how should i step down my meds?

[fibrocentric]

I have been taking Tramadol 50mg-100mg two to four times daily (never exceeding 200 mg) since september 09.  It works well for pain. My concern is that I may become, or have become physicaly dependant. I would like to stop taking it and see how I feel with out it but after doing some research I'm scared to just stop taking it. While it helps with my pain quite a bit, I hate the idea that i will have to take it for the rest of my life.

I was also wondering what the health risks of long term treatment at this dose might be?

[fibrocentric]

thanks for your response!

it is a really hard condition to treat. this med was sort of a last ditch effort. i had been on coat therapy in the past which is just constant narcotic treatment along with cymbalta but stopped taking do to the need to increase so often because of tolerance. it can be so difficult to deal with this disorder, a person is sometimes criminalized by dr and pharmacist alike when they ask for pain meds.

i will talk to my doc, i hold out hope all the time that more natural remedies will be found for us.

thanks again!!!

[Alison L, RPh]

Tramadol is an opioid analgesic and as such is associated with tolerance, dependence, and abuse even though it is not a considered a controlled substance. Taking an opiate for an extended period of time usually results in some level of dependence and abrupt discontinuation of the medication can lead to withdrawal symptoms resulting in a failed attempt at discontinuation. The maximum daily dosage of Tramadol in a 24 hour period is 400mg and as such your dosage is not usually associated with long term effects due to being below the maximum recommended daily dosage. However, the warnings that Tramadol use does carry are dependence, constipation, seizure risk (seizures can occur even while taking the recommended dosage – patients are at an increased risk if they take other medications including SSRIs, other opioids, tricyclic antidepressants, MAO inhibitors, or other drugs that may lower the seizure threshold, and patients with a history of seizures), and respiratory depression (when taking in excess of the recommended dosage or combined with other medications or alcohol which cause respiratory depression).  

Withdrawal symptoms that may be experienced include anxiousness, diarrhea, nausea, muscle aches, weakness, sweating, and tremor. Withdrawal can be lessened or avoided if the medication is tapered slowly and should be done under the supervision of your prescribing physician. Tramadol stays in the body a relatively short time and is cleared in approximately 2 days (immediate-release formulations). Slowly decreasing the dose by 25-50mg/day (cutting the tablets in half to get 25mg) over a period of a week may help to avoid experiencing withdrawal symptoms.

Fibromyalgia pain is a difficult disease to manage due to not responding to many therapies. Options for treatment include both medications and physical therapy. Medications include Analgesics, Antidepressants, and Anti-seizure medications. Each of these classes have been associated with relieving the pain associated with fibromyalgia but are not side-effect free and you should have a discussion with your physician to see if an alternative choice is right for you.