Medical Reviewer

Tramadol Withdrawal Symptoms, Timeline, and Treatment

Last Medical Review On: July 18, 2024
Updated On: June 15, 2024
5 min read
Written by:

Amanda Stevens, B.S.

Medical Review by:

Dr. Po-Chang Hsu, M.D., M.S.

Tramadol is a synthetic opioid medication prescribed to alleviate pain.[1] While effective for relief, tramadol also carries a potential for abuse and dependence, as its opioid properties can lead to euphoria and a sense of relaxation.

Tramadol withdrawal, like that of other opioids, can pose significant challenges to those who have developed a dependence.[2] When abruptly discontinued or reduced in dosage, you may experience a range of withdrawal symptoms, and managing the withdrawal process requires careful medical supervision and support to mitigate symptoms to promote a safe transition toward recovery.

Tramadol Withdrawal
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    How Does Tramadol Work?

    Tramadol, a synthetic opioid pain reliever, works by binding to opioid receptors in the brain, where it acts as a weak agonist.[3] This means that it activates the same receptors as other opioids, such as morphine or codeine, but to a lesser extent than more powerful medications or illicit drugs.

    Additionally, tramadol inhibits serotonin and norepinephrine reuptake in the brain, enhancing their effects. These dual mechanisms of action contribute to tramadol’s properties, effectively relieving moderate to moderately severe pain.

    What is Tramadol Withdrawal Like?

    Experiencing tramadol withdrawal can be an extremely uncomfortable process, often requiring medical assistance to manage symptoms effectively. The severity and duration of tramadol withdrawal can vary depending on factors such as the dosage and duration of use, individual physiology, and prior experiences with opioid withdrawal.

    Typically, withdrawal symptoms begin within a few hours to a day after the last dose and may include physical discomfort such as muscle aches, nausea, vomiting, and diarrhea, as well as psychological distress like anxiety, insomnia, and irritability.[4] In severe cases, individuals may experience intense cravings for tramadol, along with symptoms like sweating, chills, and tremors, all of which significantly impact daily functioning and well-being.

    Tramadol Withdrawal Symptoms

    Tramadol withdrawal symptoms can manifest with varying intensity and duration, comprising a spectrum of physical and psychological effects:[5]

    • Flu-like symptoms: Individuals undergoing tramadol withdrawal may experience symptoms akin to a severe cold or flu, such as body aches, chills, and fever.
    • Gastrointestinal discomfort: Nausea, vomiting, diarrhea, and abdominal cramping are common gastrointestinal symptoms of tramadol withdrawal.
    • Anxiety and irritability: Feelings of anxiety, restlessness, irritability, and agitation are prevalent during tramadol withdrawal.
    • Insomnia: Difficulty falling or staying asleep may occur, leading to disrupted sleep patterns and fatigue.
    • Muscle discomfort: Generalized muscle aches and pains are frequently reported during tramadol withdrawal, contributing to overall discomfort.
    • Sweating: Profuse sweating, accompanied by hot flashes or cold sweats, can occur as the body adjusts to the absence of tramadol.
    • Pupil changes: Pupil dilation or constriction may occur as a physiological response during tramadol withdrawal.
    • Cravings: Intense cravings for opioids, including tramadol, may emerge as the body yearns for the substance it has become dependent on.
    • Mood fluctuations: Mood swings ranging from depression and sadness to irritability and agitation are common features of tramadol withdrawal.
    • Fatigue: Feelings of exhaustion, lethargy, and decreased energy levels are prevalent throughout tramadol withdrawal.

    Tramadol Withdrawal Timeline

    The withdrawal timeline for tramadol can vary depending on several factors, including the dosage you’ve been taking, how long you’ve been using the medication, and your physiology:[6]

    • Early withdrawal (12 to 24 hours): Symptoms of tramadol withdrawal often commence within 12 to 24 hours after the last dose. Early withdrawal symptoms may include mild anxiety, muscle aches, sweating, yawning, and cravings for opioids.
    • Peak withdrawal (1-3 days): The peak of tramadol withdrawal symptoms usually occurs within the first one to three days. During this period, individuals may experience intensified symptoms such as nausea, vomiting, diarrhea, abdominal cramps, dilated pupils, insomnia, restlessness, irritability, and heightened cravings for opioids.
    • Subacute withdrawal (1 week): Following the initial peak, withdrawal symptoms gradually diminish over the first week. However, some individuals may continue to experience lingering symptoms such as fatigue, mood swings, anxiety, and depression.
    • Post-acute withdrawal (Beyond 1 week): In certain instances, individuals may encounter a protracted withdrawal syndrome characterized by persistent symptoms lasting beyond the first month. These symptoms may include insomnia, anxiety, depression, irritability, fatigue, and cravings for opioids. Post-acute withdrawal syndrome (PAWS) can persist for weeks, months, or even longer in some cases.

