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.

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. In many cases, tapering the tramadol dose over the course of several days or weeks can significantly attenuate, even eliminate, withdrawal symptoms.

Factors Affecting Tramadol Withdrawal Timeline

Tramadol withdrawal symptom duration and severity depend on several factors, including:

  • Tramadol Withdrawal Factors

    Duration of use



    Metabolic rate


    Whether other drugs are being used

    Physical health

    Mental health

Stages of Tramadol Withdrawal Timeline & 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 Symptoms

    Watery eyes

    Runny nose

    Sweating or chills


    Muscle pain or cramps


    Increased blood pressure

    Rapid heart rate or breathing

    Dysphoria (a general sense of unease or dissatisfaction)




    Mood swings

Serious physical and psychological symptoms associated with tramadol withdrawal are uncommon. However, approximately 10% of people will experience profoundly disturbing symptoms, including:

  • Severe Tramadol Withdrawal Symptoms



    Extreme anxiety

    Panic attacks


    Suicidal thoughts or behaviors

    Numbness or tingling in fingers and/or toes

If you or someone you know is experiencing any of these latter symptoms, seek medical assistance immediately.

Initial Reaction

Tramadol 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 Symptoms

For 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 Symptoms

Tramadol 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:

  • Early Tramadol Withdrawal Symptoms

    A “pins-and-needles” sensation






    Cravings for more tramadol

Decrease in Symptoms

After 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 Symptoms

In 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.

How to Find Help for Tramadol Detox in South Florida

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.

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.

  • Sources “Tramadol.” Updated September 2019. Accessed September 15, 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.

    Drug Enforcement Administration. “Tramadol.” October 2018. Accessed September 15, 2019.

    Mager, Dan. “Detoxing After Detox: The Perils of Post-Acute Withdrawal.” Psychology Today, May 2015. 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.