Brief Answer: Go very slow in reducing the dose. Detailed Answer: Hi, welcome to Healthcare Magic! What I have understood from your query is that you were on tramadol 50 mg, 10 tabs per day for around 2 and 1/2 months and have now come down to just 3 tabs per day over three weeks. You have managed to reduce the dose very much but now I feel that you should go very slow, as you are already having fidgetiness and difficulty in sleeping. Do not reduce the dose any further at least for a week or till you see that these symptoms have improved. I expect that these will improve in a few days, but if required, please take some over the counter sleep aids, like melatonin. In addition, it will be good if your doctor can prescribe you something for sleep, like zolpidem (Ambien) which is safe and does not have a strong dependence potential like benzodiazepines. I do not feel that your symptoms are severe enough to require increasing the dose of tramadol, but only you yourself can be the best judge of that. If you feel that it is required, hike up by one tablet and then after a week, try reducing again, but very slowly. Keep yourself well hydrated during the next few days. Once you become stable on a dose of tramadol, then just reduce by half tab each week. If you go slow and allow your body ample time to adjust to the lower dosages, then you will not have any further difficulties. Hope this works out for you. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

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