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Tramadol Side Effects and Withdrawal are Daunting

When choosing a pain reliever, prescribers do well to keep tramadol side effects and withdrawal syndrome in mind.
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Doctors love tramadol (Ultram, Ultracet) because it is perceived as safer than narcotics like hydrocodone (Lortab, Norco, Vicodin, etc.) or oxycodone (Oxycontin, Percocet, etc). In case you had not noticed, opioids have been getting a lot of bad press for their addictive potential. As a result, many prescribers are turning to tramadol to ease patients’ pain. We fear that most are unaware of the withdrawal reaction that can occur when people try to stop tramadol suddenly.

Tramadol Withdrawal:

There is a sanitized term for this extremely disorienting condition: “discontinuation syndrome.” It does not begin to describe what some people go through when trying to stop tramadol. At last count there are over 600 comments about this problem associated with this article. Some are truly hair raising. To read them all, click on the box at the bottom of this page labeled “Older Comments.” But first, the question that started this thread:

Q. I have been taking Ultracet (tramadol) for several years for back pain. I was taking 100 mg three times a day as prescribed. The pain is better and I tried stopping the tramadol and had a terrible reaction.

I went to my internist who advised that I stop taking the tramadol over a period of time. I am now taking 50 mg three times a day but cannot get any lower than that without experiencing nerve twitches in my legs and intense jitteriness that interferes with my sleep.

Have you heard of similar problems and do you know of any way to alleviate the withdrawal symptoms without getting hooked on another medication?

A. Tramadol (Ultram, Ultracet, Rybix ODT, Ryzolt) is a strong pain reliever that was originally thought to have opioid-like activity without the same potential to cause addiction as morphine or similar narcotics. To quote the “experts,” tramadol was thought to have a “low potential for abuse.” In other words, it wasn’t supposed to cause physical dependence or produce a “withdrawal syndrome.”

It turns out the drug is a lot more complicated than many experts first believed. In addition to its analgesic action via opioid receptors in the brain, tramadol exerts a profound effect on other neurochemistry. That means that brain chemicals like serotonin and norepinephrine are profoundly impacted by tramadol.

Many antidepressants also affect the reuptake of the neurotransmitters serotonin and norepinephrine. For years clinicians thought there would be no consequences after altering brain chemistry with drugs such as desvenlafaxine (Pristiq), duloxetine (Cymbalta) or venlafaxine (Effexor). Sudden discontinuation of such drugs can bring on a host of symptoms. Here is a link with over 1,300 comments regarding Cymbalta complications:

Remember that tramadol not only affects neurotransmitters. It is a synthetic cousin of codeine and binds to opioid receptors. That means it is weaker than narcotics like hydrocodone or oxycodone. But it works in part to ease pain by binding to opioid receptors in the brain. Many physicians were convinced that it would not cause dependence the way strong opioids might. In other words, no worries about abuse and no DEA (drug enforcement administration) agent looking over your shoulder.

The Double Whammy:

The problem is that patients may be vulnerable to a double whammy. Stopping tramadol suddenly may affect the brain and nervous system via multiple pathways. First, you have the opioid issue. But there could also be the serotonin and norepinephrine pathways. Here is what we have discovered when it comes to that sanitized phrase “discontinuation syndrome”:

Tramadol Withdrawal Symptoms:

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

Some of the symptoms of tramadol withdrawal may persist longer than many health professionals realize. There is no one-size-fits-all program for tapering off tramadol. People vary greatly in the way their bodies adapt and recover. It may take several months to gradually wean off from tramadol. You should not attempt this on your own. A health professional who understands the complexity of the drug may be essential.

Stories from Readers:

Arika in Washington is going through prolonged withdrawal:

“I was on tramadol for about five years. By the end of that time I was only taking 50 mg per day. I’ve been off of it for about a month and I’ve had several nightmarish weeks. One week, the anxiety and panic was hellish.  The next week I had to deal with extreme fatigue and muscle pain.

“I think I’m past the worst but am still being plagued by anxiety, panic, muscle weakness and fatigue (which gets worse after eating and exercise). Then there’s tingling and numbness all over my body.”

“I’m not seeing a light at the end of my journey – just making it through a day feels like a battle.”

Sweety in Bangalore shared this story:

“My mother-in-law has osteoporosis, rheumatoid arthritis and spondylosis. Her rheumatologist started her on tramadol. She took this medicine for nearly a year.

“Then her doctor changed her pain medicine in one day. After stopping the tramadol she experienced withdrawal symptoms: extreme pain, seizures and electric shock-like sensations. She got no sleep because of the symptoms.

“She also received anti anxiety drugs given by her doctor. The tramadol was not tapered.  She is going through bad withdrawal.”

Shae in the Cayman Islands reports:

“I took it [tramadol] for 6 weeks, 4 x per day at 50MG per dose. I stopped cold turkey and I’m on my fourth day of withdrawal symptoms.

