Tramadol Withdrawal Treatment: How to Treat Tramadol Withdrawal

Tramadol is a synthetic opiate agonistic that provokes physical dependence or addiction after regular use. So how do you treat tramadol withdrawal, given this potential to be habit forming? We explore here.

minute read
Reviewed by: Dr. Dili Gonzalez, M.D. Dr. Juan Goecke, M.D.

ARTICLE OVERVIEW: Our bodies can develop a chemical dependency on tramadol after only a few weeks of regular dosing. This means that when you stop taking tramadol, you will go through a period of withdrawal. We review the medical ways you can treat tramadol withdrawal. Plus, we’ll discuss what you can expect so that you can be best prepared.


Tramadol Basics

Tramadol was first suggested for the treatment of postoperative and chronic pain in 1970 in Germany. It was approved in 1994 in the United Kingdom, and entered the markets of the United States after the Food and Drug Administration (FDA) approved it in 1995. [1]

Tramadol is an opioid analgesic, also known by its trade name Ultram. It is an opioid analgesic that works through three different mechanisms:

  • Inhibition of serotonin.
  • Interacting with the mu-opioid receptor.
  • Reuptake of norepinephrine.

Tramadol is used both orally and as an injection to treat mild to severe pain. An oral dose of 50-100 mg is suggested every 4-6 hours with a maximum of 100 mg per day and a single dose of 50-100 mg IM or IV in 2-3 minutes for the treatment of postoperative pain.

Why Withdrawal Occurs

Withdrawal occurs because the body becomes chemically adapted to the presence of tramadol; regular doses of tramadol become “normal”. The presence of tramadol becomes part of the functioning of the body. The brain does this in order to continue functioning. In the case of tramadol – a central nervous system depressant – the brain “speeds up” certain function. However, when you stop taking tramadol, your body takes time to readjust.

During withdrawal, you are actually experiencing the adaptive symptoms of “speeding up”, which were originally triggered to counterbalance the psychoactive effects. Over the course of several days and weeks, the chemical state of the central nervous system returns to balance and symptoms resolve.


Tramadol has a half-life of 3-10 hours; the average life of a medication depends on the dose and formulation of the medication and it refers to the time it takes for the medication to be in the middle of a person’s system. Therefore, it is likely that abstinence from tramadol begins between 6 and 20 hours after discontinuing use.

ALWAYS seek medical supervision if you are dependent on tramadol and want to quit. Withdrawal can provoke benzodiazepine-like symptoms such as seizure.

Acute Symptoms

Tramadol has both opioid and non-opioid properties. Therefore, the withdrawal symptoms of tramadol mimic those experienced during withdrawal from opiates AND benzodiazepines. This is why it is very important to seek medical supervisions any time you need to get off tramadol and are drug-dependent!

The withdrawal effects of tramadol manifest in body as pain and discomfort. Abstinence from tramadol also alters your mood regulation and can have a psychological effect on you. The craving for drugs can make abstinence from tramadol even more difficult.

It can be complicated identify and treat withdrawal from tramadol symptom because around 50, or so, withdrawal symptoms are possible during tramadol withdrawal. Like other opioids, you can expect withdrawal from tramadol symptoms to feel like the common flu. However, tramadol affects everyone on an individual basis can produce non-opiate reactions in the body such as seizures. Withdrawal symptoms to look out for include:

  • Aggressiveness.
  • Chills.
  • Convulsions.
  • Diarrhea.
  • Dizziness.
  • Hallucinations (sensations and images that seem real though they are not).
  • Headaches.
  • Irritability.
  • Muscle pain.
  • Nausea.
  • Nightmares.
  • Panic attach.
  • Poor appetite.
  • Seizures.
  • Sweating
  • Tingling sensations.
  • Tremors.

Protracted Symptoms

Post-acute or protracted withdrawal symptoms (PAWS) refers to any symptom of drug withdrawal that persist after a person has ended acute physical dependence on a drug. Each episode can last for a few days, and these can continue cyclically for a year. The PAWS symptoms for tramadol typically include:

  • Agitation.
  • Anxiety.
  • Impairment of memory or learning capacity.
  • Depression.
  • Mood swings.
  • Sensitivity to stress.
  • Sleep problems.

These symptoms can persist for weeks, months, or in rare cases, even years after a person has stopped using an opioid pain reliever like tramadol.


The symptoms of withdrawal from tramadol begin within the first day after the final dose of tramadol. These can last for up to 72 hours before hitting peak intensity.
24-72 hours after the last tramadol dose:

  • Anxiety
  • Confusion
  • Cravings
  • Nervousness
  • Palpitations
  • Pins and needles
  • Sweating

NOTE HERE: It is critical that medical professionals observe you for signs of serotonin syndrome, a group of symptoms that may occur following use of certain serotonergic medications or drugs. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea. Body temperature can increase to greater than 41.1 °C or 106.0 °F. Complications may include seizures and extensive muscle breakdown.

