Tramadol Withdrawal: The Withdrawal Symptoms and Timeline

Last Updated: April 13, 2021

Authored by Roger Weiss, MD

Reviewed by Michael Espelin APRN

Tramadol, also sold under the brand name Ultram, is an opioid analgesic prescribed to treat moderate pain. The fact that it is legal makes many people assume that it is a drug with few health risks. However, it is an opioid, so for those who abuse this substance, it can have many effects on their health. Opioid drugs can cause addiction, and when stopped, can lead to withdrawal. These can last for weeks and can push the addict back to abuse. It makes weaning off tramadol hard.

For anyone trying to stop tramadol, they should be made aware of this information. These symptoms are very uncomfortable, though usually not life-threatening. Despite this, trying to stop tramadol should not be done without contacting health workers, particularly if other drugs are abused, such as accompanying alcohol abuse. Recovery is best made professionally.

Why It Is Different

Although it is an opioid similar to drugs like morphine and heroin, the symptoms that it exhibits are different from those typically expected during opioid withdrawal. Apart from activating opioid receptors as expected by these drugs, it also causes increased action of the neurotransmitters serotonin and norepinephrine. This is an opioid that works with multiple mechanisms.

It means that there are two kinds of withdrawal occurring during tramadol withdrawal. One is the regular opioid type, while the other is atypical.

Typical Opioid Withdrawal Symptoms Include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Muscle aches

The Symptoms of Atypical Tramadol Withdrawal Are More Psychological and Include:

  • Confusion
  • Anxiety
  • Hallucinations
  • Paranoia
  • Psychosis
  • Unusual sensations such as numbness and paresthesia

Because Ultram is considered a weaker opioid, in Tramadol vs. Oxycodone comparison the latter will have more pronounced symptoms. However, with Oxycodone the user will experience only typical opioid withdrawal.

Tramadol Withdrawal Symptoms

Ultram is a drug that many abuse recreationally, sometimes in combination with alcohol. But it also finds a lot of use for legitimate complaints. When patients use this drug for a long time and discontinue using it, they may begin to experience tramadol withdrawal symptoms.

Woman suffering from tramadol withdrawal, feeling bad.

These are usually not life-threatening, but it is essential to get help for withdrawal by getting in contact with a professional center as it can be very uncomfortable. These treatment centers will be able to provide medically facilitated detox for the patients, which can reduce the risk of any health complications and make it more comfortable for the patient. They will also address any accompanying drug habits, such as alcohol abuse.

These Tramadol Withdrawal Symptoms Include the Following Psychological Symptoms:

  • Depression
  • Anxiety
  • Confusion
  • Agitation
  • Difficulty concentrating
  • Depersonalization
  • Cravings for the drug
  • Loss of appetite
  • Insomnia
  • Mood swings
  • Restlessness
  • Irritability
  • Dizziness
  • Nightmares

The Physical Symptoms Are:

  • Nausea
  • Vomiting
  • Diarrhea
  • Tremors
  • Abdominal pain and cramps
  • Sweating
  • Headaches
  • Muscle pain
  • Tingling and prickling sensations

Timeline of Withdrawal

From the moment a person stops using the drug, the countdown to tramadol withdrawal symptoms begins. The duration of tramadol withdrawal and the time of onset depend on many factors, such as the dosage addicts abuse, how long the person has been using it, and genetic factors. The involvement of other drugs with Tramadol can complicate things.

However, in most cases, the very first symptoms appear one or two days following the time the last dose was taken. For more severe abusers of the drug, it can be in a matter of hours.

There is a rough timeline to how tramadol withdrawal symptoms appear. This information can help addicts know what to expect on the way to recovery.

Day 1 to 3

In the first few days of tramadol withdrawal, the individual will feel mostly mental symptoms. This includes nervousness, anxiety, confusion, and cravings. Physically, they may begin to sweat and feel tingling sensations. They may also feel muscle aches.

Day 4 to 7

After the body begins to clear itself of tramadol, it will try to get back to its normal state of health. It will seem as if the chemical balance has returned to normal following the substance abuse, but this is not yet over as the attempts for the body to completely adjust are still underway.

Dizzy man experiences tramadol withdrawal symptoms and holds his head.

Now is the most unpleasant time when previous symptoms continue, and some new ones add on. Users can experience cravings for the drug, insomnia, disorientation, or blurred vision. They may also begin to experience physical symptoms such as nausea, vomiting, diarrhea, and numbness.

Day 8 to 14

At this stage, most of the symptoms have passed. However, some persist. This usually applies to psychological symptoms. For example, users might experience being anxious again or find their thinking pattern is not coherent. They are also likely to develop insomnia, and cravings can be extreme at this point of tramadol withdrawal. It usually lasts some days at most.

As their body struggles to adapt without the presence of the drug, they can also have hallucinations. Though not directly life-threatening, this can cause indirect harm to the person struggling with addiction or those around them. It emphasizes why treatment and care should be carried out after making contact with a professional treatment center.

Day 15 to 28

After two weeks of abstinence, the body and the brain gradually get back to normal. However, in some individuals, drug cravings or depression can persist for several months.

Depression is the most stable effect one will encounter. It is mainly caused by modifying brain chemistry. It should fade after a month or two.

Other mental symptoms such as insomnia and anxiety may also be present at this stage of tramadol withdrawal. They may also begin to feel apathetic or have irrational feelings spring up, such as sudden anger and feel irritability.

Factors Affecting the Severity of Symptoms

One important thing to keep in mind when it comes to addiction is that every case is different. Several factors influence the intensity of the addiction and how it develops, and these same factors can also affect the intensity of the symptoms that are felt. This also changes how treatment will be given.

Knowing these factors can be used to estimate how severe symptoms might be. This information is essential for treatment and care in professional centers an addict might come in contact with.

These Factors Include the Following:

  • The dosage. The usual dose is between 50-100 mg per day, with 400 mg being the maximum recommended dose. Withdrawal from tramadol of such an amount will be quick and not very painful. However, many people build up a tolerance and need more potent 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 symptoms will be stronger accordingly. The same applies with detox after an Ultram overdose.
  • Duration and frequency of use. It matters how long the person has been taking the substance. Tramadol withdrawal after short-term use shouldn’t cause too many problems for a person. If they were taking it occasionally and irregularly, one should not have issues getting through detox. But if one has used it for several years daily, the 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 increased tolerance to the drug. People then require increasing their dosage to achieve the same pain relief. That is how Tramadol addiction develops. Luckily, addiction (psychological attachment) is relatively rare. But if someone is physically dependent on tramadol, the symptoms will be stronger.
  • The method of quitting. Many people stop using abruptly because they want to get rid of their dependency problem as fast as possible. But that is a trap because weaning off tramadol “cold turkey” causes sudden and rough changes to the brain and the whole body. It results in equally unexpected and intense effects. The impact depends on the size, duration, and frequency of the dose. Tapering is a much safer method of weaning off tramadol: it consists of gradually decreasing the dosage. It is recommended that tapering lasts ¼ of the duration of the substance’s 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 withdrawal from tramadol.

Seek Medical Assistance

Many factors can affect how one will experience the withdrawal period. Patients should not stop the use of the drug on their own. That could lead to complications if care is not taken because the body chemical balance would be drastically modified. For that reason, one should seek help, medical treatment, and care under supervision in the detox phase. A doctor can follow the timeline of the symptoms progressing and use this information to give medication and appropriate treatment to reduce some effects of Tramadol abuse. This is the best way for an addict to be back on the path of recovery.

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Page Sources

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Published on: September 26th, 2016

Updated on: April 13th, 2021

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.