” I have blurred vision, severe abdominal cramps and pain breathing. I am disoriented, have body aches, swelling of my feet, electric shocks in my hands and feet, back pain, chills, depression and flu-like symptoms.”

Many of the withdrawal symptoms associated with tramadol are reminiscent of those linked to sudden discontinuation of antidepressants like sertraline (Zoloft), paroxetine (Paxil) or venlafaxine (Effexor). Symptoms can include dizziness that will not quit, brain “zaps” or “shivers” that are a bit like electrical shock-like sensations, sweating, insomnia, headaches and difficulty concentrating. Read stories from readers who tried to get off antidepressants like duloxetine (Cymbalta) at this link.

Where is the FDA?

The FDA has not provided physicians with clear guidelines on how to phase off such drugs. We frequently see recommendations like “gradual withdrawal,” but no one bothers to provide clear instructions about what that really means. We’re really sorry that we don’t have any great insight on this process either. Readers have shared their own solutions at this link.

Although many people can relieve their acute or chronic pain with tramadol, here are some symptoms to be aware of while taking this medication.

Tramadol Side Effects:

  • Nausea, vomiting, indigestion, diarrhea
  • Constipation
  • Headache
  • Drowsiness, dizziness, fatigue
  • Restless legs
  • itching
  • Dry mouth
  • Sweating, flushing
  • Loss of appetite
  • Difficulty sleeping, insomnia
  • Skin rash
  • Serotonin syndrome

Serotonin Syndrome Can Be Life Threatening:

Please note serotonin syndrome above. This can be a life-threatening situation and can be precipitated if tramadol is combined with other medications such as “triptans” prescribed for migraine headaches or antidepressants that affect serotonin. ALWAYS check with a pharmacist about the drug interactions before combining tramadol with any other medication. To learn more about serotonin syndrome, click here and here!

Share your own tramadol story below in the comment section. Have you suffered from tramadol side effects or tramadol withdrawal? Was tramadol the right solution for you? If you found this article helpful please vote on this article by clicking the 5 stars at the top of the page.

Revised: 3-1-17

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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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PLEASE HELP!!! I’ve been taking tramadol for over 10 years. Can I ask how you’re feeling now? Did you eventually get off the tramadol? I’ve been reducing my dose since December, and I’m 35 hours in to having none, and I’m hoping not ever to take them again but my body is hurting so much. I was literally crying at work today as I just couldn’t find the energy to go on. I’m having brain zaps, dizziness, and I’m just losing the will to live.

I couldn’t even bathe my 5 year old this evening, and this broke my heart. I just want to know I’m not going to be like this forever. I can’t take time off work, as I’m self employed. Please tell me you’re doing well and not experiencing any nasty after-effect. Going by the sound of most of these horrendous experiences in the comments it doesn’t feel like I’ll ever get over these nasty experiences. I really do hope you’re doing amazingly well. I hope and pray you are all doing well and able to get off the tramodol. Thank you.

I have been taking Tramadol 50 mg for 5 years. I started only when lower back and knee pain existed. The first day I took it I had taken the day off for lower back pain. 30 min after my first dose I was moving the refrigerator and cleaning behind it. I felt like I had taken crack or something. I increased the dose to 50mg 2 times a day. This drug affected me differently than most people. I was able to ride my bicycle over 40 miles and be in a state of happy energy. I became outgoing (this wasn’t like me) so I began taking it when I felt down and tired, and it helped me go on.

I did wake up in the middle of the night and had to take tylenol Pm to go back to sleep. I have at times tried to get off it because it causes me pain in lower calves. It’s like the blood flow is low, restricted below the knees. Today is my first day taking only 1 tablet. I want to wean off this because my new liver test is no longer within normal range. Not sure it’s the Tramadol but I’m having a hard time. I’m thinking if I can’t quit slowly I will have to quit cold turkey.

I have been on Tramadol ER 300mg for about 3 years now. I have chronic pain spanning more than 40 years due to severe degenerative disc disease throughout my spine, with stenosis and spondylosis. After taking opioids, and later tramadol every 4-6 hours, I was frustrated with “chasing the pain.” Once my pain specialist switched me to the extended-release form I felt like a new person.

I know the maximum dose per day and would never exceed it. I am also on an antidepressant to treat depression that dates back to my childhood, long before I took any pain medications. My psychiatrist is convinced it is the effects of chronic pain that contributes to my depression, not the pain meds.

I would like to make a few important comments based on my experience and education (I was a Physical Therapist for 30 years.
1. Chronic pain is best treated by pain management specialists – NOT primary care physicians or orthopedists. Pain specialists have a wide range of possible treatments and are trained to spot “drug seeking abusers.” I have a signed contract not to obtain pain meds from anywhere else and to undergo periodic urine tests. Also cannot get more than a one-month supply of pain meds at a time.
2. In this day and age all my doctors know every prescription medicine and over-the-counter meds and supplements I take. I carry a complete list to every doctor I see. Be proactive, and take responsibility rather than “assuming” your doctors know what you take. And ask your pharmacist about interactions every time something is added – supplements and OTC drugs included. That is his/her specialty.
3. NEVER stop a medication abruptly unless it is life threatening. ALWAYS ask your doctor for a plan to taper off, and call with any adverse effects.

