Tramadol Withdrawal Timeline & Symptoms

Some 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.

Hallucinations

Paranoia

Extreme anxiety

Panic attacks

Confusion

Suicidal thoughts or behaviors

Numbness or tingling in fingers and/or toes

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.

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.

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.

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 a “pins-and-needles” sensation, sweating, nervousness/anxiety, nausea, palpitations, insomnia, and cravings for more tramadol.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Medical 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 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.

Undertaking 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.

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