Tapering off tramadol

DEAR DR. ROACH: I’m 78 and a male. I had a total hip replacement on the right side 28 days ago. After the surgery, I was hospitalized two nights with physical therapy, then went home with six supervised therapy sessions. I walk with a slight limp that I am working on.

Everything was a breeze until I stopped the tramadol I was given for pain (100 mg, four times a day, 19 days). No one told me that I could experience withdrawal symptoms within 12 hours if I stopped cold turkey. I’ve weaned myself off it, but I’m wondering if I am too critical about not being warned. -- J.F.

ANSWER: I don’t think you are too critical at all. Tramadol (a common brand name is Ultram) is an opioid (a synthetic derivative of opium, in the same category as oxycodone) painkiller. Many physicians have been under the impression that it is a safer drug to use than others in this category; however, tramadol has clear risks similar to all of the drugs in this category. Its boxed warning (the highest degree of warning to physicians in the official package insert) reminds doctors: “Tramadol exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing tramadol, and monitor all patients regularly for the development of these behaviors and conditions.” It is particularly dangerous in children. You should have been warned about its potential side effects and how to taper off the medication safely. Again, the package insert clearly states “Do not abruptly discontinue.”

Tramadol certainly may be an appropriate medication for acute pain relief, which is absolutely indicated in someone with a major surgery, like your hip replacement. However, more information should have been provided to you or your family at the time you received it, including written information. Surgeons should give only enough pills to cover the expected duration of need. I am glad you wrote to share your experience.