By The Recovery VillageThe Recovery VillageAbout our Editorial TeamEditor Rob AlstonRob AlstonRob Alston has traveled around Australia, Japan, Europe, and America as a writer and editor for... read moreMedically Reviewed By Annie Tye, PHDAnnie Tye, PHDAnnie earned her PhD in Neuroscience from the University of Iowa, where she studied migraine... read more×This medical web page has been reviewed and validated by a health professional. The information has been screened and edited by health professionals to contain objective information on diagnosis and treatment of diseases. Contains bibliographic reference sources. If you are a healthcare professional and you find any issue, please reach out to [email protected]Updated on 08/10/21 Key Points Tramadol withdrawal is unlikely to occur from normal use. Despite having a somewhat different mechanism of action than other popular opioids, tramadol can be addictive when used regularly, even when taken as directed. People who have developed a dependence on tramadol can find quitting to be incredibly difficult, especially if they try to quit “cold turkey.” The most effective way to stop using tramadol is to work with a medical professional who can create a tapering schedule that suits the needs of the patient. Detoxing from tramadol at home is risky because the desire to continue substance use can be strong. What Causes Tramadol Withdrawal? Tramadol withdrawal occurs when a person becomes dependent on tramadol and relies on it to feel normal. When this happens, their body has adjusted to the drug constantly being present and no longer knows how to function normally in the absence of the drug. If a person who is dependent on tramadol suddenly stops using it, they will most likely go through withdrawal. A person who uses tramadol according to their prescription and not exceeding the daily dose recommendation is unlikely to experience the symptoms of withdrawal that a person abusing tramadol would feel. Tramadol Withdrawal Symptoms Tramadol dependence can occur in anyone who uses it for an extended period, even when they are taking it exactly as prescribed. Withdrawal becomes evident when someone misses a dose or tries to reduce their dose and uncomfortable physical symptoms develop. Common signs and symptoms associated with tramadol withdrawal include: Tramadol Withdrawal SymptomsSome physical tramadol withdrawal symptoms include restlessness, watery eyes, runny nose, yawning, excessive sweating, chills, muscle pain, dilated pupils, insomnia, nausea or vomiting, and increased blood pressure, respiratory rate or heart rate. The physical withdrawal symptoms associated with tramadol withdrawal are sometimes referred to as a “tramadol hangover.” Psychological withdrawal symptoms may include irritability, anxiety, panic attacks, confusion, suicidal thoughts, depression, mood swings, and dysphoria (a general sense of unease or dissatisfaction). These types of withdrawal symptoms are less common than the physical symptoms and occur in only about 10% of cases. Severe Tramadol Withdrawal SymptomsHallucinations Paranoia Extreme anxiety Panic attacks Confusion Suicidal thoughts or behaviors Numbness or tingling in fingers and/or toes Symptoms of Post Acute Withdrawal Syndrome (PAWS)Post acute withdrawal syndrome (PAWS), also known as protracted withdrawal symptoms, occurs when a person experiences long-term withdrawal symptoms after stopping tramadol use. These effects usually only occur in people who have used tramadol chronically and in very large doses. The symptoms are typically psychological rather than physical and can include feeling weak or fatigued, having intense cravings to use tramadol, depression, anxiety, insomnia and increased sensitivity to pain. Serious physical and psychological symptoms associated with tramadol withdrawal are uncommon. However, approximately 10% of people will experience profoundly disturbing symptoms. If you or someone you know is experiencing any of these severe symptoms, seek medical assistance immediately. Related Articles About TramadolTramadol Treatment & RehabTramadol AddictionSee More Tramadol Withdrawal Timeline & Stages Tramadol withdrawal symptom duration and severity depend on several factors, including duration of use, dose, age, metabolic rate, genetics, other drugs being used, physical health, and mental health. Initial ReactionTramadol has a half-life of 5-6 hours, meaning that it takes 5-6 hours for half of the tramadol in someone’s system to be metabolized into inactive byproducts. A general rule of thumb for estimating how long a drug will remain active in your system is to multiply the half-life by a factor of five. For tramadol, over 95% of the active ingredients will be metabolized within 25-30 hours. Withdrawal symptom onset is a consequence of the half-life of a drug. With the passing of each half-life, smaller amounts of the active drug will be available for use. Tramadol withdrawal will often set in as soon as