How to Taper off Tramadol

A tramadol taper is a safe way to stop taking tramadol gradually while avoiding withdrawal symptoms. Your doctor can help you choose the best taper for your health needs.

Article at a Glance:

• A taper is a slow and gradual discontinuation of a drug.
• Tapering an opioid like tramadol can help avoid withdrawal symptoms.
• Your doctor can help you choose the best taper scheduled for your health needs while helping you avoid withdrawal.
• Medical detox is available to help you taper in a medically supervised setting.

When you regularly take a drug like tramadol and decide to stop, it can be hard to know where to turn. Although it might be tempting to stop taking tramadol cold turkey, doing so can lead to unpleasant withdrawal symptoms. Instead, your doctor may recommend a taper or a slow decrease of tramadol’s dose over time to get you off the drug and avoid withdrawal.

What To Expect When Tapering or Weaning Off Tramadol

Tapering off tramadol is a gradual and methodical undertaking. Those using tramadol for medical and recreational purposes will have their own reasons for quitting. Family, friends, finances, health and endless more motives can drive one to seek out opioid treatment. Choosing a taper to reach this goal is often twofold: it detoxes the body, physically and mentally, to prepare for a tramadol-free life while preventing withdrawals in the interim. 

What Is a Tramadol Taper?

A taper is a slow dose reduction of tramadol. Reducing your tramadol dose gradually instead of stopping the drug cold turkey can help you avoid withdrawal symptoms. Usually, your doctor will instruct you on the best tramadol taper schedule for your health needs.

Who Can Benefit From Tapering Their Tramadol Intake

People who may be physically dependent on tramadol because they take the drug regularly often benefit from tapering their tramadol intake.

When you regularly take an opioid like tramadol, your body becomes used to the drug’s presence. This is called physical dependence. Physical dependence does not mean you are addicted to a drug, merely that your body and brain have adapted to expect its presence. If you regularly take tramadol and suddenly stop, you may have withdrawal symptoms that a taper can help you avoid.

Types of Tramadol Opioids Tapering Methods

Multiple opioid tapering methods exist, including direct, substitute and titration tapers. When the opioid is a legal medication like tramadol, the Centers for Disease Control and Prevention (CDC) recommends a direct taper.

Direct Tapering

Direct tapering is straightforward and involves slowly lowering the tramadol dose over time. The CDC recommends that prescription opioids like tramadol be weaned using direct tapers. The tramadol dose should be decreased by 10% a month if you have taken tramadol for a year or more. If you have taken tramadol for less than a year, your dose should be reduced by 10% weekly.

Substitute Tapering

In a substitute taper, the opioid is replaced by a different opioid. This type of taper is often used when the person is taking an illicit opioid like heroin, which a doctor cannot prescribe. In that case, illegal heroin would be converted to a legal drug like methadone. The methadone dose may then slowly be reduced over time, as in a direct taper. 

Titration Tapering

Experts do not recommend titration tapering, which involves dissolving a drug in water to dilute it and taking progressively smaller amounts. However, this often does not work well. This is because not all drugs are soluble in water, which can cause an overdose. Tramadol, for example, doesn’t completely dissolve in water, making it risky to try a titration taper.

Why Consider Tapering vs. Stop Opioids Cold Turkey?

A taper is a gentler and safer alternative to stopping tramadol cold turkey. Suddenly stopping tramadol is not recommended due to the risk of withdrawal symptoms. Withdrawal symptoms are unpleasant in the best circumstances but can also be dangerous as they can lead to relapse and potentially fatal complications like dehydration. In contrast, slowly tapering eases you off tramadol, bypassing or minimizing withdrawal symptoms. 

Common Opioid Withdrawal Symptoms

When tramadol is stopped cold turkey, a person may go into withdrawal. Symptoms of opioid withdrawals include:

• Agitation
• Anxiety
• Muscle aches
• Increased tearing
• Trouble sleeping
• Runny nose
• Sweating
• Yawning
• Abdominal cramps
• Diarrhea
• Wide pupils
• Goosebumps
• Nausea and vomiting

Side Effects of Opioid Tapering

When done correctly, a tramadol taper should be generally free of side effects. This is because tapering the drug eases you off it over time to avoid withdrawal side effects. Since the point of a taper is to minimize withdrawal symptoms, experts recommend pausing or slowing a tramadol taper if you start to have withdrawal symptoms. 

Tramadol Opioid Withdrawal Timeline

Tramadol exists in short and long-acting dosage forms, impacting the duration of the withdrawal timeline you can expect. Short-acting tramadol generally has a shorter, quicker withdrawal, while long-acting tramadol has a longer withdrawal.

• Short-acting tramadol: Withdrawal symptoms start within 12 hours of the last dose, peak within 24–48 hours and subside over three to five days. 
• Long-acting tramadol: Withdrawal symptoms start within 30 hours of the last dose, peak within three to eight days and can last around 10 days.

Whether you take short or long-acting tramadol, prolonged withdrawal symptoms may occur. These can potentially last a few weeks to months and include:

• Anxiety
• Depression
• Insomnia
• Concentration problems

Medications Used When Tapering off Tramadol

Sometimes, doctors prescribe medications during tapering to help you off tramadol. Sometimes, this is part of medication-assisted treatment (MAT), where medication is used alongside therapy and rehab to help keep you off a drug. While MAT using methadone and buprenorphine during opioid addiction recovery is common, it would be very rarely, if ever, done during a tramadol taper as these medications are much stronger than tramadol, which is considered a weak opioid.

Methadone

Methadone is a first-line medication prescribed to prevent and treat opioid withdrawal. However, since methadone is about 30 times stronger than tramadol, methadone would generally not be used to taper down the much weaker tramadol.

