Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Tramadol is often thought of as a milder pain reliever, and many people are surprised to learn it is an opioid. It is prescribed for moderate to severe pain and sold under brand names such as Ultram and, combined with acetaminophen, Ultracet. Because it is sometimes seen as a lower-risk option, people may take it for long periods without realizing how much their bodies have come to depend on it.
This article explains how tramadol works, why its withdrawal can look different from other opioids, the risks to be aware of and how to stop more safely. If tramadol was prescribed for you, please talk with your prescriber before stopping or changing how you take it.
How Tramadol Works
Tramadol has two main actions. It acts on opioid receptors, like other opioid pain medications. It also affects serotonin and norepinephrine, two brain chemicals involved in mood and pain signaling. That second action is similar to the way some antidepressants work.
The Drug Enforcement Administration classifies tramadol as a controlled substance because it can be misused and can lead to dependence and addiction. The U.S. Food and Drug Administration requires tramadol labeling to warn about addiction, misuse, breathing problems and dangerous interactions with other medications.
Signs Tramadol Use Has Become a Problem
Physical dependence can develop with prescribed use, and it is not the same as addiction. Our article on what opioid dependence is explains the difference. Still, some patterns suggest it is time for an honest conversation with a provider:
- Taking extra doses for stress, sleep or mood rather than pain
- Running out before a refill is due
- Getting tramadol from more than one prescriber or from other people
- Feeling sick or anxious when a dose is late
- Continuing to use it after the pain it was prescribed for has improved
Why Tramadol Withdrawal Can Be Unusual
Because tramadol affects both opioid receptors and serotonin and norepinephrine, withdrawal can include two types of symptoms.
Typical opioid withdrawal symptoms
- Muscle aches and restlessness
- Sweating, chills and goosebumps
- Runny nose, watery eyes and yawning
- Nausea, vomiting, diarrhea and stomach cramps
- Trouble sleeping
- Anxiety and irritability
- Cravings
Less typical symptoms some people experience
- Severe anxiety or panic attacks
- Confusion or trouble thinking clearly
- Feelings of paranoia
- Hallucinations
- Numbness, tingling or unusual sensations in the skin
- A sense of unreality or detachment
- Low mood or depression
Not everyone experiences the less typical symptoms, but knowing they are possible can help you recognize them and ask for help rather than feeling frightened or confused.
A General Look at the Timeline
Tramadol withdrawal often follows a pattern similar to other opioids: early symptoms such as restlessness, anxiety and aches, followed by a period when physical symptoms peak, then gradual improvement. The less typical symptoms, when they occur, may appear alongside the physical ones or linger afterward.
Timing depends on whether you were taking an immediate-release or extended-release form, how long you took it, the amount and your overall health. These are general patterns, not a day-by-day forecast.
Risks to Take Seriously
Seizures. Tramadol itself can lower the seizure threshold, particularly at higher amounts or when combined with certain other medications. Anyone with a seizure history should be especially careful and closely supervised.
Serotonin syndrome. Taking tramadol with antidepressants or other medications that affect serotonin can cause serotonin syndrome, which may include agitation, confusion, fever, sweating, rapid heartbeat, muscle stiffness or twitching. This is a medical emergency.
Breathing problems. Combining tramadol with alcohol, benzodiazepines or other sedatives can dangerously slow breathing. Withdrawal from alcohol and benzodiazepines can also be life-threatening, so do not stop those abruptly without medical guidance either.
Mood changes. Because tramadol affects mood chemicals, stopping it may bring on depression or anxiety. If you have thoughts of suicide, call or text 988.
Call 911 for a seizure, signs of serotonin syndrome, slowed breathing, severe confusion or chest pain.
Why a Supervised Taper Makes Sense
Stopping tramadol suddenly can bring on both the typical and less typical withdrawal symptoms at once. A gradual taper planned with a medical provider gives the brain time to adjust. If you have been taking more than prescribed, using tramadol with other substances or getting it from non-medical sources, a supervised detox setting may be safer than an outpatient taper.
It also helps to bring a full list of your medications to any appointment, including antidepressants, sleep aids and over-the-counter products, so your provider can check for interactions.
Treatment at Promises Dallas-Fort Worth
Our opioid detox in Lewisville provides medically supervised withdrawal management, with medication-assisted treatment used during detox when clinically appropriate. The care team watches for both physical and emotional symptoms and adjusts care as needed.
After detox, our prescription drug addiction treatment helps people whose use began with a prescription understand how dependence developed and learn new ways to manage pain and stress. For those with a more established pattern of opioid use, our opioid addiction treatment program offers a fuller continuum of care, from residential treatment to virtual IOP and aftercare planning.
Frequently Asked Questions
Is tramadol really an opioid?
Yes. Tramadol acts on opioid receptors and can cause dependence, addiction and withdrawal, even though it also affects other brain chemicals.
Why do I feel anxious and strange while stopping tramadol?
Tramadol affects serotonin and norepinephrine, so some people experience anxiety, unusual sensations or feelings of unreality during withdrawal. Tell your provider about these symptoms.
Can I stop tramadol if I take an antidepressant?
Talk with your prescribers first. They can coordinate a plan that accounts for both medications.
Get Support to Stop Tramadol Safely
If tramadol has become harder to stop than you expected, you are not alone, and help is available. Our admissions team is available 24/7, and same-day admission is often possible when a bed is available.
We offer free, confidential insurance verification. See our insurance options, call (469) 546-9303, or contact us online.