Substance Use

Tramadol Withdrawal

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Tramadol Withdrawal Symptoms, Timeline & Detox Treatment Options

Tramadol is an FDA-approved drug prescribed for pain. However, it is also a Schedule IV drug by the FDA. This schedule means that tramadol can be addictive and create a dependency, but less so than Schedules I, II, and III (e.g., heroin, codeine, ketamine, etc.).

Although tramadol has a low risk of abuse compared to other opioid pain medications, tramadol addiction and dependence do occur. Those who have a prior history of substance abuse face an increased risk. However, users have no record of abuse in other cases, developing an unexpected physical dependence following a prescription for pain. 

Since complications can arise during the tramadol withdrawal process, including the possibility of coma or death, you must seek professional clinical support. Allowing tramadol withdrawal symptoms to prevent you from getting the help you need could lead to severe health, financial, and social consequences. 

If you or your loved one are struggling with tramadol use or abusing a combination of tramadol and other substances of abuse, here is what you need to know about the tramadol withdrawal process and how to seek optimal help. 

What Are the Symptoms of Tramadol Withdrawal?

All medications come with some level of risk, ranging from mild side effects to severe reactions. There is a risk of dependence with tramadol, followed by a risk of tramadol withdrawal symptoms. 

When tramadol was first approved in 1995, it was not considered an opiate, even though it acted similarly. Once cases of abuse and addiction increased, the classification of tramadol changed, along with associated warnings. In 2014, the FDA declared tramadol a controlled substance. Despite the risks, tramadol remains a common pain treatment. Several professional societies include tramadol in their guidelines as a recommended drug, including the American Academy of Orthopaedic Surgeons when aiming to treat osteoarthritis.

When prescribing any medication with a risk of abuse, it’s important to weigh the expected benefits and known risks. However, addiction is a complex disorder, and when opioid-like substances are involved, the potential consequences can be challenging to predict. Since there is a potential for abuse, doctors can only prescribe a maximum of five refills. A new prescription is required every six months. 

Following continued use, tramadol dependence is possible. If you stop using tramadol suddenly after developing physical dependence, you could experience the following symptoms, many of which are common to opioid withdrawal. 

  • Anxiety 
  • Fever
  • Irritability 
  • Muscle, joint, and bone pain 
  • Excessive sweating
  • Flu-like symptoms 
  • Tremor or muscle spasms
  • Stomach cramping 
  • Nausea and vomiting 

Psychological dependence is also a cause for concern, leading to long-lasting post-acute tramadol withdrawal symptoms, including depression, poor sleep, anxiety, irritability, and poor focus. These symptoms are referred to as post-acute withdrawal syndrome (PAWS) and last longer than expected. PAWS symptoms can change and develop over time, often lasting weeks, months, or even years. 

Since tramadol has two different mechanisms, the stimulation of opioid receptors and the inhibition of serotonin and norepinephrine reuptake, it is atypical compared to other opioid painkillers. Based on its unique effect on the brain, tramadol withdrawal may also cause hallucinations, panic attacks, paranoia, depersonalization, and unusual sensory experiences.

These atypical tramadol withdrawal symptoms tend to develop in approximately one out of eight cases. There is no relation between these symptoms and your age, sex, or drug intake duration. However, many users who develop atypical tramadol withdrawal symptoms take more than 400 mg tramadol per day. The standard dose is 25 mg to 100 mg, with some users becoming dependent on a daily dose of 30–50 mg.

What Causes Tramadol Withdrawal?

A lack of willpower does not cause tramadol addiction–addiction to tramadol can happen to anyone.

Like any substance of abuse, tramadol can lead to physical and psychological dependence. In many cases, users with a history of drug abuse begin taking tramadol combined with other opioids or alcohol. This combination is dangerous and complicates the tramadol withdrawal process. However, inpatient tramadol withdrawal support is required for users with no previous history of drug use, in some cases. 

Several case studies have been documented, including the case of a 39-year-old man who sought emergency support for tramadol addiction. He was a college-educated, active duty military officer who was married with four children. He had no previous history of drug use, did not smoke, and consumed just 5–6 alcoholic beverages a year. He was prescribed tramadol two years prior for pelvic pain. He gradually took more and more because of his growing tolerance. Significant tramadol withdrawal symptoms caused him to continue using when he tried to stop. From anxiousness to muscle cramps, restlessness to a sensation of bugs crawling on his skin, his tramadol addiction was severe enough to interfere with his work and home lives. A tapering plan was administered, and several medications were prescribed, as discussed in greater detail below. 

To better understand tramadol withdrawal, it’s important to discuss its mechanism of action. Tramadol is an opioid that binds to opiate receptors in the central nervous system (CNS). This drug also inhibits the reuptake of the brain chemicals serotonin and norepinephrine.

How Long Does Tramadol Withdrawal Take?

There are two forms of tramadol — extended-release and immediate release. Both come in capsule form, which is something to consider concerning administration methods. For example, how a user takes tramadol matters as far as its effect, as you are not supposed to crush or dissolve the extended-release formulation before administration. 

Tramadol’s half-life is six hours. A drug’s half-life is the time it takes for the body to reduce the drug’s active substance by half. Taking half-life into consideration is important to understand the tramadol withdrawal timeline. 

When taking the extended-release formulation, you can expect tramadol to reach its peak concentration by 12 hours, compared to the immediate release, which will peak between 1.6 and 1.9 hours. 

