This dose of diazepam (up to a maximum of 40mg) is then given to the patient daily in three divided doses. Calculate how much diazepam is equivalent to the dose of benzodiazepine that the patient currently uses, to a maximum of 40mg of diazepam (Table 8).Table 8Calculating diazepam equivalent doses. Store tramadol hydrochloride extended release tablets securely and dispose of properly [see Patient Counseling Information (17)]. For this reason, breastfeeding is not recommended during treatment with ULTRAM ER [see Use in Specific Populations (8.2)]. But be careful not to use these medications in amounts greater than the recommended dose. Table 3 provides guidance on medications for alleviating common withdrawal symptoms.Table 3Symptomatic medications in withdrawal management. These drugs have a history of successfully being used off-label in treating opioid withdrawal. Tramadol works like an opioid, which means that many of its withdrawal symptoms resemble those of other opioid withdrawal syndromes. It works like a traditional opioid, blocking pain signals from opioid receptors in the brain and nervous system. By binding to these receptors and altering the levels of neurotransmitters, tramadol reduces the intensity of pain signals sent to the brain.