Tramadol Withdrawal

tramadol withdrawal

Tramadol is an opioid painkiller prescribed to treat both acute and chronic pain, ranging from moderate to moderately severe. Like other prescription opioids, tramadol has a high risk of diversion, misuse, dependence, and addiction. If you are dependent on tramadol, you’ll experience unpleasant withdrawal symptoms when you attempt to quit. The duration of tramadol withdrawal symptoms will depend on which formulation you’re using or misusing. Fortunately, professional detox services are available to help manage your symptoms and cravings and keep you comfortable throughout the process.

Tramadol Withdrawal Symptoms

When you suddenly quit using or misusing tramadol, you may experience painful withdrawal symptoms that are extremely difficult to endure. Common tramadol withdrawal symptoms include:1,2

  • Nervousness
  • Panic attacks
  • Sleep problems
  • Excessive sweating
  • Fever
  • Runny nose
  • Watery eyes
  • Cough
  • Muscle or bone pain
  • Goosebumps
  • Chills
  • Dilated pupils
  • Sensitivity to light
  • Nausea and vomiting
  • Diarrhea
  • Uncontrollable shaking
  • Rapid heartbeat
  • Increased blood pressure
  • Excessive yawning
  • Hallucinations

Tramadol withdrawal syndrome can be so distressing that you may return to tramadol or opioid use in an effort to alleviate these symptoms. The cycle of withdrawal and relapse contributes to the progression of a tramadol addiction, as you find that you’re unable to control your use.

Withdrawal Timeline

Your tramadol withdrawal timeline will vary depending on whether you’re taking a short-acting tramadol formulation or extended-release. These drugs have different half-lives, or the time it takes for the amount of tramadol in your system to be reduced by 50%. The speed of onset and severity of tramadol withdrawal symptoms depends on its half-life.3

There are several short-acting versions of tramadol, including tablets, capsules, and drops. You tend to feel the effects soon after using this opioid and the effects last between 4 and 6 hours. If you misuse or use an immediate-release tramadol formulation, your withdrawal timeline may resemble below:3

  • Tramadol withdrawal symptoms emerge within 6-12 hours after last using it.
  • Symptoms peak within 1-3 days.
  • Symptoms gradually resolve within 5-7 days.

On the other hand, the effects of a long-acting tramadol drug may last up to 12 hours, which means the onset of withdrawal will be delayed compared to the immediate-release.3 The timeline for withdrawal from long-acting tramadol may include:4

  • Tramadol withdrawal symptoms emerge within 12-48 hours after last using it.
  • Symptoms gradually dissipate within 10-20 days.

Is Tramadol Withdrawal Dangerous?

Typically, tramadol withdrawal symptoms are not fatal, although they can be incredibly severe, so much so that you require medical detox in a hospital to manage the symptoms.

However, tramadol withdrawal is not without risks—some of the symptoms can lead to serious complications, such as:5

  • Excessive diarrhea and vomiting can cause electrolyte imbalance and dehydration.
  • Vomiting and inhaling stomach contents into lungs can cause a lung infection.

Another potential hazard of opioid withdrawal is depression and associated suicidal thoughts or ideation. This concern is two-fold:2

  • Many people misuse or abuse tramadol to self-medicate their pre-existing depression
  • Tramadol withdrawal causes profound depression in some people

If you are struggling with depression while withdrawing from tramadol, it’s important to seek medical attention immediately.

Overdose Risk After Withdrawal

Lastly, one of the most severe dangers associated with tramadol withdrawal is the risk of relapsing and overdosing after completing tramadol detox or withdrawing on your own.

When you go through tramadol withdrawal, your tolerance decreases significantly, which means you now need a lower amount of tramadol to feel the desired effects, such as euphoria, relaxation, or pain relief. After withdrawing, if you relapse and begin using the same dose of tramadol you were previously taking, you may run the risk of overdosing.

In fact, the majority of opioid overdose deaths occur after a period of opioid withdrawal.5

Why Does Tramadol Withdrawal Happen?

Tramadol withdrawal syndrome occurs when you develop a physiological dependence on this opioid painkiller—and dependence is a result of chronic tramadol use or misuse.

