Stopping Tramadol + Acetaminophen (Ultracet) Led to Withdrawal

You have heard an awful lot about the opioid epidemic. According to the National Institute on Drug Abuse, “Opioids are addictive. People can quickly lose control over their opioid use and need to keep using them to feel ‘normal.’” This kind of message has made people afraid to use opioids even after serious surgery. We have heard from a number of people after a knee replacement operation that they experienced a lot of pain. They were afraid to take opioids for more than a few days. What has not made headlines, however, are the potential problems with alternate pain medicines. Many doctors are now prescribing tramadol, a key ingredient in the brand name pain reliever, Ultracet. This reader says that stopping tramadol was challenging.

Stopping Tramadol Can Be Challenging:

Q. I started taking Ultracet about a year ago. This medicine contains tramadol and acetaminophen.

I began with just one a day. In less than a month, I was taking five pills a day. Now I want to get off this medication. Should I start by tapering the dosage? Or just stop it altogether?

Three days have passed since I took my last tablet. I haven’t slept during that time and I’m feeling anxious and sweaty. If these symptoms don’t increase, I will be able to continue without medication. But if they get worse, I wouldn’t know what to do!

A. When tramadol was first introduced, the maker presented it as an alternative to narcotic pain relievers. It has since become clear that some people can become dependent on tramadol. Stopping tramadol suddenly can be challenging. Sadly, neither the FDA nor the manufacturer give clear guidelines about how to taper off tramadol gradually.

What’s the Story on Tramadol?

This drug has some opioid activity, but it also affects neurotransmitters such as serotonin and norepineprine. That means it can trigger a “discontinuation syndrome” similar to one people might experience if they abruptly stopped drugs like sertraline (Zoloft) or venlafaxine (Effexor).

Stopping tramadol suddenly can lead to withdrawal symptoms such as

• Anxiety
• Insomnia
• Sweating
• Nausea
• Pain
• Tremors
• Diarrhea

A few people report panic attacks or “brain zaps.”

The Double Whammy:

Because tramadol has both weak opioid action as well as antidepressant-like neurochemistry, there could be a dual effect. Stopping tramadol suddenly could lead to side effects such as those our reader reported.

You can learn more about tramadol side effects and withdrawal at this link.

Stories from Other Readers:

This person has had a tough time:

“My doctor first prescribed Ultram/Ultracet for my fibromyalgia about 25 years ago, when I was in my late 40s.. I took 20 mg 2 x a day so I could continue to work. The feeling when I was late with a dose was awful.

“After a few years I weaned off it very slowly and went back to work part time. Then as I got older, and arthritis and old injuries began to slow me down with more pain, I went back on it (50 mg 2 x a day). After two years and trouble sleeping the doctor increased the dose to 3 x a day.

“Now I am retired and downsized. I have been weaning myself off SLOWLY for about 5 weeks by cutting pills. I am now down to about 1/3 of the 50mg pill 3 x a day and I’m paying close attention to how I feel. Only my husband believes how bad stopping Ultracet has been. All symptoms are true, and unbelievably bad.

“In a few weeks, I will be seeing a new doctor. Hopefully, I will be done with this by then. I am eating only organic food and getting on a good schedule. I hope pain management will not be the monster it has been.

“My knees are shot, I have had spinal surgery, two shoulder surgeries, a broken ankle, etc. I am 71, I hope to get to a good place for the rest of my life.

“This all got started because my doctor told me to ‘take more to feel good.’ I got almost no encouragement to wean off. My doctor told me,’good luck; you are brave.’ That may have been only because I had been his patient for 25 years, and I was a medical professional too.”

Tresa shared this story about stopping tramadol:

“I was on medication for depression for 2 years. Last year I fought through the withdrawal symptoms and stopped the medications completely. Recently I had a miscarriage and last week I had a hip surgery. Mostly I was on tramadol injections and when I came home they gave me 2 painkillers. One of them was Ultracet.

“I stopped it whenever I felt my pain was bearable. After a day, I had severe panic attacks. I had suicidal thoughts and sleepless nights. I was scared to death that my husband would leave me (for no reason). As a result, I cried all night.

“I was confused about what was causing all this. It is just by chance I went through the comments on the PeoplesPharmacy.com website and now I know these are withdrawal symptoms. It will be difficult at first, but I will have to taper off this drug properly. Otherwise I will end up in that hopeless place again.

“I will be stopping Ultracet little by little. It’s difficult, but it’s possible.”

C.S. is scared and confused after stopping Ultracet:

“I’m on day 28 of Ultracet withdrawal. I was doing better after 2 weeks of hell. Cold turkey. No other choice. Now it’s like withdrawals are starting all over again. No sleep. Heart palpitations, nausea, anxiety and twitchiness 24/7 the past three days. What the hell is going on?”

Doctors are advised to reduce the dose gradually to avoid such problems. But what does “gradually” mean? Is it a week, a month, six months or longer? Without guidance many patients feel like C.S. We suspect that many people can be successful with a six-week taper, but some may need to reduce the dose even more gradually.

A review of tramadol in the official journal of the College of Family Physicians of Canada (CFP-MFC, Sept. 2025) offers this

“Comparative data on analgesics facilitates informed discussions with patients about anticipated efficacy and harm. This review includes comparative studies from a range of settings, incorporating patients with both acute and chronic pain, and found no significant differences between tramadol with or without acetaminophen and opioid comparators for any safety or efficacy outcomes. When compared with NSAIDs, tramadol with or without acetaminophen was less effective at pain reduction of 30% or more and resulted in significantly higher WDAEs [withdrawals from the study due to AEs], total withdrawals, and total AEs [adverse events].”

We discovered an interesting analysis of tramadol in the journal Addiction & Health, Summer, 2009:

“Since tramadol binds to opioid µ receptors, it is expected that its cessation after chronic use cause withdrawal symptoms and signs. However, in some cases tramadol withdrawal symptoms are similar to serotonin reuptake blockers withdrawal symptoms rather than opioid blockers and this may be related to tramadol mechanism of action as a serotonin and epinephrine reuptake blocker [antidepressants].

“Tramadol withdrawal symptoms and signs include typical and atypical types. Symptoms normally seen in tramadol withdrawal according to their prevalence are as follows: gastrointestinal pain, anxiety, bone pain, depression, diarrhea, insomnia, epiphora, nausea, agitation, rhinorrhea, excessive perspiration. Atypical symptoms include severe anxiety, panic attacks, unusual CNS symptoms such as confusion, delusion, derealization, depersonalization, paranoid thoughts (2.27% prevalence), unnatural sensory experiences such as numbness, tingling, prickling, tinnitus (4.25% prevalence) and hapatic, visual, and auditory hallucinations (20% prevalence).”

Please share your own experience stopping tramadol in the comment section below. If you did not experience any problems stopping tramadol, please let us know that as well.