Acute abstinence syndrome following abrupt cessation of long-term use of tramadol (Ultram(R)): a case study
by
Freye E, Levy J
Pain Center,
Extension of the Heinrich-Heine-University of Dusseldorf,
Graf-Adolf-Strasse 16,
Dusseldorf, 40211, Germany.
Eur J Pain 2000; 4(3):307-11

ABSTRACT

We report on a patient who had taken the centrally acting analgesic tramadol for over 1 year. The compound had proven to be sufficient to treat her painful episodes related to fibromyalgia. Due to lack of supply while being on a trip, intake of the drug was stopped abruptly, resulting in the development of classical abstinence-like symptoms within 1 week. Abstinence-like symptoms consisted of restlessness and insomnia for which the benzodiazepine lorazepam was given. Diarrhoea and abdominal cramps were treated with the peripherally active opioid loperamide, while bouts of cephalgia were treated with sumatriptan. Diffuse musculoskeltal-related pain and restless leg syndrome (RLS) were treated with dextromethorphan. All these different medications proved to be efficacious as they resulted in the cessation of symptoms. Within 1 week symptoms ceased and the patient regained her normal activities without any sequelae. Although tramadol is considered a non-habit- and non-dependence-forming analgesic, abstinence symptoms are likely to develop following abrupt cessation of intake, especially when the compound had been taken over 1 year. Therefore patients should be advised of such an effect whenever they decide to stop intake or their physician is planning to switch to another medication. To avoid abstinence-like symptoms doses should be slowly tapered down

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Immune response
The tramadol option
Tramadol and analgesia
Tramadol and acute pain
Tramadol versus morphine
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Official prescribing indications
Tramadol as an antidepressant
Tramadol: risk/benefit analysis
Tramadol, morphine and the stomach
Pharmacokinetics and pharmacodynamics
Tramadol, depression and Parkinson's disease

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