    Post Acute Withdrawal Syndrome for Tramadol

    PAWS can manifest after the acute phase of tramadol withdrawal has passed, presenting a prolonged set of symptoms that may persist for weeks or months beyond the initial withdrawal period.[7] While the acute withdrawal symptoms of tramadol typically peak within the first few days after cessation, PAWS can bring about a continuation or recurrence of certain symptoms in a milder form.

    Effectively managing post-acute withdrawal syndrome often requires a comprehensive approach involving medical intervention, therapy, lifestyle modifications, and ongoing support from healthcare professionals. Adopting healthy lifestyle practices, such as regular physical activity, balanced nutrition, and stress management techniques, can help you navigate the challenges of PAWS and sustain your recovery.

    Types of Drug Withdrawal Treatment

    If you or someone you love is struggling with opioid addiction (or any other substance use disorder), seeking treatment is an important step toward healing. Alpas is committed to providing comprehensive care throughout the recovery journey, with services tailored to meet your unique needs:

    • Medical Detox: Medically managed detoxification, also known as medically supervised withdrawal or detox, plays a crucial role in the treatment of opioid withdrawal, especially for individuals with moderate to severe opioid dependence. This level of care involves a supervised process designed to safely manage the discontinuation of opioids from the body while effectively managing withdrawal symptoms and addressing any potential complications that may arise.
    • Medically Managed Care: Medically managed care, often referred to as medically supervised care, is an essential aspect of tramadol withdrawal treatment, particularly for individuals with moderate to severe dependence on the medication. This level of care provides comprehensive medical oversight and intervention to ensure the safety and well-being of the individual throughout the withdrawal process.
    • Inpatient Treatment: Inpatient treatment, also known as residential treatment, provides a comprehensive level of care for individuals struggling with opioid dependence, especially those with severe addiction or co-occurring mental health disorders. Within a specialized facility, individuals reside and receive round-the-clock medical and therapeutic support in a structured environment.

    How Tramadol Withdrawal Treatment Works

    Tramadol withdrawal treatment typically employs a comprehensive approach aimed at managing withdrawal symptoms, addressing underlying factors contributing to tramadol dependence, and laying the groundwork for sustained recovery.[9] The process usually begins with a thorough assessment conducted by healthcare professionals to determine the most suitable level of care based on your medical history, the severity of your tramadol dependence, and assessing for potential withdrawal symptoms.

    After the initial assessment, those requiring medical supervision to navigate withdrawal symptoms safely may undergo medical detoxification. Medications may be administered to alleviate symptoms and ensure a safe transition from tramadol dependence. From there, most will progress to more intensive levels of care once stabilized, such as residential or inpatient treatment programs, where you’ll receive comprehensive therapy, counseling, and support to address the psychological, social, and behavioral aspects of tramadol dependence.

    As you achieve further stability and progress in your recovery journey, you may transition to lower levels of care, such as outpatient treatment or participation in support groups. This stepwise approach allows you to access appropriate care at each stage of your recovery, promoting long-term success in overcoming tramadol dependence and setting the stage for long-term sobriety.

    Medications Used for Tramadol Withdrawal

    Various medications can be employed to manage withdrawal symptoms associated with tramadol dependence and facilitate a smoother detoxification process:[8]

    • Clonidine: Clonidine can help alleviate symptoms such as agitation, anxiety, elevated blood pressure, and rapid heartbeat during opioid withdrawal, including tramadol.
    • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs like ibuprofen or acetaminophen can be used to address physical discomfort such as muscle aches, joint pain, and headaches associated with tramadol withdrawal.
    • Antiemetics: Antiemetic medications such as ondansetron (Zofran) may be administered to manage nausea and vomiting, common symptoms during tramadol withdrawal.
    • Sleep aids: Certain medications, including sedative-hypnotics like zolpidem (Ambien) or trazodone (Desyrel), may be prescribed to promote sleep and alleviate insomnia, which can occur during tramadol withdrawal. These medications can help improve sleep quality and duration, restoring normal sleep patterns.

