Addiction Treatment

Tramadol Withdrawal Symptoms and Timeline

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Last updated: 01/26/2021
Author: Addictions.com Medical Review

Reading Time: 5 minutes

Table of Contents

What is Tramadol Withdrawal?

Tramadol withdrawal symptoms, which are extremely unpleasant and painful, emerge when someone who is physically dependent on tramadol abruptly discontinues use or dramatically reduces their tramadol dose. You are physically dependent on tramadol when your body has adapted to the presence of the opioid, which means you require tramadol to feel “normal.”

If you’re physically dependent on tramadol, it doesn’t necessarily mean you’re addicted, as people who are taking tramadol exactly as prescribed may still develop dependence.1 That said, physical dependence is often a sign of tramadol addiction, especially if the person is abusing or purposefully misusing the opioid in order to get high.

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Common Tramadol Withdrawal Symptoms

Tramadol withdrawal symptoms are extremely uncomfortable but they are usually not life-threatening, although they can be. The biggest risk includes elevated blood sodium due to dehydration caused by diarrhea and vomiting—elevated sodium levels can lead to heart failure.2

Common tramadol withdrawal symptoms include:3

  • Tingling sensations
  • Goosebumps
  • Flu-like symptoms
  • Anxiety and panic attacks
  • Nausea, vomiting, and diarrhea
  • Extreme sweating
  • Insomnia
  • Pain
  • Tremors

Additionally, there have been occasional reports in which people who are dependent on tramadol have experienced hallucinations during withdrawal, although these instances are rare.4  Because of these distressing withdrawal symptoms, many people in tramadol withdrawal may seek out tramadol or another opioid in order to alleviate these symptoms, making it difficult to quit without help.

If you are struggling with tramadol withdrawal symptoms, call 800-926-9037 for help quitting tramadol and proper healthcare during withdrawal.

Neonatal Abstinence Syndrome

Individuals who abuse tramadol are also not the only ones at risk for experiencing withdrawal. People who abuse tramadol while pregnant may cause their baby to become physically dependent on the opioid and present with withdrawal symptoms at birth, a condition known as neonatal abstinence syndrome.5

Tramadol withdrawal syndrome can be fatal for newborns, so contact your doctor right away if your baby is exhibiting any of the following symptoms:6,7

  • Vomiting and diarrhea
  • Uncontrollable shaking
  • Failure to gain weight
  • Hyperactivity
  • Extreme irritability
  • High-pitched cry
  • Abnormal sleep patterns
  • Seizures
  • Fever
  • Rapid breathing
  • Sweating
  • Hyperactive reflexes

Tramadol Withdrawal Timeline

Your tramadol withdrawal timeline will differ depending on whether you’re dependent on a short-acting or long-acting tramadol formulation. Withdrawal from short-acting tramadol will typically begin within 8-12 hours after the most recent dose and resolve within 5-7 days. Conversely, if you typically use a long-acting tramadol formulation, withdrawal symptoms may appear within about 30 hours after you last used tramadol.8

Once your acute withdrawal period resolves, you may experience protracted or prolonged withdrawal known as post-acute withdrawal syndrome (PAWS). Post-acute withdrawal symptoms, such as insomnia and anxiety, can last for several months after you’ve quit using opioids.3

Who Is At Risk For Tramadol Withdrawal?

 Not everyone who abuses tramadol will experience withdrawal symptoms when they suddenly stop using it; some people are more likely to than others. Many factors influence whether you’ll experience withdrawal, such as:9

  • How long you’ve been using tramadol: The longer you’ve been using tramadol, the more likely you’ll experience withdrawal.
  • How much tramadol you use: The higher your tramadol dose, the more likely you’ll experience tramadol withdrawal symptoms.
  • Type of formulation: If you abuse a short-acting tramadol medication, you may experience more severe withdrawal symptoms.
  • Previous withdrawal experiences: If you’ve been through opioid withdrawal before, you have an increased risk of experiencing subsequent withdrawal episodes.
  • Co-occurring drug use: If you mix tramadol with other drugs, you may have a higher risk.

