Tramadol Abuse Symptoms, Withdrawal And Treatment Options

Tramadol, a strong prescriptive painkiller often prescribed to those with severe or long term pain, is making headlines following a number of deaths linked to its addictive nature. What is Tramadol and why is it so addictive?

What is Tramadol?

Tramadol is a strong painkiller that is used to treat moderate to severe pain. It is prescribed to treat chronic pain when weaker painkillers are no longer effective, and also for intense temporary pain after an operation or following an accident. Tramadol works by blocking pain signals from travelling along the nerves to the brain.

Tramadol comes in tablet form, in capsules and in liquid drops, more rarely it can be administered via intravenous injection. Tramadol is also prescribed under the brand names Invodol, Larapam, Mabron, Maneo, Marol, Maxitram, Oldaram, Tilodol, Tradorec, Tramquel, Tramulief, Zamadol, Zeridame and Zydol.

Tramadol can be addictive, particularly if it is being taken in a way that has not been advised by a doctor.

Use and Dosage

The amount prescribed of this drug will entirely depend on your pain levels as well as any preexisting medical conditions. Tramadol is taken normally every 4 to 6 hours as needed. To lower the risk of side effects, your doctor may start you on a very small dose, before slowly increasing the dosage until optimum pain relief is reached.

The absolute maximum it is possible to take is 400 milligrams a day, and if you are over the age of 74, then it is advisable to take no more than 300 milligrams a day. As with all pain medication, it is recommended to take the medication on the onset of pain, as if it is taken once the pain has worsened it may not work at all.

Finally, given the effect it can have on breathing, this medication should not be taken if the patient suffers from asthma, a blockage in the stomach or if there is a history of addiction.

Side Effects

Like any other drug tramadol has a number of side effects which include:

  • Nausea
  • Constipation
  • Dizziness
  • Headache
  • Euphoria
  • Indigestion
  • Weakness

Long term usage of tramadol may also affect fertility in both men and women, although it is unknown if these effects are permanent or temporary. Any side effects are far more likely to be serious in the elderly, as well as those who are over or underweight.

Tramadol increases the amount of serotonin in the brain, which when mixed with other medications that increase your serotonin levels, including antidepressants, can cause a condition called serotonin syndrome. Symptoms of this include agitation, fever, nausea, muscle stiffness as well as loss of consciousness.

Tramadol should be used with caution in the treatment of those who have a history of addiction, because of its addictive nature.

Overdose and Withdrawal

Taking too much tramadol can be dangerous. If you’ve taken an overdose of Tramadol you may feel very sleepy, sick or dizzy. You may also have difficulty breathing. In serious cases you can become unconscious and may need emergency treatment in hospital. The amount of tramadol that can lead to an overdose varies from person to person.

If you use Tramadol in a way other than how it has been prescribed to you, you are putting yourself at risk of overdose. If you crush, chew or suck slow-release tablets for example, the slow-release system won’t work correctly and the dose may get into your system at once. This could cause a potentially fatal overdose.

Traditional opioids like oxycodone and hydrocodone increase sensations of pleasure and can produce a “high” when taken in large doses. Tramadol works a little differently than most opioids, as it not only activates the opioid receptors, it also stops neurotransmitters like serotonin and norepinephrine from being reabsorbed back into the system. Thus tramadol withdrawal make vary somewhat from usual opioid withdrawal.

Signs of opioid withdrawal

  • Runny nose
  • Sweating
  • Tearing up
  • Yawning
  • Muscle and body aches
  • Trouble sleeping and/or insomnia
  • Anxiety
  • Restlessness
  • Agitation
  • Racing heart rate
  • Hypertension
  • Fast breathing
  • Further Symptoms:
  • Chills and goosebumps
  • Stomach pain and cramping
  • Diarrhea
  • Vomiting
  • Loss of appetite
  • Pupil dilation
  • Difficulties concentrating or thinking clearly
  • Irritability
  • Drug cravings
  • Depression
  • Depersonalization

The severity and duration of withdrawal symptoms will very much depend on the level of dependency you have – if you have been taking tramadol at large doses for a long time you may need more time in which to bounce back following detox.

Treatment Options for Addiction

If you are struggling with addiction you should always seek professional help. Trying to detox alone can be very uncomfortable and sometimes dangerous. There are various treatment options available for addiction in the form of rehab, medication, and therapy.


Experts agree that residential rehab is the best treatment option for addiction recovery. If you have found your addiction taking over your life, perhaps it is time to seek some help Rehab is immensely in terms of successful detox and with getting into long term, ongoing recovery. In rehab you will benefit from trained experts on site at all times.

Going to rehab will give you the opportunity to recover away from the stresses of ‘normal’ life. You will have the opportunity to get clean and sober with the support of trained and dedicated professionals. You will be able to start the healing process in a therapeutic setting, with 24 hour support and a community of peers who are going through the same things as you.

If you choose to go to rehab the first step will usually be an initial assessment and evaluation. This assessment occurs prior to your entering the programme. A therapist will evaluate your mental health status and any physical issues you may have. You will be asked questions about your addiction but also about other external factors like relationships and work. This is done in order to create an individualized treatment programme that will best serve your needs and goals.

If a detox is required you will be seen promptly by a doctor and will be prescribed a medical detox, through which you will be supported. Following detox you will move on to the therapeutic programme. Often rehabs will have an integrative approach blending the one-to-one counselling and group therapy with the 12 Steps and/or other holistic approaches.

Our rehab programme for prescription drug addiction can be found here.


Since tramadol is an opioid analgesic using the following medications can help during detox:

  • Methadone – relieves withdrawal symptoms and helps with detox. It is also used as a long-term maintenance medicine for opioid dependence. After a period of maintenance, the dose may be decreased slowly over a long time.
  • Buprenorphine (Subutex) – treats withdrawal from opiates, and it can shorten the length of detox. It may also be used for long-term maintenance.
  • Clonidine – is used to help reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. It does not help reduce cravings.
  • Tapering – taper tramadol use over time. You will need discuss your tramadol use with your prescribing doctor and they will figure out the best tapering protocol for you withdrawal. Doctors need an idea of how much your body has developed need for tramadol before suggesting a tapering schedule. A safe taper is considered a 10% reduction every week and then a 20% reduction every 3 to 5 days.

Since you may experience atypical Tramadol withdraw symptoms from too little serotonin, you can reduce the severity of atypical withdrawal symptoms with medications that increase serotonin or serotonin and norepinephrine levels in the brain. However, taking any serotonin-increasing medication at the same time as serotonin-increasing tramadol puts you at risk of serotonin syndrome.

Some examples of medications that raise serotonin levels include:

  • SSRISs or SNRIs
  • St. John’s Wort
  • 5-HTP supplements


Therapy is an incredibly part of recovery. Uncovering the underlying trauma or reasons that behind your addiction can be an integral part of recovery. Therapy provides a safe space in which you can explore, process, and resolve experiences and processes which are affecting you negatively. There are various different types of therapy available for addiction recovery, these include:

  • Individual counselling – These sessions will typically last for one hour and will be between you and your focal counsellor. During these sessions the therapist will listen and help you to share, process, accept and heal. These sessions are private and confidential and will be a part of your therapeutic rehab plan.
  • Group Therapy – Group sessions will usually consist of a fairly small group of peers who share similar issues, and is facilitated by a therapist and support staff. In these sessions you will benefit from hearing the insights and experience of your peers and share your insights and experiences with the group.
  • Creative Therapy – Guided expressive art workshops which provide therapeutic insight and help with processing emotion.
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