four hours after the last dose. Onset of SymptomsFor many people who have developed a tramadol dependence, withdrawal symptoms may appear as soon as four hours after the last dose, although immediate release and extended-release formulations will have slightly reduced or increased timeframes, respectively. Peak & Persistent SymptomsTramadol withdrawal symptoms often peak around one to two days after the last dose, after which time they gradually subside over the course of several days. Early symptoms often include a “pins-and-needles” sensation, sweating, nervousness/anxiety, nausea, palpitations, insomnia, and cravings for more tramadol. Decrease in SymptomsAfter the peak of symptom severity (usually within two days after the last dose), symptoms gradually reduce in intensity over several days. The vast majority of people will have near-total relief within two weeks. Lingering SymptomsIn extreme cases of tramadol use disorders, symptoms may persist beyond two weeks. This is known as post-acute withdrawal. The most common symptoms associated with prolonged withdrawal include depression and anxiety. Genetic or other physiological predispositions to prolonged withdrawal may exist, but most cases are the result of serious dependence or addiction that occurs with chronic heavy tramadol abuse. Seeking Help for Tramadol Abuse? Whether you're calling for yourself or a loved one, our Intake Coordinators are here to help. We are ready and waiting to answer your questions and there's no pressure to commit to treatment until you're ready. 24/7 Tramadol Helpline FAQs About Tramadol Withdrawal What is tramadol?Tramadol (brand name Ultram, among others) is a commonly prescribed opioid-like drug that is used to treat moderate to severe pain. Unlike typical opioids (oxycodone, for example), tramadol does not interact strongly with opioid receptors in the brain. Further differentiating tramadol from typical opioids, tramadol inhibits serotonin and norepinephrine “reuptake,” which increases the amount of time that serotonin and norepinephrine are present in the brain. Serotonin and norepinephrine reduce pain perception, complementing the pain-relieving mechanism of opioids. What is tramadol withdrawal?Due to its opioid-like effects, when tramadol is used inappropriately or other than intended, it can be addictive. If a person becomes addicted to tramadol, they may experience tramadol withdrawal symptoms when they stop using the drug. Tramadol detox treatment can aid in the withdrawal process and it makes it more comfortable for the person going through it. Can tramadol withdrawal kill you?While withdrawal from tramadol can be painful and challenging, the chance of death from withdrawal is unlikely. Tramadol deaths are more likely to be associated with an overdose. Going through the withdrawal process, though uncomfortable, will lead to a healthier lifestyle in the end. How long does tramadol stay in your system?The half-life of tramadol is six hours, meaning that half of the original dose of tramadol that is taken will remain six hours later. The tramadol schedule to peak concentration depends on the type of tramadol that is used. The extended-release form takes 12 hours to reach its peak, while the immediate-release form takes only 1.6 to 1.9 hours. The tramadol withdrawal timeline will depend on how long it has been since the person last took the drug since withdrawal occurs as a reaction to the absence of the drug in a person’s system. The first signs of withdrawal will usually occur within a day of stopping use, given the short half-life of the drug. The full withdrawal process can take anywhere from ten days to several weeks. How long do tramadol withdrawal symptoms last?The answer depends on a variety of factors. The level of dependency is a major contributor to how long the withdrawal symptoms will last. People who have used tramadol for longer and at larger doses have a harder time overcoming the withdrawal symptoms. The manner in which it is taken can also play into the length of the withdrawal process. A person who misuses tramadol by injecting or snorting it will take longer to recover than a person who takes it as recommended. Tramadol withdrawal after short-term use is unlikely to occur. Tramadol withdrawal is usually associated with extended abuse of the medication, where the person has become dependent on the drug to feel normal. What should be taken for tramadol withdrawals?Tramadol withdrawal can be medically treated with buprenorphine/naloxone, which acts on opioid receptors to activate them while simultaneously preventing them from becoming too activated. This process lessens the euphoric effect from the drug, making it less desirable and easier to quit using. Other medications may also be used to lessen the severity of the withdrawal symptoms. What are the alternative treatments for tramadol withdrawal?Instead of using other medications to relieve the symptoms of withdrawal, another course of