Long-term tramadol use causes changes in the brain’s function and structure called neuroadaptations—opioid receptors, neurons, and neurotransmitters adapt to the presence of tramadol. These neuroadaptations make it so the brain functions normally when tramadol is present and abnormally when it’s not.6

Specifically, the area of the brain that opioid dependence affects is the locus ceruleus. Neurons in the locus ceruleus product noradrenaline and circulate it throughout the rest of the brain. It’s responsible for blood pressure and breathing regulation, as well as alertness and wakefulness. When tramadol activates the receptors on these particular brain cells, it prevents the release of noradrenaline, which causes some of the tramadol side effects, such as drowsiness and slowed breathing.6

Over time, the neurons in the locus ceruleus adapt by increasing the amount of noradrenaline so that when you use tramadol, you feel more or less normal. However, when you abruptly stop taking tramadol, the opioid isn’t there to suppress the increased noradrenaline, which results in excessive amounts of this neurotransmitter. Those incredibly high levels result in tramadol withdrawal symptoms like anxiety, jitters, diarrhea, and muscle cramps.6

Detox Programs: Tramadol Withdrawal Treatment

Although tramadol withdrawal can be extremely tasking, both physically and mentally, the good news is professional support is available. Tramadol detox programs can provide you with a myriad of interventions designed to keep you safe and comfortable throughout withdrawal, with the goal of achieving a medically stable, drug-free state.

Below are the different settings for tramadol detox:7

  • Ambulatory detox without extended onsite monitoring: The least intensive outpatient option, you withdraw from tramadol under the guidance of a doctor. This option is recommended only for someone who has been taking tramadol for medical reasons and wants to taper off.
  • Ambulatory detox with extended onsite monitoring: A more structured outpatient option, you attend appointments at a hospital during the way and then return home in the evening.
  • Clinically managed residential detox: The least intensive inpatient detox option, this is also commonly known as “social detox,” in which you receive around-the-clock support but no medical care.
  • Medically monitored inpatient detox: This form of medical detox occurs in a freestanding detox facility and provides you with medical oversight and care.
  • Medically managed inpatient detox: The most structured and intensive option, this type of detox program involves staying at a medical facility or hospital. You receive 24/7 medical supervision and care. This option is best for someone who has a co-occurring psychiatric condition or medical condition.

If you are looking for a tramadol detox program, we can help. Give us a call at 1-800-429-7690 to speak to a treatment support specialist about your detox options.

Medications for Tramadol Withdrawal

When you attend a tramadol detox program, you will likely receive tramadol withdrawal medications that can mitigate your symptoms and reduce your cravings. These FDA-approved opioid withdrawal medications include:2

  • Buprenorphine: A partial opioid agonist that reduces tramadol withdrawal and alleviates opioid cravings without getting you high; it also has a very low overdose risk due to its ceiling effect
  • Methadone: A full opioid agonist that also mitigates symptoms and cravings without producing euphoria

Your medical team may also use medications to address individual withdrawal symptoms. These may include:2

  • Promethazine: Helps manage nausea and vomiting
  • Clonidine: Helps lower your blood pressure
  • Loperamide: Helps treat diarrhea

Attending Addiction Treatment After Detox

Detox is not a replacement for formal addiction treatment services; rather, it is the first step on the recovery journey. Tramadol detox doesn’t address the underlying issues that led to your tramadol abuse in the first place. Once you’ve detoxed from tramadol, you will want to consider transitioning into a tramadol addiction treatment program—the two main settings are inpatient and outpatient.

These programs offer a combination of therapeutic services, such as:

  • Psychotherapy, such as cognitive-behavioral therapy (CBT) or dialectical behavioral therapy (DBT)
  • Group counseling
  • Family therapy
  • Relapse-prevention classes
  • 12-step or non-12-step support meetings
  • Aftercare planning

Frequently Asked Questions About Tramadol Withdrawal

Does Tramadol Need to be Tapered Off?

Yes, if a doctor has prescribed you tramadol for pain and you’ve developed a dependence, they will need to create a gradual tapering schedule for you to wean off the medication. The tapering schedule prevents the sudden emergence of unwanted tramadol withdrawal symptoms.

How Long Does Tramadol Withdrawal Last?

Withdrawal from a short-acting tramadol formulation lasts about 5-7 days, whereas withdrawal from a long-acting tramadol drug lasts about 10-20 days.3,4

Is it Hard to Get Off Tramadol?

Going through tramadol withdrawal on your own can be painful and distressing and may lead to relapse. It’s always better to seek professional detox treatment so your withdrawal can be managed by a medical team.

Will Tramadol Help with Opiate Withdrawal?

Because tramadol is an opioid medication, it will help ease the symptoms of withdrawal from another opiate like heroin or fentanyl. However, you should never self-medicate your opiate withdrawal at home without medical supervision. If you want help quitting an opiate, seek out a medical detox program by calling 1-800-429-7690.

Tramadol Withdrawal Resources

  1. U.S. National Library of Medicine. (2020). Tramadol.
  2. Shah M, Huecker MR. Opioid Withdrawal. [Updated 2021 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. 
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  4. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management. 
  5. U.S. National Library of Medicine. (2020). Opiate and opioid withdrawal.
  6. Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatmentScience & practice perspectives1(1), 13–20.
  7. Center for substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45). 2 Settings, Levels of Care, and Patient Placement.


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