Tramadol Withdrawal: Symptoms, Timeline, and How to Quit Safely
“When I don’t take it, my whole body aches, I can’t sleep, and I’m so irritable I can’t sit still.” This is a common description from people who have used tramadol for a while and then try to stop. In Thailand, tramadol capsules are often called “ya khiao lueang” (green-yellow pills) among young people. Many families only discover that a loved one is using tramadol when they notice these unusual symptoms, and they are unsure what to do next.
Tramadol is a prescription painkiller. When it is misused in large amounts over time, the body adapts until dependence develops, and stopping leads to withdrawal. Understanding what withdrawal looks like, when it is at its worst, and when medical help is urgent makes quitting safer and more likely to succeed.
How to Recognize Tramadol (“Green-Yellow Pills”)
Tramadol belongs to the opioid painkiller group, like morphine and heroin, but it also affects the brain chemicals serotonin and norepinephrine. In medicine it is used for moderate to severe pain under a doctor’s prescription. For the basics of what tramadol is and why it can become addictive, read What Is Tramadol, and Why Does This Painkiller Become Addictive?
Signs families can look out for include:
- Common names: green-yellow pills, taxi pills, tramadol, Tram, or names based on the numbers on the blister pack
- Appearance: green-and-yellow capsules; some brands are tablets sold in blister packs
- How it is used: swallowed several capsules at a time, or mixed into drinks such as soft drinks, energy drinks, cough syrup, or boiled kratom leaf water, a mix often seen among teenagers
- What you might find: many empty blister packs, green-yellow capsules in bags or bedrooms, or bottles of pre-mixed soft drinks or cough syrup
What Does Tramadol Withdrawal Feel Like?
After regular use, the brain and nervous system adjust to working alongside the drug. When it is stopped or reduced suddenly, the nervous system that was being suppressed becomes overactive, which causes withdrawal. Common symptoms include:
- Physical: muscle and bone aches, sweating, runny nose and watery eyes, frequent yawning, goosebumps, chills, nausea, vomiting, stomach cramps, diarrhea, and a fast heartbeat
- Mental and emotional: restlessness, irritability, anxiety, insomnia, and strong cravings
Because tramadol also acts on serotonin and norepinephrine, some people may have more prominent emotional symptoms than with other opioids, such as intense anxiety, panic, low mood, or numbness and tingling in the body. These symptoms lead many people to give up and use again.
When Is Withdrawal at Its Worst?
With short-acting opioids, withdrawal usually starts within a few hours of the last dose and peaks around days 2–3. Most physical symptoms improve after about a week, but insomnia, mood swings, and cravings can last for weeks or even months. This later period carries the highest risk of relapse.
Warning Signs That Need Urgent Medical Care
If you can stop on your own, stop. But if withdrawal is severe, or any of the following occur, go to a doctor or emergency room immediately:
- Seizures: high doses of tramadol increase the risk of seizures, especially when combined with other substances
- Extreme drowsiness, being hard to wake, or slow or shallow breathing: this may be an overdose, which can be life-threatening
- Confusion, hallucinations, or incoherent speech
- Vomiting or diarrhea so severe that the person cannot keep fluids down, which risks dehydration
- Thoughts of self-harm
Tramadol withdrawal on its own is usually not life-threatening, but it is very distressing. It is also often combined with other substances such as cough syrup, kratom water, or sleeping pills, which makes symptoms more complex and more dangerous. Learn more about using multiple substances.
How to Quit Tramadol Safely and Avoid Relapse
Quitting tramadol successfully means caring for two connected stages: detox and recovery.
Detox: A doctor assesses how much and how long tramadol has been used, any other substances, and existing health conditions, then provides medication to ease symptoms, such as sleep aids, anti-anxiety medication, and medication for aches and stomach symptoms. In severe withdrawal, a doctor may consider a long-acting replacement such as methadone for a short period, then taper it until it can be stopped. Day One Rehabilitation Center is licensed by the Thai Ministry of Public Health and can therefore prescribe methadone legally. However, the team starts with psychiatric and symptom-relief medications first, and uses methadone only when a psychiatrist assesses that withdrawal is severe.
Recovery: Getting through withdrawal is only the beginning. What often leads people back to tramadol is lingering cravings, stress, and old social circles. This stage focuses on building skills to handle cravings and triggers through individual therapy and group therapy, along with care for any emotional symptoms. See the full picture in Day One’s 4-phase residential treatment program.
If your loved one does not yet accept that there is a problem, read how to talk to someone with a drug problem about getting treatment.
Frequently Asked Questions
How long does tramadol withdrawal last? Physical symptoms usually peak around days 2–3 and improve after about a week. Insomnia, mood swings, and cravings can last for several weeks to months.
What are “green-yellow pills”? “Green-yellow pills” is a common Thai street name for tramadol, an opioid painkiller that usually comes as green-and-yellow capsules. It is a legitimate medicine when prescribed, but it is widely misused and can cause addiction.
Can I stop tramadol on my own? If you can stop on your own, stop. But if withdrawal is severe, or there are seizures, extreme drowsiness, slow breathing, confusion, or thoughts of self-harm, seek medical care immediately.
Does a urine test detect tramadol? Yes. Day One can test urine for 10 substances, including tramadol. Learn more about how long drugs can be detected in urine.
Withdrawal Can Be Overcome With the Right Care
Tramadol withdrawal can be so uncomfortable that many people believe they cannot quit. But these symptoms have a peak and a period when they gradually ease. With proper symptom care and ongoing relapse prevention skills, quitting tramadol is truly possible, no matter how many times your loved one has tried before.
If someone you love is addicted to tramadol and has not been able to quit alone, contact the psychiatric team at Day One Rehabilitation Center, a residential addiction treatment center. We are available every day, and all information is kept confidential.
Phone: +66 2-028-7775
LINE: @dayone
Location: 99/1 Moo 6, Si Chula, Mueang Nakhon Nayok, Nakhon Nayok 26000, Thailand (only a 1-hour drive from Bangkok)