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Tramadol Withdrawal and Detox

The withdrawal symptoms caused by tramadol overlap with both opiate and antidepressant withdrawal syndromes.1

  • Gastrointestinal pain
  • Depression
  • Diarrhea
  • Agitation
  • Numbness in the extremities
  • Ringing in the ears
  • Hallucinations
  • Paranoia
  • Agitation
  • Confusion
  • Opiate withdrawal symptoms1

Opiate withdrawal symptoms are often categorized by symptoms occurring early in withdrawal and those experienced late in the withdrawal process.2

Early Symptoms

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning2

Late Symptoms

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Gooseflesh (goose bumps)
  • Nausea
  • Vomiting2

Tramadol Detox Treatment

Medically supervised detoxification from tramadol is recommended to minimize the dangers associated with withdrawal. Interestingly, oral tramadol doses of 200 or 400 mg have shown modest efficacy in controlling opioid withdrawal suppression in people addicted to heroin and other illicit opioids. Studies comparing tramadol to buprenorphine and clonidine showed mixed results but implied tramadol is an option to treat severe opioid withdrawal associated with stronger illicit and prescription opioids.3

As with other opioids, serotonin syndrome can occur during withdrawal and recovery from tramadol. For people addicted to tramadol, studies have reported some efficacy using medications such as clonidine, benzodiazepines, buprenorphine/naloxone (Suboxone) and methadone during detox. Successful maintenance of abstinence has been reported with the use of naltrexone and mirtazapine. Over-the-counter medications such as NSAIDs can also help with some withdrawal symptoms.4

Case Study

A 39-year-old female U.S. Army veteran presented for tramadol dependence treatment as required by Child Protective Services after her son was born with opioid withdrawal syndrome. At the height of her addiction, she was consuming an average of 1400 mg of tramadol a day. Upon admission, she reported no other substance abuse other than tramadol. She entered residential inpatient treatment for 28 days and was successfully treated with a daily regimen of 8 mg buprenorphine and 2 mg naloxone while maintaining abstinence. She transitioned to an outpatient treatment center during which she maintained sobriety with the continued use of buprenorphine/naloxone.5

After detox, behavioral therapies help individuals address the emotional and psychological underpinnings of addiction. Interventions include individual and group therapy, cognitive behavioral therapy, contingency management, motivational enhancement therapy and 12-step programs. A primary goal of therapy is to help clients understand, monitor and control the compulsion to use tramadol and identify and avoid triggers to prevent relapse.4

  1. Tramadol Abuse. Drug Abuse website. http://drugabuse.com/library/tramadol-abuse/ Accessed February 20, 2017.
  2. Opiate withdrawal. Drugs website. https://www.drugs.com/enc/opiate-withdrawal.html Accessed February 20, 2017.
  3. Ziaaddini H, Ziaaddini A, Asghari N, Nakhaee N, Eslami M. Trial of Tramadol Plus Gabapentin for Opioid Detoxification. Iran Red Crescent Med J. 2015;17(1):e18202. doi:10.5812/ircmj.18202.
  4. How to treat tramadol addiction. Addiction Blog website. http://drug.addictionblog.org/how-to-treat-tramadol-addiction/ Published November 20, 2012. Accessed February 20, 2017.
  5. Cupples N, Moore T. A case of tramadol dependence and successful treatment with buprenorphine/naloxone. MHC. 2013 3:6, 283-285.
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