WE are responsible for taking charge. Doctors are no longer “Demi-gods” who know all or take the time to tell all. If your doctor isn’t willing to listen and answer questions and take you seriously – find another doctor! A hassle, yes, but well worth it. I am tired of hearing peoples’ horror stories after taking themselves off medication abruptly without consulting the doctor!

I just took 3 of the 50 mg. tablets on the day after knee surgery, 3 in 18 hours. I hardly slept for the next 2 nights, maybe 3 hours each. I would wake with little electric shocks going through my body. I had no appetite for 2 days. I could not defecate but had lots of stomach pain. I decided I would rather have post-surgical knee pain than all of this. It took about 36 hours after the last pill to be able to go to the bathroom normally. I could sleep after about 24 hours. They also like to pretend that none of these medications cause dependance or habituation. Why ?

Been on Tramadol 50 mg 3 times a day for 6 weeks after knee surgery. Not knowing any better I went off suddenly. What is anybody’s guess as to how long this withdrawal will last? Please comment.

I have been on tramadol for 25 years- unreal! The last 6 years after a car accident I have taken 6 -50mg a day=300. It is not helping anymore with back pain, and I refuse to increase because I don’t feel well even though being monitored this whole time. I want to get off Tramadol. I started 1/2 pill less, and it will be 2 weeks. At 2 weeks will go to 1 pill (in 2 days). I hope that doing it this slowly will not be as horrible with the above stories. I live alone and do not have anyone to support me. Wish me luck!

I have been on tramadol for almost a year and I have a procedure coming up so I thought “Why not just stop all of my meds while prepping for it.” I logged online to see if I was having withdrawal from it because I was told it’s not habit forming by my former PA. I thought I was coming down with the flu. Body aches, sweating, diarrhea, nausa, dizzy. I had to have my husband bring me some so I would feel better and make it through the day. I see a new Dr. soon so hopefully we can find something else, or I stay on it. This is horrible.

Hi David,
I really don’t know what to tell you.I don’t know how your body and mind will react after being on them for so long.I only know from my own experience(related in this forum) of going cold turkey after 15 years on this drug. I am 5 months clean now and it gets better each day. No thoughts of ever taking it again. I still have back pain but it is much more bearable than being in either in a state of constant withdrawal or taking increasing amounts of tramal.I tried tapering but always felt so bad i would relapse so cold turkey was the only way for me. Acute withdrawals are bad and paws are the pits but if you can hang in there it’s worth it. People recommend suboxone while tapering and this forum has many stories that may help.I am 65 and never thought i would get off them .All the best and keep us informed.

Let me first say that when I had to go on pain medication I was adamant about not wanting to get hooked on them. I was assured that tramadol was not habit forming! I’ve been on tramadol since the summer of 1995 before my 1st of 4 back surgeries. I take 8 50MG tablets a day, and that’s down from 12 a day! I have chronic pain from arthritis in my back, feet, hands and neck. I started early on trying to get off tramadol by using Tylenol and glucosamine triplex. I started to wean of the tramadol but quickly realized that my body would not function, and the withdrawal was hell.

So here I am going on 24 years, and even dropping 1 pill a day I started after just a few days having restless legs, insomnia, lack of motivation, and on and on with all different sorts of withdrawal symptoms. I’ve even tried alternating days of my regular schedule, and that turned into a nightmare (literally). I moved to another state and got new doctors. All 3 of them said there was little I could do at this point. My cardiologist (3 heart attacks also) said it would be very stressful on my heart to go through withdrawal. I’ve been on disability since I started having dementia along with my heart disease and chronic pain. My primary physician said since I’m 60 it’s highly improbable that I could ever get off of them. So I’ve said all that to say I’m screwed!

One year Tramadol free today. A very long haul but I’m pleased that I’ve made it. It’s not been a problem to not take it. I don’t miss it or have a desire to take it, just still have horrible sleep issues. Some nights it takes me hours to sleep, and then I wake up wide awake after only a few hours sleep. I just hope that some day this, too, shall go away.

Please stay strong, everyone!

Dennis D
I was on 300 mg tramadol from July 2010 to Dec 2018. Withdrawal was classic and, as expected, severe. Do not go cold turkey. Take the time to taper off or be prepared for some serious misery.

I wonder if I will ever be “happy” again. I initially lost 5 pounds due to diarrhea and nausea. I then gained 16 pounds due to consuming comfort food as I tried to find a better mental state and fight chronic pain. I am two months clean and feel I am barely on track to feeling better. Tramadol reduced my chronic pain which now has to be addressed by some other means.

The reason I wanted off tramadol was it was affecting my cognitive process causing me to make a lot of bad financial decisions. The reason I want back on it is it mellowed my personal relationships with family and friends, in other words, I was a lot more tolerant with others. Still looking for an alternative. Considering THC.

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