action would be to taper the use of tramadol gradually, until the person is no longer using it. Professional vs At Home Detox Tramadol detox can help a person go through the tramadol withdrawal process. The goal of detox is to minimize harm to the person as their body adjusts to the absence of the drug. Ways to clean your body from tramadol vary based on individual needs. Medical DetoxMedical detox involves taking medication to lessen the withdrawal symptoms and make them more bearable. This is usually done in an inpatient setting, where the person can have 24-hour access to care when they need it. Outpatient DetoxOutpatient detox involves regular visits to a therapist or counselor who will monitor their progress and help keep them on track to recovery. People choosing outpatient detox may also receive medical help through the detox process but will not have the 24-hour care and access to professional help that an inpatient detox program has. Detoxing at HomeUndertaking Tramadol detox treatment at home may seem like an appealing option because the person can be comfortable in a familiar place. However, detoxing at home is difficult and requires extreme self-control. A couple of factors to consider about detoxing at home are: Risks of abrupt discontinuation: Stopping tramadol use abruptly can be dangerous because the person is likely to experience severe effects of withdrawal. These effects may be unbearable and hard to deal with in the absence of medical help. Oftentimes a person experiencing these severe withdrawal symptoms will resort to tramadol use to relieve the symptoms. Controlled Taper: A tip for dealing with tramadol withdrawal is to do a controlled taper. This process is when a person gradually uses less and less of a drug until they are no longer using any. A controlled taper can lessen the effects of withdrawal by slowly changing its presence in a person’s system. However, this can be very difficult to do at home, as a person will have to control the urge to continue using more of the drug. Controlled tapers are more successful in an inpatient setting. Tips for Finding a Detox Center Tramadol is an atypical opioid that has a slightly different mechanism of action than other opioids do. As a result, it has a modestly reduced risk of dependence when taken for short periods and in small doses. However, tramadol dependence and addiction do occur with prolonged use as directed, as well as with misuse or abuse. Dependence can make quitting tramadol challenging, and withdrawal can be very uncomfortable. If you are concerned that you or someone you know has developed a tramadol use disorder, the first step is to seek an evaluation with an addiction specialist who can recommend an appropriate course of action. A residential or outpatient rehab program may be suggested. Residential programs will be especially beneficial for people who are at high risk for relapse in the first few days of recovery. There are a number of rehab facilities in South Florida. Look for a facility that provides evidence-based, comprehensive programs that can be adapted to suit your needs. Multidisciplinary teams can address all facets of recovery, including physical and emotional health and wellbeing. Accreditation through CARF International or The Joint Commission guarantees a certain standard of care. Our Drug Detox Center Contact The Recovery Village Palm Beach at Baptist Health today to speak with a representative about how professional addiction treatment can help you begin your journey to recovery. The Recovery Village Palm Beach at Baptist Health 4905 Lantana Rd Lake Worth, FL 33463 561-340-7269 SourcesCupples, Nicole; Moore, Troy. “A case of tramadol dependence and successful treatment with buprenorphine/naloxone.” Mental Health Clinician, December 2013. Accessed July 26, 2019. Dhesi, Manraj; Maani, Christopher V. “Tramadol.” StatPearls Publishing, January 6, 2019. Accessed July 26, 2019. DrugBank.ca. “Tramadol.” Updated September 2019. Accessed September 15, 2019. Drug Enforcement Administration. “Tramadol.” October 2018. Accessed September 15, 2019. Food and Drug Administration. “Tramadol Prescribing Information.” May, 2010. Accessed July 26, 2019. Mager, Dan. “Detoxing After Detox: The Perils of Post-Acute Withdrawal.” Psychology Today, May 2015. Accessed September 15, 2019. McCarty, D.; Braude, L.; Lyman, D.R.; Dougherty, R.H.; Daniels, A.S.; Ghose, S.S.; Delphin-Rittmon, M.E. “Substance abuse intensive outpatient programs: assessing the evidence.” Psychiatric Services, June 1, 2014. Accessed July 26, 2019. Melemis, Steven. “Relapse Prevention and the Five Rules of Recovery.” The Yale Journal of Biology and Medicine, September 2015. Accessed July 26, 2019. Ojha, Rashmi; Bhatia, Subhash C . “Tramadol dependence in a patient with no previous substance history.” Primary Care Companion to the Journal of Clinical Psychiatry, 2010. Accessed September 15, 2019. Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.