ULTRAM AT-HOME WITHDRAWAL AND TAPERING PROGRAM

In 1995 Ultram (Tramadol) was released in the United States and used primarily as a pain reliever for acute and chronic pain. While Ultram was initially considered to have a low abuse potential, it was popular in China since the early 1990s, particularly for opiate addicts. Studies have shows that Ultram does have a high risk potential for addiction.

Ultram can cause physical dependence and a withdrawal syndrome with symptoms associated with SSRI withdrawal, including numbness, anxiety, tingling, tinnitus, stomach upset, insomnia and many others. Symptoms generally surface 12-20 hours after the last dose but this can vary depending on drug metabolism. Ultram withdrawals last longer than those of opiates and follow the withdrawal syndrome length of antidepressants.

Ultram was isolated from the root bark of N. latifolia, an African medical plant and synthesized into a chemical structure similar to Effexor, an SNRI (Serotonin-Norepinephrine Reuptake Inhibitor).  Ultram can be associated with Serotonin Syndrome, a serious condition caused by excess Serotonin activity. As a result, Ultram should never be combined with St. John’s Wort, 5HTP, Antidepressants or any other item that increases Serotonin. Alcohol should not be consumed while taking Ultram.

Ultram has a relatively short half-life that helps to explain the severity of the withdrawals frequently experienced by patients.  Ultram should be tapered slowly to minimize withdrawal symptoms.

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ULTRAM WITHDRAWAL SYMPTOMS MAY INCLUDE:

abdomnial cramping, anxiety, backache, diarrhea, insomnia, chills, irritability, joint pain, muscle pain, vomiting, weakness, perspiration, nausea, increased heart rate, increased blood ULTRAM WITHDRAWAL SYMPTOMS MAY INCLUDE: , confusion, hallucination, numbness, panic attacks, paranoia, tingling 

ULTRAM SIDE EFFECTS MAY INCLUDE: 

vertigo, nausea, constipation, headache, somnolence, vomitting, cns stimulation, sweating, dry mouth, insomnia, menstrual issues, sinusitis, cough, rash 

ULTRAM ADVERSE REACTIONS MAY INCLUDE: per PDR   

Severe: visual impairment, hepatic failure, pancreatitis, GI bleeding, bradycardia, serotonin syndrome, seizures, suicidal ideation, Stevens-Johnson syndrome, toxic epidermal necrolysis, proteinuria, cholecystitis, hearing loss, myocardial infarction, pulmonary embolism, pulmonary edema, torsade de pointes, bronchospasm, anaphylactoid reactions, angioedema, fetal death, neonatal opioid withdrawal syndrome, SIADH 

Moderate: constipation, euphoria, hallucinations, orthostatic hypotension, peripheral vasodilation, hypertension, hypertonia, depression, dyspnea , urinary retention, hyperglycemia, peripheral edema, hot flashes, blurred vision, confusion, withdrawal , dysphagia, hepatitis, stomatitis, hypotension, amnesia, ataxia, impaired cognition, migraine, dysuria, hematuria, cystitis, anemia, thrombocytopenia, elevated hepatic enzymes, cholelithiasis, cataracts, impotence (erectile dysfunction), palpitations, sinus tachycardia, gout, QT prolongation, dysphonia, respiratory depression, physiological dependence, psychological dependence, hyponatremia, infertility, adrenocortical insufficiency 

Mild: nausea, vertigo, dizziness, headache, drowsiness, vomiting, flushing, agitation, tremor, anxiety, emotional liability, xerostomia, dyspepsia, asthenia, pruritus, insomnia, diarrhea, diaphoresis, anorexia, arthralgia, malaise, syncope, paresthesias, increased urinary frequency, infection, fever, weight loss, myalgia, flatulence, abdominal pain, fatigue, weakness, lethargy, sneezing, nasal congestion, rhinorrhea, cough, hypoesthesia, miosis, restlessness, rash, chills , rhinitis, pharyngitis, sinusitis, influenza, back pain, gastroesophageal reflux, yawning, hyperkinesis, night sweats, irritability, pallor, urticaria, menstrual irregularity , tinnitus, libido decrease, ecchymosis, muscle cramps, gonadal suppression, amenorrhea 

ULTRAM BOXED WARNINGS: per PDR cont. 

Accidental exposure, acute intoxication of CNS depressants, ethanol ingestion, ethanol intoxication, potential for overdose or poisoning  
Use of tramadol is associated with a significant potential for overdose or poisoning. Tramadol in excessive doses, either alone or in combination with other CNS depressants such as alcohol, is a major cause of drug-related deaths. Fatalities within the first hour of overdosage are not uncommon. Many of the tramadol-related deaths have occurred in patients with previous histories of emotional disturbances or suicidal ideation or attempts, as well as histories of misuse of tranquilizers, alcohol, and other CNS-active drugs. Some deaths have occurred as a consequence of the accidental ingestion of excessive quantities of tramadol alone or in combination with other drugs. 

According to the FDA:

Discontinuation of Treatment

Withdrawal symptoms may occur if tramadol hydrochloride extended-release capsules is discontinued abruptly. Clinical experience with tramadol suggests that withdrawal symptoms may be reduced by tapering tramadol hydrochloride extended-release capsules [see WARNINGS AND PRECAUTIONS (5.10) and DRUG ABUSE AND DEPENDENCE ( 9.3)].

Dependence
Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist.

REFERENCES:

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/tramadol-information

https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022370s000lbl.pdf

https://clinicaltrials.gov/ct2/show/NCT00142896

https://www.ncbi.nlm.nih.gov/pubmed/14723474

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