lady Jayne asked
I have been taking tramadol for about 10 years. Dr. has been trying to increase my dose to 6 per day. I do not want to continue with the meds as they just take the edge off the pain. I have been trying to taper off as they make me VERY tired. I feel very weak and down since I have quit a couple days ago. Can't see my Dr till next week. Should I talk to a pharmacist?
Answer
In many cases, it is recommended to taper tramadol before discontinuation if you have been taking the medication for an extended period of time.
Abrupt discontinuation of tramadol has been associated with a variety of withdrawal reactions, including (1, 2):
- Anxiety
- Restlessness
- Insomnia
- Rigors
- Sweating
- Goose bumps
- Restless legs
- Rebound pain
- Nausea
- Tremors
- Abdominal cramping
- Upper respiratory symptoms
- Hallucinations (rare)
- Panic attacks
- Paresthesias
- Headaches
The prescribing information for Ultram, the brand name for tramadol, states the following:
"Withdrawal symptoms may occur if ULTRAM® [tramadol] is discontinued abruptly. Reported symptoms have included anxiety, sweating, insomnia, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, piloerection, and rarely hallucinations. Other symptoms that have been reported less frequently with ULTRAM® discontinuation include panic attacks, severe anxiety, and paresthesias. Clinical experience suggests that withdrawal symptoms may be avoided by tapering ULTRAM® at the time of discontinuation."
Tramadol Tapering Recommendations
While some sources state that tramadol does not need to be tapered (3), most studies do recommend it for certain individuals. Unfortunately, there is no single agreed upon or "recommended" method.
Tapering protocols should individualized to a specific patient, and need to take into consideration a variety of factors, including:
- Age of the patient
- How long tramadol has been taken for
- Dose of tramadol currently taking
- Concomitant medications
- Concomitant disease states
In the studies that do recommend tapering tramadol, they state to do so slowly, over a period of at least a few days to a few weeks to lessen potential symptoms (4, 5, 6).
If you are going to be discontinuing tramadol, it is important to discuss an appropriate taper protocol for your specific situation with your doctor and be monitored for the length of time you are tapering the drug.
If you do experience withdrawal symptoms while discontinuing tramadol, they have been reported to last only a few days on average. Nevertheless, if they are troublesome, it may be prudent to return to a previously well tolerated dose and taper more slowly (5, 6).
If you are having problems tapering the medication or with associated adverse effects, it is important to speak with your doctor (or the office if you cannot get in touch with them) as they have your complete medical history.
Below is some additional information regarding tramadol.
Tramadol Information
Tramadol is a centrally-acting analgesic with a unique, dual mechanism of action. It is both a mu-opioid receptor agonist and a weak inhibitor of norepinephrine and serotonin reuptake.
Tramadol is a synthetic analog of codeine but has less potential for abuse or respiratory depression than other opiate agonists, but both may occur nonetheless. The onset of action of immediate release tramadol products is within 1 hour of administration, with effects lasting between 4 to 6 hours on average.
Tramadol is available in a variety of formulations:
- Immediate-release tramadol (Ultram)
- Orally disintegrating tablet (Rybix)
- Once-daily, oral, extended-release tablet (Ultram ER)
- Once-daily, oral, extended-release tablet (Ryzolt)
- Once-daily, extended-release capsule (ConZip)