Weeks 1 and 2 of tramadol withdrawal:

  • Blurred vision.
  • Cravings.
  • Diarrhea.
  • Dilated pupils.
  • Disorientation.
  • Hallucinations (sensations and images that seem real though they are not).
  • Nausea.
  • Numbness.
  • Paranoia.
  • Panic attacks.

Weeks 3 and 4 of tramadol withdrawal:

  • Anxiety.
  • Depression.
  • Irrational feelings.
  • Insomnia.
  • Apathy.
  • Depression.
  • Irritability.

Once these sensations pass, the person’s body does not need tramadol to feel normal. However, addiction is a more complex, chronic illness; detox alone does not solve the issue. The person may still struggle with cravings for the drug and compulsive ingestion if the drug is available. It is important to get help through a rehabilitation program after withdrawing from tramadol.

Main Treatments

The three main ways you can treat tramadol withdrawal symptoms include:

1. Hospitilization or medical supervision. Treating tramadol withdrawal under medical supervision is always wise. You can do this on an outpatient or inpatient basis. You might choose hospitalization during tramadol withdrawal or to withdraw from tramadol at home under the supervision of your prescribing doctor. Often helpful for people with cases of extensive tramadol abuse and/or addiction, support groups are also a great resource.

2. Detox clinics. Detox is the process by which tramadol is removed from the body either with the aid of medications or supportive therapies. Treating tramadol withdrawal symptoms in a specialized medical clinic ensures that you do so under medical supervision and help. This way, you can treat adverse withdrawal from tramadol symptoms immediately.

3. Treating serotonin syndrome. One major complication of tramadol withdrawal is the potential for serotonin syndrome. Serotonin syndrome occurs when your brain cannot regulate serotonin and your body experiences extreme depression and anxiety. Treating this naturally or with antidepressant can help to regulate the normal levels of serotonin in the body.

Medications That Help

Since tramadol is an opioid analgesic, its withdrawal symptoms can be treated as opioids withdrawals are treated, using the following medications that can help to recovery:

  • Methadone relieves withdrawal symptoms and helps with detox. It is also used as a long-term maintenance medicine for opioid dependence. After a period of maintenance, the dose may be decreased slowly over a long time. This helps reduce the intensity of withdrawal symptoms. Some people stay on methadone for years.
  • Buprenorphine (Subutex) treats withdrawal from opiates, and it can shorten the length of detox. It may also be used for long-term maintenance, like methadone. Buprenorphine may be combined with Naloxone (Bunavail, Suboxone, Zubsolv), which helps prevent dependence and misuse.
  • Clonidine is used to help reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. It does not help reduce cravings.
  • Naltrexone can help prevent relapse. It is available in pill form or as an injection. Help to treat the overdose too.

Anyone going though detox for opioids, like tramadol, should be checked for depression and other mental illnesses. Treating these disorders can reduce the risk of relapse. Antidepressant medicines should be given as needed.


Tramadol is the medical practice of slowly lowering doses of a psychoactive drug over time. Because drugs interact in the body in ways unique to each person…this can help minimize the severity and intensity of withdrawal. Everyone is going to withdraw from tramadol differently and the best way to withdraw from tramadol will vary by person. However, one of the best ways to treat tramadol withdrawal, and which many doctors recommend, is to taper tramadol use over time.

You will discuss your tramadol use with your prescribing doctor and they will figure out the best tapering protocol for you withdrawal. Doctors need an idea of how much your body has developed need for tramadol before suggesting a tapering schedule.

A safe taper is considered a 10% reduction every week and then a 20% reduction every 3 to 5 days. To decrease any more then this can be dangerous and you will be more likely to experience severe tramadol withdrawal symptoms. However, if you able to tolerate large dose decreases without risk of seizure, then this might be recommended, as well. [2]

Why Detox In A Clinic?

If you are dependent on tramadol, the safest way to withdraw should probably involve supervision of some sort. That way, you can be in a safe environment while you go through withdrawal to prevent relapse and/or adverse side effects. Medical supervision of tramadol withdrawal can also address and treat pain and symptoms as they occurs. That is why detox in a clinic will always be the safest option and recommended by professionals.

Detox At Home?

Should you detox from tramadol at home? Possibly, but it comes with side effects. In fact, when you detox alone, you face a number of risks, including:

  • Aggression and mood changes that may cause you to lash out at those you love.
  • Physical side effects that, if left untreated or when compounded on top of other serious medical conditions, can turn dangerous.
  • Psychological distress that can cause you to harm yourself.

It is better, and safer to withdraw from tramadol under the supervision of a medical doctor. Always seek medical guidance when getting of tramadol after a period of dependence.

Safety During Withdrawal

Safety comes first, and if you are or planning to get detox of tramadol, is better that you consider that serious problems could arise during the process of abstinence, such as the reoccurrence and overdose of very serious complications, such as respiratory failure and death.

Tramadol is a unique opioid drug in that it can trigger serious, difficult, and uncomfortable health problems. Correct withdrawal requires time, perseverance and hard work..and the process of detoxification can even endanger your life. For these reasons any withdrawal case must be supervised with the help of a professional doctor in conjunction with family and friends. This process cannot be completed alone.