Buprenorphine (Suboxone, Sublocade)

Buprenorphine is another first-choice medication to prevent and treat opioid withdrawal. It is available in oral dosage forms like Suboxone (which combines buprenorphine with naloxone) and injectable dosage forms like Sublocade. However, it is difficult to convert a tramadol dose to a buprenorphine one. Therefore, experts recommend reserving buprenorphine for someone experiencing significant withdrawal symptoms.

Naltrexone (Vivitrol)

Naltrexone is an opioid blocker. As such, it is rarely, if ever, used during detox or tapering because it triggers withdrawal symptoms. That said, after detox is complete, naltrexone may be prescribed to help you avoid relapse. 

Narcan (Naloxone)

As an opioid blocker like naltrexone, naloxone is rarely, if ever, used on its own during tapering as it would trigger withdrawal symptoms. However, naloxone is an ingredient in the combination drug Suboxone, which may be prescribed for withdrawal symptoms. Your doctor may also order naloxone after you have completed detox to help you treat an overdose if you relapse.

Other Medications

Different medications commonly treat withdrawal symptoms. These can vary based on the symptoms you are experiencing and your medical history but may include:

• Insomnia: promethazine
• Nausea and vomiting: metoclopramide
• Abdominal cramps: hyoscine
• Diarrhea: loperamide
• Muscle cramps: quinine
• Headaches: acetaminophen and/or ibuprofen
• Agitation: diazepam

Why Tramadol Withdrawal Symptoms Occur

When a person takes an opioid like tramadol, the drug impacts a brain region called the locus coeruleus. The locus coeruleus produces norepinephrine, or noradrenaline, which helps control breathing and wakefulness. Because opioids like tramadol are central nervous system depressants, they slow this process, causing drowsiness and slowed breathing, which are common opioid side effects.

However, over time, the brain becomes used to the presence of the opioid. The locus coeruleus adjusts and produces even more norepinephrine to overcome the opioid’s sedating effects. This means if a person abruptly stops taking the opioid, they suddenly have the increased norepinephrine in their body without any opioid to counter it. This phenomenon is responsible for the withdrawal symptoms that many people experience when quitting an opioid like tramadol cold turkey.

Can Tapering Your Tramadol Intake Reduce Withdrawal Symptoms?

Doctors recommend tapering tramadol to reduce your risk of withdrawal symptoms. Slowly decreasing the drug dose allows your brain and body to adjust to the drug’s absence. When you are ready to completely come off tramadol, a gentle taper may help avoid withdrawal altogether.

How to Taper off Tramadol

A tramadol tapering schedule gives the person a hands-off role in the planning process so they can concentrate on the recovery itself. Physicians will craft a plan on a patient-by-patient basis, including check-ins and appointments in a healthcare facility.

Tramadol should be tapered at a consistent speed to ward off the two conceivable withdrawals. Experts advise several general reduction rates, ranging from a conservative 10% dose reduction weekly to a rapid 50% dose reduction weekly. Please consult with your physician before participating in a taper regiment.

Of course, the taper frequency can and will be adjusted if the situation requires it. Whether they fall under the short-term or long-term classification, there is hope for everyone to overcome their substance use disorder with a taper.

Choosing To Wean Yourself off Tramadol

Choosing a tramadol taper instead of quitting tramadol cold turkey can help you avoid withdrawal symptoms. While cold-turkey tramadol discontinuation may seem quicker, the withdrawal symptoms can be uncomfortable and may last weeks or months. In contrast, a tramadol taper may be over in a few weeks, depending on your starting tramadol dose.

Challenges of Cutting Down Your Tramadol Intake

Weaning yourself off tramadol without medical supervision can be complex. First, it is important for your doctor to be aware of all the medications you are taking. Second, choosing the best taper schedule can be tricky. For example, if you accidentally become too aggressive with your taper schedule and experience withdrawal symptoms, your doctor will have an easier time helping you if they are already aware of your tramadol dose and attempt to taper.

Searching for Help

Your doctor is an excellent resource for helping you wean off tramadol. They can help you design a taper schedule to decrease your tramadol dose gradually. This may even involve prescribing lower doses of the medications so you do not need to cut higher-dose pills.

Relapse Prevention Strategies

Avoiding tramadol withdrawal can help reduce your relapse risk. Research has shown that a person’s risk for opioid relapse can increase if they suffer withdrawal symptoms. This is especially true in women. Limiting withdrawal symptoms through a medically managed taper increases your chances of successfully staying off tramadol long-term.

If you or a loved one are struggling with a tramadol addiction, help is available. Opioid addiction experts at The Recovery Village can provide personalized treatment programs designed to meet your needs and get to the root of why you started tramadol in the first place. Contact us today to answer your questions and discuss treatment options.

Opioid Taper Calculator

Morphine Equivalent Dose calculators, or MEDs, are used by licensed physicians in some tapering programs. An opioid taper calculator is designed to establish an equivalent dosage amount of morphine compared to the opiate a patient is using. All opiates (not opioids) can be traced back to morphine as the source. Some also convert to morphine in the brain.

Morphine is the oldest known opiate and was considered the standard of care (or yardstick by which opiates are measured) for decades, so everything is translated into morphine measurements, even if the opioid in question (like fentanyl) has nothing to do with morphine. With a baseline morphine dose, healthcare providers can craft a personalized tapering schedule and determine the best medication to replace the opiate. Methadone and Suboxone are prime examples of medicines used for opiate substance use recovery.

How The Recovery Village Uses Tramadol Tapering

If you or a loved one struggles with tramadol, The Recovery Village will work with you to ease you off the drug. This may involve slowly decreasing your tramadol dose over time or changing you to a different drug if medically appropriate. Recovery from a tramadol addiction is possible with support. Contact us today to see how we can help.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more