Tramadol Withdrawal Timeline, Symptoms and Tips Constipation (24-46%) Nausea (24-40%) Dizziness (10-33%) Verto (26-33%) Headache (18-32%) Somnolence (7-25%) Vomiting (9-17%) Agitation (7-14%) Anxiety (7-14%) Emotional lability (7-14%) Euphoria (7-14%) Hallucinations (7-14%) Nervousness (7-14%) Spasticity (7-14%) Dyspepsia (5-13%) Asthenia (6-12%) Pruritus (8-11%) Diarrhea (5-10%) Dry mouth (5-10%) Sweating (6-9%) Hypertonia (1-5%) Malaise (1-5%) Menopausal symptoms (1-5%) Rash (1-5%) Urinary frequency (1-5%) Urinary retention (1-5%) Vasodilation (1-5%) Visual disturbance (1-5%) Abnormal gait Amnesia Cognitive dysfunction Depression Difficulty in concentration Dysphoria Dysuria Fatue Hallucinations Menstrual disorder Motor system weakness Orthostatic hypotension Paresthesia Seizures Suicidal tendencies Syncope Tachycardia Tremor Renal impairment (reduce dose) Anaphylactoid/fatal reactions including pruritus, hives, angioedema, epidermal necrolysis, and Stevens-Johnson syndrome reported with use; risk hher in patients with previous anaphylactoid reactions to opioids Use caution when administering with other respiratory depressants and monoamine oxidase inhibitors (MAOIs); risk of respiratory depression or increased ICP Increased risk of respiratory depression in patients with respiratory disorders including COPD, hypercapnia, cor pulmonale, or hypoxia Seizure risk even at recommended dosage, epilepsy patients, or recognized risks (head trauma, metabolic disorders, alcohol and drug withdrawal, central nervous system [CNS] infections), concomitant administraiton with other opioids, SSRIs, tricyclic antidepressants, cyclobenzaprine, promethazine, neuroleptics, MAO inhibitors, or drugs that impair metabolism of tramadol (CYP2D6, 3A4) Not recommended for obstetric preoperative medication or for postdelivery analgesia in nursing mothers May impair ability to perform sed or hazardous tasks Serotonin syndrome (potentially life-threatening) may develop Increased risk of serotonin syndrome if oadministered with serotonergic drugs (eg, selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], MAOIs, triptans) or drugs that may impair tramadol metabolism (CYP2D6 and CYP3A4 inhibitors) may increase risk for serotonin syndrome May impair ability to diagnose or determine clinical course of patients with acute abdominal conditions Use caution in patients with history of chemical dependency Avoid use in patients who are suicidal; use caution in patients taking tranquilizers and/or antidepressants Metabolized in liver by CYP2D6 and CYP3A4 via N- and O-demethylation and glucuronidation/sulfation Metabolites: M1 (O-desmethyltramadol; active); M1 metabolite has 200-fold greater affinity for opioid receptors than parent drug In CYP2D6 poor metabolizers, tramadol levels may increase by 20% and M1 levels decrease by 40% The above information is provided for general informational and educational purposes only. Tramadol is labeled as a Schedule IV controlled substance by the Drug Enforcement Administration DEA, as it is an opioid narcotic medication prescribed to.
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