Signs of a Drug Problem

Does your tramadol dependence point to addiction? Not always. Doctors use the American Psychiatry Association’s Diagnostic and Statistical Manual (The DSM-V) for the diagnosis of an addiction problem, or, as they call it, a “substance use disorder”. [3]

Diagnostic criteria for substance use disorders of the DMS-V are the following:

  • Continuing to use, even when it causes problems in relationships.
  • Continuing to use, even when it puts you in danger.
  • Continuing to use, even when physical or psychological problems may be made worse by use.
  • Craving.
  • Giving up important activities because of use.
  • Inability to manage commitments due to use.
  • Increasing tolerance.
  • Spending a lot of time to get, use, or recover from use.
  • Using in larger amounts or for longer than intended.
  • Wanting to cut down or stop using, but not managing to.
  • Withdrawal symptoms.

Persons exhibiting fewer than two of the symptoms are not considered to have a substance use disorder. Those exhibiting two or three symptoms are considered to have a “mild” disorder, four or five symptoms constitutes a “moderate” disorder, and six or more symptoms is considered a “severe” substance use disorder.

If you or someone you love has discovered that you have a problem with tramadol, it is best to seek help to start the detox program, before it is too late.

Who Uses Tramadol?

Addiction to tramadol has been a growing problem in the United States and around the world. While tramadol abuse represents a fraction of the overall pain reliever market, in 2014, the Drug Enforcement Administration (DEA) reported that 3.2 million people over the age of 12 in the United States used tramadol for non-medical reasons in their lifetime. This represents about 10% of the total pain reliever abuse market. [4]

According with the National Survey on Drug Use and Health (NSDUH), an estimated 881,000 people aged 12 to 17 in 2016 were current misusers of pain relievers, which represents 3.5 percent; in addition. There were 2,454,000 people aged 18 to 25, were current misusers of pain relievers, which represents 7.1 percent of the young adult, a 3,6 percent more than the first age group, and 3,2 percent more that other age groups. [5]

Which means that young adults (between 18 and 25 years of age) are the most consumed pain relievers like tramadol, in 2016.

So, as you can see, if you are facing a problem…you are not the only one with a pain reliever problem…

Don’t become a statistic!

Reach out for help to a trusted friend, family member, or drug hotline. You can call us on the phone number listed on this page. Or, send us a comment in the section below.

Dependence vs. Addiction

The Drug Enforcement Administration (DEA) permanently moved to tramadol to Annex IV of the Controlled Substances Act in 2014, because of its potential for abuse and dependence. A study in the United States reported that the abuse of tramadol was one in one hundred thousand people. At first, it was assumed that the risk of dependence on tramadol was very low, but after its extensive use to relieve chronic pain and also in cases of drug abuse…patterns of misuse began to emerge. [6]

The terms dependence and addiction are used, in many cases, interchangeably, however they do not mean the same, and undoubtedly represent two different processes.

Dependence is a condition caused by the chronic use of a tolerance-forming drug, in which abrupt or gradual abstinence from the drug causes unpleasant physical and psychological symptoms.

Addiction, according to the American Society of Addiction Medicine (ASAM), is characterized by the inability to consistently abstain from a substance, the deterioration in control of behavior and anxiety, the decrease in recognition of significant problems with behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. [7]

In other words, the drug necessarily creates dependence, but not addiction. If the person is dependent, it does not mean that is addicted; addiction is about intention of use.

Your Questions

Still have questions about tramadol withdrawal or tramadol withdrawal treatment? Please ask us now. In the comment section, you are invited to ask questions you would like to have answered. We will get back to you as soon as possible.

Reference Sources: [1] FDA: Label: Tramadol
[2] CDC: Pocket Guide: Tapering Opioids For Chronic Pain
[3] DSM LIBRARY: Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition
[4] BUSINESS INSURANCE: DEA Reclassifies Painkiller Tramadol As A Controlled Substance
[5] SAMHSA: Key Substance Use And Mental Health Indicators In The United States: Results From The 2016 National Survey On Drug Use And Health
[6] DEA: The Controlled Substances Act
[7] ASAM: Definition Of Addiction
AJP: Abuse, Dependence, Or Withdrawal Associated With Tramadol
DEA: Tramadol
FDA: Ultram
MEDLINE PLUS: Opiate And Opioid Withdrawal
NCBI: Psychosis Following Tramadol Withdrawal
NCBI: Tramadol
PSNET: Dependence Vs. Pain
PUBCHEM: Tramadol
SAMHSA: Emergency Department Visits For Drug Misuse Or Abuse Involving The Pain Medication Tramadol
SAMHSA: Results From The 2016 National Survey On Drug Use And Health: Detailed Tables
TOXNET: Tramadol
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
Medical Reviewers
Dr. Dili Gonzalez, M.D. is a general surgeon practicing women's focused medici...
Dr. Goecke is a medical doctor and general surgeon with personal experience of...

All of the information on this page has been reviewed and verified by a licensed medical professional.

I am ready to call
i Who Answers?