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    What’s the Best Way to Find Tramadol Withdrawal Treatment?

    The best way to find tramadol withdrawal treatment is to start by consulting with healthcare professionals, such as your primary care physician. They can conduct assessments to determine the most appropriate level of care based on your individual needs and the severity of your opioid dependence. Additionally, seek support from family and friends, as their encouragement and assistance can be invaluable in embarking on recovery.

    Do your research to identify programs that offer evidence-based treatments and comprehensive care. Look for treatment modalities that integrate medical interventions, behavioral therapies, and holistic approaches to address the multifaceted nature of opioid dependence. Various resources are available to assist in finding treatment referrals as well, including:

    Cost of Drug Withdrawal Treatment

    The cost of drug withdrawal treatment is always an important consideration—but don’t let it get in the way of accessing care. There are several avenues to seek assistance, including your insurance plan and sliding scale options.

    Additionally, many treatment facilities offer financial aid programs or flexible payment arrangements to accommodate individuals with financial constraints. While the cost of drug withdrawal treatment can vary depending on factors such as the type of facility and level of care needed, prioritizing access to care is paramount for achieving long-term recovery.

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    Frequently Asked Questions about Tramadol Withdrawal Treatment


    How do I cope with cravings during tramadol withdrawal?


    Coping with cravings during tramadol withdrawal can be challenging but manageable. Techniques such as mindfulness, distraction, and relaxation exercises can help redirect your focus away from cravings. Additionally, staying connected with your support network, engaging in healthy activities, and adhering to your treatment plan can strengthen your resolve to resist cravings and maintain sobriety.


    How do I know if I need inpatient or outpatient treatment for tramadol withdrawal?


    The decision between inpatient and outpatient treatment for tramadol withdrawal depends on factors such as the severity of your dependence, the presence of co-occurring disorders, and your support network. Inpatient treatment provides round-the-clock care in a structured environment, ideal for those with severe addiction or significant medical or psychological issues. Outpatient treatment offers flexibility and allows you to attend therapy sessions while living at home, suitable for individuals with milder dependence and strong social support.


    What steps can I take to prevent relapse after completing tramadol withdrawal treatment?


    Preventing relapse after completing tramadol withdrawal treatment involves developing coping strategies, maintaining a healthy lifestyle, and staying connected with your support system. This may include attending support groups, therapy sessions, or continuing medication-assisted treatment as your healthcare provider recommends. Identifying triggers and implementing relapse prevention techniques, such as avoiding high-risk situations and practicing stress management, can help you stay focused on your recovery goals.


    [1] Dhesi, M., & Maani, C. V. (2023, April 16). Tramadol. PubMed; StatPearls Publishing. on April 10, 2024

    [2] Sidana, A., Domun, I., & Arora, P. (2019). Tramadol withdrawal psychosis. Indian Journal of Psychiatry, 61(6), 655. on April 10, 2024

    [3] Tramadol (Oral Route) Description and Brand Names – Mayo Clinic. (n.d.). on April 10, 2024

    [4] Rajabizadeh, G., Kheradmand, A., & Nasirian, M. (2009). Psychosis following Tramadol Withdrawal. Addiction & Health, 1(1), 58–61. on April 10, 2024

    [5] Opiate and opioid withdrawal: MedlinePlus Medical Encyclopedia. (2016). on April 10, 2024

    [6] World Health Organization. (2019). Withdrawal Management.; World Health Organization. on April 10, 2024

    [7] Haskell, B. (2022). Identification and Evidence-Based Treatment of Post–Acute Withdrawal Syndrome. The Journal for Nurse Practitioners, 18(3), 272–275. on April 10, 2024

    [8] Sidana, A., Domun, I., & Arora, P. (2019). Tramadol withdrawal psychosis. Indian Journal of Psychiatry, 61(6), 655. on April 10, 2024

    [9] Mukau, L., Wormley, K., Tomaszewski, C., Ahmad, B., Vohra, R., & Herring, A. (2022). Buprenorphine for High-dose Tramadol Dependence: A Case Report of Successful Outpatient Treatment. Clinical Practice and Cases in Emergency Medicine, 6(1), 83–86. on April 10, 2024

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