From the Guidelines
Yes, patients can withdraw from long-acting tramadol, but it should be done gradually under medical supervision to minimize withdrawal symptoms and prevent potential harms. Withdrawal symptoms typically include anxiety, sweating, insomnia, pain, tremors, nausea, diarrhea, goosebumps, dilated pupils, and drug cravings, as a result of physical dependence developed from repeated exposure to opioids 1. More severe symptoms may include hallucinations, paranoia, confusion, and seizures. A typical tapering schedule might reduce the dose by 10-25% every 1-2 weeks, but this should be personalized by a healthcare provider, taking into account the patient's individual needs and medical history.
Key Considerations for Tapering
- The severity of withdrawal symptoms varies depending on the opioid medication and the duration of treatment 1.
- Abrupt reduction or discontinuation of opioids can lead to serious withdrawal symptoms, psychological distress, self-medicating with illicit substances, uncontrolled pain, and suicide 1.
- A gradual tapering approach can help minimize these risks and ensure a safer withdrawal process.
- Supportive medications, such as clonidine for autonomic symptoms, anti-nausea medications, and short-term benzodiazepines for anxiety or insomnia, may be used to manage specific symptoms during withdrawal.
- Patients should be encouraged to stay hydrated, maintain good nutrition, exercise moderately, and use relaxation techniques to help manage symptoms.
Tapering Schedule
A personalized tapering schedule should be developed by a healthcare provider, considering the patient's individual needs and medical history. For example, someone taking 200mg daily might decrease to 150mg for two weeks, then 100mg, 50mg, and finally discontinue. The withdrawal timeline typically begins within 12-24 hours after the last dose, peaks at 2-3 days, and gradually improves over 1-2 weeks, though some symptoms may persist longer.
Importance of Medical Supervision
Medical supervision is crucial during the tapering process to monitor the patient's progress, adjust the tapering schedule as needed, and provide supportive care to manage withdrawal symptoms. This can help prevent potential harms and ensure a safer withdrawal process. By prioritizing a gradual tapering approach and providing supportive care, healthcare providers can help patients withdraw from long-acting tramadol while minimizing risks and promoting a better quality of life.
From the FDA Drug Label
Withdrawal symptoms may occur if tramadol hydrochloride is discontinued abruptly (see also DRUG ABUSE AND DEPENDENCE) 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 tramadol hydrchloride discontinuation include panic attacks, severe anxiety, and paresthesias Clinical experience suggests that withdrawal symptoms may be avoided by tapering tramadol hydrochloride at the time of discontinuation.
Yes, patients can withdraw from long-acting tramadol. The symptoms of withdrawal may include:
- Anxiety
- Sweating
- Insomnia
- Rigors
- Pain
- Nausea
- Tremors
- Diarrhea
- Upper respiratory symptoms
- Piloerection
- Hallucinations (rarely)
- Panic attacks
- Severe anxiety
- Paresthesias
It is recommended to taper tramadol hydrochloride at the time of discontinuation to avoid withdrawal symptoms 2, 2.
From the Research
Withdrawal from Long-Acting Tramadol
- Patients can withdraw from long-acting tramadol, and the risk of physical dependence and withdrawal symptoms should not be diminished 3, 4.
- Tramadol should not be considered a "safer" opioid therapy without the potential for classic or atypical withdrawal symptoms, as well as the risk of abuse, misuse, or addiction 3.
Symptoms of Tramadol Withdrawal
- Symptoms of tramadol withdrawal can include significant mucus production, fullness in the chest, and soreness in the neck 3.
- Other symptoms may include nausea, vomiting, and other opioid withdrawal symptoms 5, 4, 6.
Management of Tramadol Withdrawal
- Tramadol extended-release (ER) may be effective in reducing opioid withdrawal symptoms during a residential tapering program 5.
- Gradual tapering of tramadol is recommended to minimize withdrawal symptoms, especially after lengthy treatment periods 4.
- Tramadol may be considered a viable replacement for some existing opioid withdrawal treatment regimes due to its low potential for abuse and fewer side effects in specific clinical scenarios 6.