take the full dose in the evening for quite a while because my pain was more noticeable at night. When it finally came time to reduce the evening dose, I took it very slowly. As I recall, I cut the dose by quarter tabs.

I think it took me longer to withdraw from tramadol than the number of days I spent taking a full dose, but I would take it again for a situation requiring major pain control.

I have had absolutely no problems from taking Tramadol (only) for at least 15 years. If it’s ever removed from the market, I don’t know what I’ll do. Have arthritis in various parts of my body now (am 73), plus scoliosis pain. I understand the big concern about opioids, but think each case should be considered thoroughly rather than eliminating everything so drastically on a nationwide basis. By the way, I’ve had no difficulty with statins either, and have been taking them since I was 40! Everyone is different, and I don’t want to live my “Golden Years” in pain just because other people can’t handle even a mild Opioid like Tramadol.

I’ve taken tramadol for years (4 ruptured disks in my lower back). Without it I can hardly walk (look like an upside down L). With it I can exercise (lift lighter weights, play tennis daily, etc.). I take 2 tabs a day. NO side effects. Please do not scare folks into believing this is similar to seriously addicting opioids.

I’ve been on 350 mg Tramadol and 2000 tylenol for three years for severe fibromyalgia pain. I envy those able to terminate it. Though it barely works at this point, there is nothing else. I have been experimenting with low dose naltrexone, first as a supplement to boost Tramadol pain effect, and, less likely, to facilitate my withdrawal if I’m ever able to taper. Facebook has helpful groups on LDN.

Is this article conflating Ultracet and Ultram? One of the stories does. In addition to acetaminophen (325 mg), Ultracet contains ONLY 37.5 mg of tramadol. Please clarify for your readers.

Very helpful.

I have been using Ultracet for back pain for years. However, I take it infrequently, “as needed” the prescription suggests. The point is, at least for me, there is a difference between tolerable discomfort and serious pain. I use it for the latter and never for the former. As with any drug of this kind, discipline is key. There are times when I am tempted to use it but exercise better judgment. I have learned when using it is necessary versus a mere convenience. In this way, a single dose is extremely useful, and my body does not require more than that. I understand how it can easily become routine, and for some people serious pain is far too regular. But for my condition, I choose to exercise extreme caution and avoid its addictive properties.

I have heard of people ending up on Suboxone (a medication used to control opioid withdrawal symptoms) after using high doses of tramadol. The FDA needs to investigate this drug and how it is withdrawn/tapered.

For me tramadol withdrawal was virtually no different than other opiod withdrawal, MAYBE a bit less severe. I used Benadryl and Imodium for the nausea and diarrhea. Unfortunately, I also had a hair trigger temper during the first few weeks, and my sleep was messed up too. About the only advantage to tramadol when taking it is it doesn’t cause the “high”, or brain fogginess that other narcotics do. Otherwise, withdrawal isn’t much different from any other narcotic pain killer.

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