If you have developed a physical dependence on tramadol, suddenly stopping will likely lead to flu-like symptoms. These initial symptoms generally begin in the first 1–2 days and peak within the first few days. Some users will experience tramadol withdrawal symptoms between 8 and 12 hours following their last dose. There are many variables concerning symptom severity, including how long you have been taking tramadol and what dosage. How you administer tramadol also matters. Were you taking it as prescribed in capsule form, or do you smoke, snort, or inject it?

Once the physical symptoms of tramadol withdrawal wear off — which can take up to two weeks — some users experience a wave of psychological symptoms. If you have a pre-existing mental health condition or experienced trauma, this is something you’ll want to discuss with your care team. Ongoing support will be required to help reduce the risk of relapse. 

As discussed above, PAWS may also develop in some users, lasting weeks to years. There is no definitive timeline for PAWS, as each individual must be treated based on their unique history, needs, and ongoing goals. 

When a user stops taking tramadol, symptoms may be unexpected, and the overall timeline for tramadol withdrawal differs for each individual. This case study documented severe tramadol addiction in a 61-year-old without a history of drug abuse and nothing significant within her psychiatric history. This woman was in good physical health and began taking tramadol for five years to control pain following an orthopedic procedure. She had tried to stop using tramadol several times but would become very agitated when she skipped an administration. One day, she didn’t take tramadol for two days in a row. After just a few hours, she began to feel nervous. Once she missed her second dose, she began to have significant anxiety. This anxiety was followed by sweating and the feeling of pins and needles all over her body.

Hallucinations and tremors were also present. She was prescribed several medications, including clonidine and lorazepam, as part of her tapering plan. After four months, she stopped using tramadol entirely without experiencing any physical or psychological tramadol withdrawal symptoms. 

How To Safely Manage a Tramadol Detox

If tramadol withdrawal symptoms act as a barrier to treatment for you, it’s essential to address the risks of continued use. If you have tried to quit cold turkey in the past, you know that tramadol withdrawal symptoms can create a vicious cycle of abuse. As you continue to use, you face the risk of complications. You place your health, finances, and relationships at risk.

Many people think prescribed medications are safe. For many patients, prescribed opioids serve an important role in their lives, and complications concerning addiction do not develop — but that risk is always present. One study examined the risk of death among nearly 90,000 people one year after filling a prescription for tramadol or one of several pain medications, such as codeine or naproxen. All of the participants were at least 50 years old and had osteoarthritis. 

It was found that tramadol increased the risk of death compared to prescribed anti-inflammatory medications.

The risk was nearly double when comparing tramadol to naproxen, diclofenac, and etoricoxib. Among those treated with codeine, the risk was similar to tramadol. More research is required to confirm a more definite link between tramadol use and mortality risk. Researchers need to determine why a doctor choosing to treat a patient with tramadol makes this medication appear riskier. For example, if a patient has arthritis and kidney disease, a doctor will likely prescribe tramadol rather than naproxen because the latter can worsen symptoms of kidney disease. So, is the increased risk of mortality associated with tramadol or other confounding variables, such as pre-existing health conditions?

Regardless, like many drugs of abuse, an overdose is possible, and this is something you need to consider when avoiding tramadol withdrawal treatment. The risk of an overdose increases when you combine substances of abuse, especially drugs that cause respiratory depression. Tramadol overdose is associated with respiratory depression and seizures. If you are taking tramadol, you should never mix it with alcohol, benzodiazepines, or other CNS depressants. Coma and death are possible. If you are dependent on alcohol or benzodiazepines, the tramadol withdrawal process can be complicated. To ensure your safety, professional support is highly recommended. 

In many cases, a tapering plan will be required. There is no standard schedule for tapering off tramadol, so you will need to follow the individualized plan created for you. Throughout the tapering period, you will need to be monitored to adjust your plan accordingly. 

If you are interested in medically assisted detox to better control your tramadol withdrawal symptoms, it’s critical you seek professional support. For example, naloxone is a common medication to decrease respiratory and central nervous system depression. However, this drug can increase the risk of seizures. Understanding the risks of each medication and how they react with one another is essential in maintaining your safety — especially if you have a preexisting health condition that places you at increased risk. Each individual must be assessed and monitored to ensure the safest, most optimal results. 

Other medications used to treat tapering of tramadol withdrawal symptoms include lorazepam, clonidine, and mirtazapine. 

When withdrawing from any opioid, an inter-professional care team is critical. Tramadol withdrawal symptoms can lead to death if not properly managed. However, the tramadol withdrawal period is only the beginning. For many, ongoing support is required for a potential dual diagnosis. Co-occurring mental health disorders must be addressed using the latest evidence-based therapy and treatment. 

Take the Next Step

Overcoming tramadol symptoms can be difficult, but you can overcome your dependence with the right treatment and support. 

The tramadol withdrawal period is the first step in your recovery process. The idea is to seek a professional treatment facility that offers evidence-based treatment methods, taking a holistic approach. Treating you as a whole is critical to your ongoing success, especially if you are struggling with underlying mental health symptoms. 

Once you overcome tramadol withdrawal symptoms, you can begin treating the variables that drove you to use in the first place. For some, their pain was the cause of their initial dependence, but now, they use tramadol to avoid withdrawal even though their pain has since subsided. Others take tramadol along with other substances of abuse, creating a complex and vicious cycle that requires professional support. 

Regardless of your situation, if you are ready to begin the tramadol withdrawal process in a safe, comfortable, and supportive environment, take the next step. Call now to learn more about how Zinnia Healing can help: (855) 430-9439.