Thursday July 19th 2018

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How to Stop Taking Ultram?


ARTICLE OVERVIEW: The safest way to stop using Ultram is under medical care with an appropriate tapering schedule and medication to ease withdrawal symptoms. In this article, we explain safe protocols so that you might successfully quit Ultram, plus we provide you with a list of places where you can get help.


TABLE OF CONTENTS


Dependence

Even though physicians have considered Ultram (main igredient tramadol) as having low addictive potential, there are significant evidence that people can become dependent on tramadol and its combination products. In fact, tramadol is a psychoactive medication. When marketed as “Ultram, it is mostly used to treat moderate to severe pain, but it is also successful in treating anxiety, obsessive compulsive disorder, and bipolar disorder.

So, if you’ve been taking Ultram for several weeks or more, it is likely that your body has developed physical dependence. When you try to quit, you run the risk of experiencing dangerous withdrawal symptoms. Attempting to detox from Ultram on your own can be risky and is not recommended.

What can you do? Continue reading to learn more. Finally, we welcome your comments, questions or personal experiences at the end. In fact, we try to respond to all real life questions personally and promptly.

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What Withdrawal Is

Quitting Ultram after daily use over a period of a few weeks or months will cause withdrawal symptoms because the body has become drug-dependent. These symptoms come as a natural and expected result of your body’s adaptations. But what is withdrawal? Why does it occur?

What’s really happening is that the body has adapted to the presence of tramadol by “slowing down” some functions and “speeding up” others. In order to survive and continue functioning, the brain reaches an internal balance to accommodate tramadol; this balance is called “homeostasis”.

But when the tramadol is abruptly removed, it takes time for the “slowing down” or “speeding up” functions to even out again. The manifestation of these symptoms is the body trying to get back into balance. It takes time to resolve, but the situation is temporary. While uncomfortable, withdrawal is rarely life-threatening.

Side Effects

The side effects, or symptoms, that appear when you are stopping Ultram include sets of symptoms common to other opioids as well as abnormal effects. This is because tramadol is not a straight opioid. It has been synthesized (man made) to trigger less intense effects.

Symptoms typically observed during Ultram withdrawal include:

  • Agitation
  • Anxiety
  • Bone pain
  • Depression
  • Diarrhea
  • Excessive perspiration
  • Epiphora
  • Watery eyes
  • Gastrointestinal pain
  • Insomnia
  • Nausea
  • Runny nose

Abnormal symptoms include:

  • Confusion
  • Delusion
  • Derealization
  • Panic attacks
  • Paranoid thoughts
  • Severe anxiety
  • Unnatural sensory experiences
  • Visual and auditory hallucinations

ONE IMPORTANT NOTE: Avoid using alcohol during detox. Mixing alcohol with Ultram can be very dangerous. The combination of Ultram with alcohol can worsen your withdrawal symptoms and cause:

  • Brain damage
  • Confusion
  • Depression
  • Loss of consciousness
  • Respiratory depression
  • Suicidal ideation

Can I Just Quit?

No. It is not recommended that anyone stop a prescription medication containing tramadol either abruptly or on your own. Instead, medical professionals suggest a slow and gradual taper of doses, followed by a monitored stay in a detox clinic.

Going cold turkey off Ultram is not only painful, but it can also cause seizures. This is the main reason why the most appropriate way to come off Ultram is in a detox clinic. To repeat, there are two types of Ultram withdrawal symptoms

  1. Opiate-like withdrawal symptoms
  2. Atypical, antidpressant-like withdrawal symptoms

In some cases, Ultram withdrawal symptoms are similar to serotonin reuptake blockers (SRI) withdrawal symptoms, rather than opioid blockers. This may be related to Ultram’s mechanism of action as a serotonin and epinephrine reuptake blocker.

When you plan to quit Ultram, medical supervision can help minimize your discomfort and keep you safe. In fact, managing withdrawal symptoms can be much more humane when you seek medical help.

Do I Have a Drug Problem?

Do you wonder whether you have a problem with tramadol, or not?

The good news is that you are not alone.

The American Society of Addiction Medicine (ASAM) reported that about 2 million Americans struggled with  substance use disorder to painkillers like tramadol in 2016. Moreover, the 2016 National Survey on Drug Use and Health stated that there were 1,591,000 people aged 12 or older who had misused tramadol products including Ultram in the past year. NOTE HERE: Drug problems are medical in nature. They are treated medically.

So, what do you need to do to get better?

