A schedule IV controlled substance according to the DEA, if you develop a dependence to tramadol, you’re highly likely to experience tramadol withdrawal if you discontinue use.
With over 44 million prescriptions for tramadol in 2013 at the height of the opioid epidemic, this lesser-known opioid needs highlighting for its strong abuse potential.
Before we look into what happens if you stop taking tramadol, what is this painkiller exactly?
What Is Tramadol?
Tramadol is a centrally-acting opioid analgesic that’s used to treat moderate to severe pain.
Available in tablet form, tramadol comes in both an immediate-release and extended-release form. Immediate-release tablets are normally sold under the brand name Ultram while extended-release painkillers are branded Conzip.
Both of these formulations are available as generics and they come in a variety of strengths.
Since tramadol is a controlled substance – that’s down to the opioid content – it cannot be bought over-the-counter and you should use it only under your doctor’s close supervision.
Unfortunately, when tramadol is used long-term, mental and physical dependence can develop. This is what we’ll be examining in more depth today.
Why is it prescribed in the first place, then?
Why Is Tramadol Used?
Tramadol is used for moderate to severe pain.
These painkillers can also be used for combination therapy. This means you’ll take tramadol with other medications but this is where part of the problem lies.
When used with other drugs, the effects of tramadol can be magnified. We’ll look at some of these contraindications below.
Tramadol acts rather differently to traditional opioids like hydrocodone and oxycodone. How does it work and how does taking a simple painkiller lead to potential dependence?
How Does It Work?
Tramadol is classified as an opioid agonist.
This medication works by altering the way in which your brain senses pain. Tramadol mimics endorphins in your brain. When endorphins bind to receptors – receiving cells – these receptors will send your brain reduced pain messages. Tramadol’s mechanism here is similar to the way endorphins work and responsible for you feeling less pain.
As well as acting on these opioid receptors, tramadol also works on the central nervous system and monoamine reuptake systems so you’ll feel calm and more relaxed.
Unfortunately, if you continue using tramadol for pain relief, you can end up altering the structures and pathways of your brain. Tolerance can quite rapidly build so you’ll need more tablets to achieve the same effect.
So, tramadol harnesses two mechanisms. Not only does the medication stimulate opioid receptors in your brain, it will also inhibit the reuptake of serotonin and norepinephrine. This can render you subject to two forms of opioid withdrawal, traditional and atypical.
While initially marketed as having very low potential for abuse, this simply isn’t the case.
Potential For Abuse
The FDA places a warning on the labels and information concerning Ultram, a commonly-prescribed painkiller containing tramadol as an active ingredient.
This drug is noted as having the potential to create both tolerance and dependence. Unfortunately, dependence can occur even if you use the drug as prescribed.
Tolerance and dependence are both more likely to occur when tramadol is abused.
According to the 2012 NSDUH (National Survey on Drug Use and Health), 3.2 million Americans had taken tramadol for nonmedical purposes at some point. If you’ve got any history of substance abuse or addiction, you’re more likely to fall foul of tramadol. That said, the World Health Organization and the FDA both state that tramadol can induce dependence when used long-term with a genuine prescription.
Before we explore some of the many side effects you can experience from taking tramadol, there are also a number of more general warnings concerning the drug.
Boxed warnings are the most serious warning issued from the US Food and Drug Administration. These warnings are intended to alert you and doctors to the fact the effects of the drug could be dangerous.
What’s the deal with tramadol, then?
The boxed warnings include the following:
- Accidental ingestion warning: The drug can be fatal if swallowed accidentally, especially by children
- Addiction and misuse warning: Taking tramadol can lead to tolerance, dependence and overdose
- Slowed/stopped breathing warning: During the first three days taking tramadol or when dosage is increased, breathing can slow or stop to the point of death
- Neonatal opioid withdrawal syndrome warning: Using tramadol long-term while pregnant can cause tramadol withdrawal in your baby. This can be fatal
- Interactions with other drugs warning: Taking tramadol with some drugs can bring about serious side effects. Tramadol levels can be increased resulting in seizures and serotonin syndrome. These drugs include amiodarone, erythromycin, ketoconazole, quinidine and ritonavir. Tramadol also interacts with benzodiazepines causing extremely serious effects up to coma and death
This drug comes with an assortment of other warnings:
- Alcohol interaction
- Breastfeeding women
- Patients with addiction issues
- Patients with breathing problems
- Patients with head injuries
- Patients with kidney problems
- Patients with liver problems
- Patients with mental health problems
- Patients with stomach problems
- Pregnant women
Sadly, tramadol carries the risk of a broad array of side effects. These occur more frequently when you first start taking the medication and side effects are likely to subside over time.
