Tramadol Withdrawal Symptoms and Timeline

Last Updated: February 5, 2020

Authored by Roger Weiss, MD

Reviewed by Michael Espelin APRN

People might think that using Tramadol has no consequences, because it is a legal medicine, “just” a pain reliever. The truth is, it is an opiate (like morphine) and as such, has such powerful effects on the body.
And that implies that the body strongly reacts once Tramadol is not delivered anymore. The user develops a range of withdrawal symptoms, which can last several weeks. This physical dependence is the primary reason people have a hard time to quit using Tramadol. In some case, people can even develop a psychological addiction.
If someone is hooked on Tramadol and consider quitting it, they should know what to expect. While they will likely experience unpleasant and quite painful symptoms, patients are usually not in physical danger.
The withdrawal effects should fade after several weeks. But for safety reasons, individuals should not withdraw from Tramadol without professional assistance. That is especially important if they are addicted to Tramadol or other substances.

Symptoms and Timeline of Tramadol Withdrawal

Day 1 to 3

All traces of Tramadol will disappear within three days. During that stage, patients will experience withdrawal symptoms:

  • Inidividuals might have the feeling of pins and needles.
  • Sweating and palpitations are very common.

Because the body gets rid of Tramadol, they mostly experience physical withdrawal effects. They will pass very quickly, and one should not worry about them.

  • But many people still become nervous and even anxious.
  • Insomnia. Thr sleep/wake cycle might be disrupted for some days.
  • Drug cravings. Patients probably started taking Tramadol to treat some form of pain in the first place. It is tempting now to take the pain reliever, to stop them withdrawal suffering.

Day 4 to 7

After the body got rid of Tramadol, it will try to get back to its normal state. It will seem as if the chemical balance returned to normal, but this not yet over.

Now is the most unpleasant time, when previous symptoms continue and some new add-on.

  • Cravings for the drug and insomnia
  • Confusion and disorientation. One might have difficulties in distinguishing fantasy from reality for a while.
  • Dilated pupils and blurred vision. The patient’s eyes might hurt from seeing unclearly. Try not to strain the vision. It is only temporary.

Day 8 to 14

Typical opiate withdrawal symptoms will be present:

  • Anxiety. Users might experience being anxious again. It usually lasts some days at most.
  • Irrational thinking. Individuals can find their thinking pattern not be coherent. That can be caused by anxiety. This symptom too is only temporary.
  • Depression.

OneYou should be vigilant after the first week because serotonin syndrome occurs in some people. That usually includes:

  • Muscle rigidity or muscle twitches, sometimes loss of coordination
  • Diarrhea
  • Headache

In severe cases, however, this can be dangerous. It is not common, but patients might face the following:

  • A high fever
  • Irregular heartbeat
  • Users become unconscious
  • Or have seizures

Patients should immediately call a doctor or go to the emergency room if they experience these.

Day 15 to 28

  • Drug cravings can persist for several months.
  • Depression.That is the most stable effect one will encounter. It is mostly caused by modifying brain chemistry. It should fade after a month or two. If it doesn’t, individuals could seek the help from a mental health professional. But make sure the rapist has experience with Tramadol withdrawal. Clinical depression should not be confused with depressive withdrawal symptoms.
  • Irritability and apathy can appear. One might begin to get frustrated and wonder if these unpleasant sensations and emotions will ever go away. They will. Extended periods of poor sleep quality do not make it easier.

Factors Affecting the Severity of Tramadol Withdrawal Symptoms

  • The dosage of Tramadol. The usual dose is between 50-100 mg per day, with 400 mg being the maximum recommended dose. Withdrawal from that amount will be quick and not very painful. However, many people build up a tolerance and need stronger doses. Some people increase their dosage without doctor supervision and end up taking up to 2000 mg per day. That is far beyond the recommended daily dose. Such a high dose induces substantial chemical changes in the body and withdrawal symptoms will be stronger accordingly.
  • Duration and Frequency of use. It matters how long the person has been taking Tramadol. If they were taking it occasionally and irregularly, one should not have problems to get through detox. That is because individual gave thedy breaks from the drug already. But if one has used it for several years on a daily basis, the withdrawal symptoms are very likely to be tough.
  • Tolerance. That point is directly related to how one used the medication. Regular and prolonged consumption often leads to increasing tolerance to the drug. People then require increasing their dosage to achieve the same pain relief. Tha is how dependence on the drug develops. Luckily, addiction (psychological attachment) is rather rare. But if someone is physically dependent on Tramadol, the withdrawal symptoms will be stronger.
  • The method of quitting. Many people stop Tramadol abruptly because they want to get rid of their dependency problem as fast as possible. But that is a trap, because quitting “cold turkey” causes sudden and rough changes to the brain and the whole body. It results in equally unexpected and intense withdrawal effects. The impact depends on the size, duration, and frequency of the dose. Tapering is a much safer method: it consists in gradually decreasing the dosage. It is recommended that tapering lasts ¼ of the duration of Tramadol consumption. The best way to do it is under medical supervision.
  • Individual factors. Everyone’s situation is unique; many additional causes can contribute to the quality of the withdrawal process.

Here are some other factors to take into account:

  • Physiology and metabolism. The general health adds considerably to the liability to face withdrawal symptoms.
  • Tolerance to pain. Some people tolerate pain better than others.
  • Taking other drugs, medicine or supplements. There can be numerous unpredictable chemical interactions.
  • Environment. The possibility to relax can ease the suffering, while stress might strengthen them.

What Can One Do to Make Tramadol Withdrawal Easier?

There are indeed some things one can do to ease the transition from Tramadol use.

