Medically reviewed by Sally Chao, MD. Last updated on Oct 24, 2022.
Symptoms of tramadol withdrawal can start 8-24 hours after the last dose. Untreated, withdrawal symptoms usually last for 4-10 days. Tramadol withdrawal is caused by stopping the drug suddenly.
The severity of withdrawal may depend on:
- The dose you are taking
- Whether you are physically dependent on it
Being physically dependent on a drug means you need to take it to prevent unpleasant symptoms. The time it takes to develop physical dependence varies, depending on the dosage and the person.
Tramadol is a synthetic opioid drug. Withdrawal from tramadol and other opioids can be very uncomfortable. Tapering off tramadol can prevent withdrawal. Withdrawal symptoms may be relieved by restarting opioid therapy and then gradually reducing the dose, or tapering. This is done under a doctor’s supervision.
Symptoms of tramadol withdrawal often resemble the flu and are usually similar to symptoms of withdrawal from other opioid drugs and some antidepressants.
Symptoms of tramadol withdrawal may include:
- Drug craving
- Upper respiratory symptoms
Most tramadol withdrawal cases are marked by:
- Flu-like symptoms
- Drug craving
These types of symptoms make up about 90% of cases of tramadol withdrawal.
Rarer withdrawal symptoms can occur in about 10% of cases and include:
- Extreme anxiety
- Panic attacks
- Numbness and tingling in the extremities
Easing withdrawal symptoms
Tapering can prevent or minimize symptoms of withdrawal.
There is no standard schedule for tapering off tramadol or other opioids, so work with your doctor to come up with an individualized plan.
You may be able to taper off tramadol more quickly if you have been taking the drug for a shorter period of time. Someone who has taken tramadol for a longer period of time may not tolerate a short taper as well.
When creating a tapering schedule, some factors considered include:
- The drug dose being taken
- How long you have been taking the drug
- The type of pain that’s being treated
- Your physical and mental health
During the tapering period, you might experience increased pain or severe withdrawal symptoms as the medication is reduced.
In these cases:
- You may need to pause the tapering schedule for the time being.
- Your doctor may prescribe the medication at your previous dose. Then you would start again with a slower and more gradual tapering period.
Tramadol overdose can happen if you take more than the recommended dose. Also, chewing, crushing or splitting tramadol tablets can alter the dosage and delivery, and increase the likelihood of overdose.
Overdose symptoms include:
- Respiratory depression
During the tapering period, you may be at increased risk of overdose if you suddenly resume taking a higher dose.
Naloxone can be used to treat an opioid overdose.
Tramadol is prescribed to manage moderate to severe pain. Although tramadol is a synthetic opioid, it is considered to be “weaker” than other opioids, like morphine. Tramadol is approximately 6,000-fold weaker than morphine.
Tramadol is thought to have a low potential for dependence, but chronic, long-term use makes dependence more likely. People with a history of substance abuse are also more likely to become dependent on tramadol.
- Drug Enforcement Administration. TRAMADOL. March 2020. Available at: https://www.deadiversion.usdoj.gov/drug_chem_info/tramadol.pdf. [Accessed September 15, 2020].
- Australian Department of Health. Clinical guidelines and procedures for the use of methadone in the maintenance treatment of opioid dependence. August 2003. Available at: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-meth-toc. [Accessed September 15, 2020].
- World Health Organization (WHO). Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. 2009. Available at: https://www.who.int/substance_abuse/publications/Opioid_dependence_guidelines.pdf. [Accessed September 15, 2020].
- MedlinePlus. Opiate and opioid withdrawal. May 5, 2020. Available at: https://medlineplus.gov/ency/article/000949.htm. [Accessed September 15, 2020].
- Food and Drug Administration (FDA). Prescribing Information for Tramadol Hydrochloride extended-release capsules. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022370s000lbl.pdf. [Accessed September 15, 2020].
- Substance Abuse and Mental Health Services Administration (SAMHSA). Emergency department visits for adverse reactions involving the pain medication tramadol. May 14, 2015. Available at: https://www.samhsa.gov/data/sites/default/files/report_1965/ShortReport-1965.html. [Accessed September 15, 2020].
- Centers for Disease Control and Prevention (CDC). Pocket Guide: Tapering Opioids for Chronic Pain. May 11, 2020. Available at: https://www.cdc.gov/drugoverdose/pdf/Clinical_Pocket_Guide_Tapering-a.pdf. [Accessed October 2, 2020].
- Food and Drug Administration (FDA). FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering. April 9, 2019. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-identifies-harm-reported-sudden-discontinuation-opioid-pain-medicines-and-requires-label-changes. [Accessed October 2, 2020].
- World Health Organization (WHO). Critical Review Report: Tramadol. November, 2018. Available at: https://www.who.int/medicines/access/controlled-substances/Tramadol.pdf?ua=1. [Accessed September 15, 2020].
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