First, be honest with yourself. Then, check out the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to help you verify your addiction status. This manual is mainly used by doctors, psychiatrists, and psychologists, and it provides 11 criteria for diagnosis of an addiction behavior. Ask yourself the following questions, “Do you”:

  1. Use the drug in larger amounts or longer than intended?
  2. Want to cut down or stop using drug but fail to succeed?
  3. Spend a lot of time obtaining, using, or recovering from the use?
  4. Experience cravings and an uncontrollable need to use the drug?
  5. Fail to perform normally at work, home, or at school due to drug use?
  6. Continue to use, even when it causes problems in relationships with family, friends, and partners?
  7. Give up important social, occupational or recreational activities because of use?
  8. Use the drug again and again, despite being aware of harmful risks and side effects?
  9. Continue to use despite the risk of developing health problems or worsened physical or physiological condition?
  10. Need more drug to get the desired effect (tolerance)?
  11. Experience withdrawal symptoms which can be relieved by taking higher dose (dependence)?

Furthermore, the DSM-V categorizes the levels of addiction disorder by the number of criteria you meet:

2-3 Criteria indicate a mild addiction disorder.
4-5 Criteria indicate a moderate addiction disorder.
>6 Criteria indicate a severe addiction disorder.

How Do I Stop?

Before you quit Ultram, it is recommended that you seek medical help from your prescribing doctor. You’ll want to start with a tapering schedule that will enable you to slowly decrease your doses. This way you will ease most withdrawal symptoms, plus you will provide your body with enough time to get accustomed to functioning without the medication.

You can expect withdrawal symptoms to occur as Ultram starts to leave your body. So, you can expect the onset of symptoms to occur when you are due for the next dose (thus the importance of a taper). Ultram withdrawal symptoms usually peak 48-72 hours after your last use. They can last anywhere from a few days to a few weeks.

Medical Detox

Stage 1: Assessment

During the first stage of medical detox, you’ll spend about an hour or two in assessment, discussion, and completion of paperwork. Also, you may need to give a urine/blood sample for a drug test. This stage helps clinicians to plan the detox services for your treatment.

Stage 2: Clinical Evaluation

Then, detox clinicians will observe your medical history, complete physical exam, and a psychological evaluation. Also, if there is a need of medications to address withdrawal symptoms, nurses will obtain prescriptions from a physician.

Stage 3: Tapering Schedule

A tapering schedule sets the pace and duration of dosage reduction. These schedules are done in accordance of doctor’s orders. During this period, you may undergo through withdrawal. So, get familiar with Ultram symptoms by time to know what to expect.

Stage 4: Transition

Medical detox is only the first stage of the addiction treatment. To prevent a relapse, you need to learn how to live without using substances. This stage will prepare you for a rehab stay. Keep in mind that continued treatment is an investment in a drug-free life. Still, this is your choice to make and doctors cannot force you to go to rehab.

Tapering Guidelines

The safest way to quit Ultram is by slowly reducing the daily dose over a period of several weeks. The tapering schedule should be planned by your prescribing doctor and based on your health condition, duration of use and dosage. Who can you look to for guidelines?

The U.S. Department of Veterans Affairs offers a safe tapering protocol for opioids following these guidelines:

  1. Decrease dosage by 20%-50% per day to 30 mg/day.
  2. Decrease by 5 mg/day every 3-5 days to 10 mg/day.
  3. Decrease by 2.5 mg/day every 3-5 days.
  4. Avoid reducing the daily dose by over 50% at any given interval.

Check out the Washington State Opioid Taper Plan Calculator for more info.

Medicines for Withdrawal

More and more, the use of medications to assist cases of dependence and addiction are in use. Often, these medications are stigmatized, and seen as “trading one case of dependence for another.” The World Health Organization has stated that buprenorphine and methadone are crucial medications to effective opioid treatment. But, there are many more medications that are used during detox. Some of them include:

1. Antidepressants.

Anyone who goes through withdrawal from tramadol should be examined for mental health issues. This is because anxiety or depression can occur at the same time. SSRIs or trazodone can help enormously for those cases.

2. Medicines that delay withdrawal.

Buprenorphine and methadone are used as replacement therapy, and they are thought to make detox and withdrawal less severe.

3. Medicines that prevent relapse.

Mostly used in combination with buprenorphine and methadone, naltrexone enhances the brain receptors that are affected by tramadol.

4. Medicines that treat specific symptoms as they happen.

  • Clonidine treats anxiety, agitation, muscle pain, sweating, and runny nose.
  • Dicyclomine hydrochloride treats abdominal cramps.
  • Diphenoxylate and Loperamide treat diarrhea.
  • Hydroxyzine and Promethazine prevent or reduce nausea and vomiting.
  • Methocarbamol treat joint pain and muscle cramps.

NOTE THIS: Undiagnosed mental health conditions can lead to relapse. Be sure to be assessed in a full medical history before undergoing tramadol withdrawal.


Detox at Home

So, should you detox at home? Generally, experts recognize that this option is a possibility, but a dangerous one. Mainly, because tramadol withdrawal can provoke seizures or unpredictable side effects. For example, you may need medical care 24/7. Detox clinicians can provide prescriptions for medications that address withdrawal symptoms. Moreover, in rehab, you will have emotional AND psychological support to prevent relapse.