What One Can Do

  • A common advice for the successful withdrawal of any opiate is to stay hydrated. Toxic chemicals are getting out of the body, so support that by drinking enough water. 2-3 liters a day is about enough.
  • Eating healthy food. Food is also acting on overall health. Try to stay away from fast food and stick to healthy meals.
  • Exercising. Being in a good physical shape makes it easier to cope with pain and withdrawal symptoms. Exercising also stimulates metabolism helping to get clean quicker.
  • Don’t take other drugs or alcohol. Consuming alcoholic drinks or other substances will either interact with symptoms or delay the detox process

Seek Medical Assistance

Many factors can affect how one will experience the withdrawal period from Tramadol.
Patient should not stop taking the drug on their own. That could lead to complications because the body chemical balance would be drastically modified. For that reason, one should seek medical attention to be under supervision the detox phase. A doctor can follow the timeline of the symptoms progressing and give a medication to reduce some effects.

Page Sources

  1. Rajabizadeh G., Kheradmand A., Nasirian M. Psychosis following Tramadol Withdrawal. Addiction and Health. 2009; 1(1): 58–61.
  2. Senay E. C. et al. Physical dependence on Ultram (tramadol hydrochloride): both opioid-like and atypical withdrawal symptoms occur. Drug and Alcohol Dependence. 2003; 1;69(3): 233-41.

Published on: September 26th, 2016

Updated on: February 5th, 2020

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.


Leave a comment

  • Richie
    This stuff or Tramadol is very dangerous. After taking it from about 2008 to 2018 I found my self suffering from bleeding lungs that my family doctor and local hospital first thought was lung cancer, valley fever (San Joaquin Valley CA), rare foreign disease (I worked overseas a lot), or ever TB. After months of test and ever taking a sample of a blood clot in my right lung, all of the tests came back negative but the blood persisted. So, at the start of this year, after coughing up over a cup of blood every other day, my family doctor decided I might have a weak heart of “Congestive Heart Failure (CHF) (this is when the left part of the heart gets weak and the blood starts back flowing into the lungs. I have been an athlete all of my life, so I thought this was BS. I then decided to go on the web to see if Tramadol would or could cause CH failure, and off course the maker of this BAD drug said no it could not. I then found a web page that said they found Tramadol did and could cause this type of heart failure. To make a long story short, I went cold turkey on February 7, 2019. I am going through all of the with-drawl symptoms and then some, but the good or great news is that my lungs stopped filling with blood about two weeks later after stopping Tramadol, which means I am NOT going to die of Congestive Heart Failure that Tramadol WAS causing. The bad news is that I now only have two with-drawl symptoms left that are very hard to ignore. One is that I am peeing about every 15 minutes to a half hour and my hands and feet cramp up day and night. PLEASE, if you or your family member has a week heart DO NOT take this killer drug. I survived because I am in great shape, but if you are weak, I am sure you won’t make it back. Please pass this post along to others Today. This drug should never have been approved.
  • Therese Bonath
    Hello. I quit cold turkey March the 1th after over 10 years of daily tramadol use 400 to 800 mg. Its 2 months now and im still very sick. I have got an inflammation in my intestens due to severe diarrea after i quit. Im not feeling human anymore this is truly hell. Now i understand the poision it is when you become this sick so long after you quit. I have been told it can take up to a year to feel ok after this long time of use. Dont ever start with tramadol it will destroy you. All i can hope for now is for this to become better or i will not have any strenght left for this life.
  • Girl
    Long term Tramadol use for severe arthritis pain from birth defect, deteriorating joints. Never asked to increase dose, maintained over a decade. Idiot doctors who are not following CDC opioid prescribing recommendations are cutting off Tramadol users without tapering, without warning. My doctor just did this to me. Didn’t even tell me to my face. I found out when my pharmacy could not get the prescription refill from her. Due to other diseases, severe IBSD, symptomatic diverticulosis, and liver unable to take up bile acid, I am already dealing with the ongoing severe diarrhea caused by my complicated medical situation. My internist simply refused to renew Tramadol prescription, did not taper me, did not discuss my already fragile medical situation, and how the Tramadol withdrawal would exacerbate my GI problems. In fact, she didn’t even consider it. Severe dehydration, no matter how much fluids I was taking in. Internist and her nurse refused to return voicemails, as I slid closer to medical crisis. Heart beating irregularly due to the loss of electrolytes. With diabetes, heart issues need taken seriously. I luckily have a very good gastro. Nurse coached me through stomach meds increases, added more medication, to slow down the diarrhea. I was very close to a heart attack, so dehydrated, heart skipping beats. I never abused my prescription medicines, never took more than prescribed. These doctors need to have their licenses revoked for doing this to so many people. I’m not saying she should just keep prescribing Tramadol. I’m saying she should have taken my other diseases into consideration, tapered the Tramadol dose, according to CDC guidelines. I never was an addict, in the sense I was receiving doctor prescribed drug therapy, and was totally compliant on all medications. I never asked for dosage increase or some other opioid. My doctor failed me. So, with my GI doc doubling my stomach meds and adding a third, today seems like I may be turning the corner. May not need to be hospitalized, hope not. I had been somewhat dissatisfied with her for some time, so have an appointment end of June. There is 3-6 months appointment wait with most doctors here. I can’t complain until I’m established with new doc and records transferred. After that, I’ll be filing complaint with state medical board and posting factual reviews online. Oh, and did I mention, I just found out this doctor has three malpractice settlements against her license in only seven years.
  • Mr Barry Callister
    I had taken 400mg of tramadol every day for years, (8 X 50mg each day). Following double hip replacement, I didn’t need them any more, so 3 months ago, I stopped, (cold turkey),and am still suffering from withdrawal symptoms, flu like condition, lack of sleep, hallucinations (weird shapes in my vision), constant sneezing, and the worst of all which I controlled with anti-histamines……unbearable itching. Beginning to think i’ll be like this for ever.