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A: Tramadol (Ultram) is a centrally acting analgesic with a unique, dual mechanism of action. It works as an opioid and also has weak inhibitory effects on the brain chemicals norepinephrine and serotonin. Withdrawal symptoms may include anxiety, sweating, nausea, tremors, diarrhea, upper respiratory symptoms, insomnia, pain, tingling, and rarely hallucinations. These symptoms can be worse in patients who have been previously dependent or chronically taking other opioid drugs (such as Vicodin). Experience suggests that withdrawal symptoms may be relieved by tapering the dosage of tramadol. The slower the tapering, the fewer withdrawal symptoms would be expected. With respect to the side effects you describe in your question, according to the package insert for tramadol, headache was reported in 18 percent and 32 percent of patients treated with immediate-release tramadol for seven and 90 days, respectively. Overuse of analgesics such as tramadol products by headache-prone patients frequently produces drug-induced rebound headache. In this case, overuse of tramadol products has been defined as taking three or more doses per day more often than three to five days per week. There is no information to suggest that tramadol can cause changes to the menstrual cycle. For more information, please consult with your health care provider and visit //www.everydayhealth.com/drugs/tramadol. Michelle McDermott, PharmD
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