Additionally, any at home detox requires medical approval. This means that you need permission and tapering schedule from your prescribing doctor. Ultram detox may be dangerous for people in poor general health, people with medical conditions, or people diagnosed with addiction.

It is highly important that you take care of yourself during detox. Here are some fundamental suggestions for anyone considering an at-home detox:

  1. Get informed about physical withdrawal symptoms.
  2. Set up a self-care routine.
  3. Follow nutrition recommendations to ease gastrointestinal discomfort.
  4. Eat nutritious and whole foods and drink plenty of water.
  5. Use over-the-counter, NSAID pain medications to treat withdrawal symptoms.
  6. Ask for medical attention when you feel it’s necessary.
  7. Practise activities that increase your serotonin levels, such as taking a walk in the sun, swimming, or exercising.
  8. Include natural supplements during your Ultram detox but with doctor consultation. Sometimes even natural supplements might interact negatively with prescription medications or your medical condition.

Cold Turkey

Each person has a different reaction to stopping Ultram cold turkey. However, a cold turkey Ultram withdrawal is generally not advised. Why?

When you go cold turkey off of Ultram, you risk painful withdrawal and dangerous consequences. Cold turkey tramadol withdrawal can lead to abnormal distress since your body has adapted to functioning with the help of this medication. By abruptly discontinuing Ultram, you can provoke the following side effects:

  • Inability to sleep
  • Muscle cramps
  • Seizures

In brief, stopping Ultram suddenly is not recommended.

Safety

The safest way to quit Ultram is to seek medical supervision and then start with a slow taper. A careful and gradual reduction can help you avoid any severe withdrawal symptoms, or at least lessen their intensity.

You may decide to stop taking Ultram on your own, but make sure that you talk with a doctor and let him/her know that you plan to quit. Your physician will be able to help you slowly reduce Ultram doses in order to minimize the withdrawal discomfort.

If you are withdrawing under medical supervision, you should be persistent during your detox period. Ask doctors about over-the-counter (OTC) medications or other prescription medicines that you might use short-term, and during Ultram detox. Some individuals, for example, are prescribed Suboxone during Ultram detox.

Where to Go for Help

Struggling with an Ultram problem can ruin your life. Dealing with daily tramadol use can exhaust your resources. So, get real, admit that you have a problem, and start working on solving it.

The most common places to find help are:

  • Addiction rehabs
  • Licensed psychologists
  • Licensed psychiatrists
  • Medical detox clinics
  • Medical doctors
  • Pharmacists
  • An addiction helpline

Is Rehab for You?

If you are dependent on and/or addicted to Ultram, treatment in a rehab setting can help you revolve underlying problems, and find the answer on the most important question: Why did I get addicted in the first place? In fact, rehabs specialize at looking into the unique patterns of drug use…and intervening using behavioral change methods to prevent relapse in the future.

So, if you’ve:

  • Been using Ultram to get high.
  • Mixing Ultram with other substances for effect.
  • Tried to quit on your own but failed.
  • Been through treatment before.

….a reputable rehabilitation center can help you get better.

Before enrolling into rehab, you need to choice between the two main options: inpatient or outpatient.

Inpatient rehab provides 24/7 medical assistance and supervision because patients live in the facility during the whole program. Some of the most common services include:

  • Individual counseling therapy
  • Group therapy
  • Educational classes about addiction and recovery
  • Medication management
  • Regular routine establishment

Outpatient rehab offers similar therapy services set up in both individual and group settings, but there is no medical supervision because patients don’t live there. Instead, you’ll attend the center for a few hours several days weekly. This program allows people to keep up with their daily responsibilities to work/school and home.

Readiness

Are you ready quit Ultram once and for all?

First, learn what to expect, and get prepared. Withdrawal may last for few days to several weeks. It’s different for each individual. But, don’t quit Ultran abruptly, unless you must. And, always consult with your doctor before doing anything.

Here are some other ideas that can help you:

1. Create a list of motivation for quitting. The list with your personal reasons for stop using Ultram will keep you going not only through withdrawal, but also in life. It will become your life guide.

2. Your environment must be supportive. Make sure that your family and friends are supportive for your decision. They can help you get through the hard times.

3. Medical education. Before quitting, prepare and learn everything you need to know on tapering schedules, detox process, and over-the-counter meds. Consult with your doctor, or a pharmacist, or the staff at the medical detox.

Your Questions Are Welcomed!

Still have questions about detoxing from Ultram? In the case you still have questions after reading this article, feel free to post more about your personal situation in the comments section below. We appreciate your feedback. We’ll try to provide a personal and prompt answer to all legitimate inquiries.

Reference sources: NCBI: Psychosis following Tramadol Withdrawal 
PubMed: Physical dependence on Ultram (tramadol hydrochloride): both opioid-like and atypical withdrawal symptoms occur 
FDA: Ultram
NIH: Frequently Asked Questions
DailyMed: Tramadol Hydrochloride tablet

Photo credit: Barney Moss

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