The most common side effects include nausea, dizziness and crushing headaches.
Common Side Effects
5% or more of people taking tramadol experience some of the following common side effects:
- Dry mouth
- Stimulation of the central nervous system
Less Common Side Effects
There’s another batch of side effects listed that impact fewer than 5% of people taking tramadol such as:
- Allergic reactions
- Constricted pupils
- Dip in blood pressure when standing up
- Disturbed coordination
- Difficulty breathing
- Menopausal symptoms
- Rapid heartbeat
- Retention of urine or frequent urination
- Serotonin syndrome
- Suicidal tendencies
- Visual disturbance
- Weight loss
- Whole body discomfort
Serious Side Effects
In a minority of cases, using tramadol can result in serious side effects including:
- QT Prolongation (heart rhythm problems)
- Respiratory Depression
- Serotonin Syndrome
This is a serious condition influencing the heart rhythm.
The QT interval is a part of the heartbeat’s electrical activity. Tramadol can cause this interval to increase leading to a potentially life-threatening irregular heartbeat.
If you experience any difficulty breathing while you’re taking tramadol, you should seek emergency medical assistance.
Even with normal doses of tramadol, respiratory depression can occur. This normally happens when you first start taking tramadol or if you increase your dosage.
Using tramadol along with other drugs increases your risk of respiratory depression.
If too much serotonin accumulates in your body, you’re at risk of serotonin syndrome. This condition can be fatal.
As you can see, using tramadol to relieve pain can actually introduce a world of other unassociated pain.
What happens in the event of tramadol withdrawal, though?
Your brain becomes accustomed to the effects of tramadol and adjusts itself chemically to make allowance for the constant presence of the drug.
When this drug is discontinued, your brain tries to self-regulate by slowing down or speeding up certain processes.
Withdrawal symptoms can ensue lasting up to 14 days. These symptoms can be to some extent mitigated if you taper off the drug slowly rather than stopping abruptly.
Common tramadol withdrawal symptoms include:
- Abdominal cramps
- Blurred vision
- Loss of appetite
- Mood swings
- Muscle pain
- Nausea and vomiting
- Tingling sensations
As mentioned earlier, tramadol has two mechanisms so you’ll be exposed to two possible sets of side effects, traditional opioid withdrawal and atypical opioid withdrawal.
Traditional opioid withdrawal symptoms include:
- Body pains
- Gastrointestinal pain
- Muscle aches
Atypical opioid withdrawal syndrome symptoms include:
- Confusion and disorientation
- High anxiety and panic attacks
- Intense paranoia
- Unusual sensory experiences
Due to the severity of some symptoms, it can be beneficial to consider a medically-assisted detox.
How long can you expect withdrawal to last?
Tramadol Withdrawal Timeline
If you discontinue or drastically reduce use of tramadol, withdrawal symptoms usually kick in after a few hours.
These symptoms last from 5 to 14 days but they can continue for weeks. This depends to some extent on how long you’ve been using tramadol, the dosage and the frequency.
Here’s an idea of what to expect and when:
- Days 1-3: Onset of general tramadol withdrawal symptoms. Expect pins and needles, excessive sweating, agitation and nervousness, nausea, insomnia and palpitations. You can also expect serious cravings
- Days 4-7: Cravings continue as does insomnia. You’ll probably feel confused and disoriented
- Days 8-14: Symptoms should now be mild. You might feel depressed, anxious and start having irrational thoughts. This is normal
Detoxing From Tramadol
Tramadol detox can range from mild to severe according to the extent of usage and any other drugs used alongside.
Even though tramadol might seem a benign medication, withdrawal can be extremely uncomfortable. You should strongly consider medical detox. At minimum you should involve your doctor and detox under his direct supervision.
If you’re planning to discontinue use of tramadol, you should step down your dosage over a period of weeks and taper off gradually. If you adopt this tapering method, you should not experience withdrawal symptoms after 7 days.
Beyond that point, PAWS (post-acute withdrawal symptoms) can last up to 2 years. These symptoms include anxiety, mood swings, depression and insomnia.
Now you’ve seen what can happen if you stop taking tramadol, what can you do if you feel you need to get help?
What To Do Next
Here at Landmark Recovery, we can help you with a range of treatment programs to ease you off tramadol or other opioids. Whether you need residential treatment or a straight medical detox, we can advise you based on the severity of your problem.
Recovery from opioid use, even if you’ve developed a severe problem, is perfectly possible and we’re here to make it easy for you.
Get in touch with our friendly team today and we’ll make sure you don’t need to deal with tramadol withdrawal alone.