Find Treatment for Tramadol Withdrawal: Detox Programs

Due to the unpleasant nature of tramadol withdrawal, many people find it hard to quit without professional detox and addiction treatment. A professional tramadol detox program may occur in an outpatient or inpatient setting, although inpatient may be best for someone experiencing severe tramadol withdrawal symptoms or someone who has struggled with quitting tramadol in the past. Inpatient detox settings tend to have higher rates of completion than outpatient since patients reside at the facility for the duration of detox.10

The most effective treatment for tramadol withdrawal consists of substituting tramadol with an opioid detox medication and then gradually tapering the medication on a predetermined schedule. The most common opioid detox medications include:10

  • Buprenorphine: A long-acting, partial opioid medication that helps prevent tramadol cravings and withdrawal symptoms without causing a high.
  • Methadone: A long-acting full opioid medication that alleviates withdrawal symptoms and cravings without eliciting euphoria or other desired effects.
  • Clonidine: A non-opioid medication that can help treat anxiety and rapid heart rate. It is often used in combination with methadone or buprenorphine.

Additionally, doctors and nurses will provide supportive measures for any persistent problems or withdrawal symptoms. For example, a patient may be prescribed a Zolpidem or Clonazepam to treat withdrawal-related insomnia if the doctor has weighed the risks of prescribing a medication with abuse potential.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen, may be used for pain or muscle cramps, ondansetron for nausea and vomiting, and Pepto-Bismol for diarrhea. The medical staff frequently supplies vitamins and mineral supplements as well to ensure proper nutritional balance.10

Follow-Up to Detox: Tramadol Addiction Treatment

Although detox is a helpful first step on the continuum of care, it is not a replacement for counseling, which aims to rectify maladaptive behaviors by equipping the individual with coping skills, anger management, impulse control, while also interrogating the connection between thoughts, feelings, and behaviors in order to reduce drug use.

The recommendation for the treatment of tramadol addiction, post-detox, is for a patient to receive long-term medication maintenance on buprenorphine or methadone while receiving therapy or counseling—whether it’s individual, group, or family therapy.10 The two main types of tramadol addiction treatment programs include:

  • Inpatient treatment: 30, 60, or 90-day programs in which you reside at the facility and receive several types of addiction interventions.
  • Outpatient treatment: Ranging from 1-2 days per week for 1-2 hour sessions to every day for several hours per day, you can still live at home while attending outpatient treatment.

The best treatment program for you will be the one that meets your individual needs. For example, if you need to continue working or attending school while recovering from a tramadol addiction, an outpatient program may make the most sense for you. Meanwhile, if you have a severe addiction and there are several drug-using triggers at home, including individuals using drugs, paraphernalia, and stressors, you may want to consider an inpatient program.

References

  1. National Institute on Drug Abuse. (2018). Is there a difference between physical dependence and addiction?
  2. Darke, S., Larney, S., & Farrell, M. (2016). Yes, people can die from opiate withdrawal. Addiction, 112(2), 199-200. doi:10.1111/add.13512
  3. Food and Drug Administration. (2010). Tramadol hydrochloride extended-release capsules.
  4. United States Drug Enforcement Administration. Drug scheduling.
  5. National Institute on Drug Abuse. (2020). Prescription Opioids DrugFacts.
  6. S. National Library of Medicine. Medline Plus: Tramadol.
  7. S. National Library of Medicine. Medline Plus: Neonatal abstinence syndrome.
  8. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  9. Pergolizzi, J. V., Raffa, R. B., & Rosenblatt, M. H. (2020). Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. Journal of Clinical Pharmacy and Therapeutics, 45(5), 892-903. doi:10.1111/jcpt.13114
  10. Kleber, H. D. (2007). Pharmacologic treatments for opioid dependence: Detoxification and maintenance options. Neuropsychiatric Manifestations of Neurodegenerative Disease Dialogues in Clinical Neuroscience, 9(2), 455-470. doi:10.31887/dcns.2007.9.2/hkleber 

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