Tramadol Side Effects and Withdrawal: Timeline, Seizures, and Why It Is an Opioid

Is tramadol an opioid?

Yes. Tramadol works partly through the same opioid receptors as oxycodone and morphine, and partly by raising serotonin and norepinephrine, which is why its risks overlap with both opioids and some antidepressants. The body turns it into an active metabolite, M1, through the liver enzyme CYP2D6, so how strongly it works varies from person to person and with other medicines, according to the FDA label.

It is a Schedule IV controlled substance. The DEA placed it in Schedule IV in a final rule published July 2, 2014, effective August 18, 2014. Schedule IV is a lower tier than oxycodone (Schedule II), but the label is direct: addiction can occur at recommended doses, in people who take it exactly as prescribed.

Tramadol side effects

In clinical trials, the most common side effects, each in 15 percent of patients or more, were dizziness or vertigo, nausea, constipation, headache, sleepiness, vomiting and itching, the label reports. The serious ones are less common and matter more:

The label also says not to prescribe tramadol for people who are suicidal or prone to addiction, and it is not for children under 12.

Tramadol withdrawal timeline

Tramadol is short-acting. The label gives average half-lives of about 6.3 hours for tramadol and 7.4 hours for M1. SAMHSA’s treatment guide for opioid use disorder (TIP 63) gives this general pattern for short-acting opioids, and tramadol’s half-life puts it in that group; individual timing varies.

The symptom list comes from the tramadol label: restlessness, watery eyes, runny nose, yawning, sweating, chills, muscle aches and dilated pupils, plus irritability, anxiety, back and joint pain, weakness, cramps, insomnia, nausea, poor appetite, vomiting, diarrhea, and higher blood pressure, breathing rate or heart rate.

Atypical tramadol withdrawal

Tramadol withdrawal can include symptoms people do not expect from an opioid. In surveillance reports to the independent committee that monitored Ultram after its launch, most withdrawal cases looked like classic opioid withdrawal, but about 1 in 8 were atypical: hallucinations, paranoia, extreme anxiety, panic attacks, confusion, and numbness or tingling in the arms or legs, according to a 2003 report in Drug and Alcohol Dependence. Withdrawal of either kind made up nearly 40 percent of all adverse events reported with long-term Ultram use. Those symptoms are frightening, and they are a reason to stop under medical care rather than alone.

How to stop tramadol safely

Do not stop suddenly or cut the dose sharply on your own if you have been taking it regularly. The label warns that rapid reduction or abrupt discontinuation in people who are physically dependent has caused serious withdrawal, uncontrolled pain and suicide, and that it has pushed some people toward street opioids. A prescriber can set a gradual taper and slow it down if withdrawal starts. If tramadol is being misused, or taken with alcohol or benzodiazepines, medical detox is the safer setting; our opioid detox guide explains what happens there, and the list of licensed detox programs in New Jersey shows where to go.

After a period off tramadol, tolerance drops. Going back to an old amount, or mixing it with alcohol or sedatives, raises the overdose risk. Keep naloxone in reach; our naloxone guide for families explains how to get and use it.

In New Jersey

Fully insured New Jersey plans and the State Health Benefits and School Employees’ plans cannot require prior authorization for the first 180 days per plan year of in-network treatment your own physician, psychologist or psychiatrist finds medically necessary. Self-funded employer plans, Medicare and Medicaid are not covered by that rule. NJ FamilyCare (Medicaid) members and people without insurance can call the IME Addictions Access Center at 1-844-276-2777, which screens callers and refers them to treatment. ReachNJ, at 1-844-732-2465, is the state’s treatment referral line. Both answer 24/7. Same-day admission is sometimes possible; it is not guaranteed. For what a specific plan covers, see the insurance guides.

Under the state’s Naloxone365 program, anyone 14 or older can get naloxone anonymously at participating pharmacies; StopOverdoses.nj.gov lists them.

Periscope Behavioral Health, which publishes this site, is opening a medical detox in Hammonton, Atlantic County, expected Summer 2027. Until then, the admissions line of our publisher, Periscope Behavioral Health, at (888) 313-3583, can talk through options in New Jersey and Florida, including facilities Periscope operates. What a plan covers depends on the plan and the facility’s network status.