Electrocardiographic manifestations of tramadol toxicity with special reference to their ability for prediction of seizures

Emamhadi, Mohammad Ali; Sanaei‐Zadeh, Hossein; Nikniya, Masoumeh; Zamani, Nasim; Dart, Richard C.

doi:10.1016/j.ajem.2011.12.009

Cited by 29 publications

(18 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In analgesic doses, cardiovascular side effects are not of much concern; however, serotonin syndrome might occur due to the action of tramadol as a serotonin and norepinephrine reuptake inhibitor, which can lead to cardiac arrhythmia [7,101,102]. The effect of tramadol in QT interval was first evaluated by Emamhadi et al [103] in 479 patients, one fourth of them had QTc prolongation, thereby suggesting a probable potassium channel blockade effect. According to this report, tramadol might pose a risk for QT interval prolongation.…”

Section: Tramadolmentioning

confidence: 99%

Opioids and Cardiac Arrhythmia: A Literature Review

2018

View full text Add to dashboard Cite

Objective: One of the most important side effects of opioids is their influence on the electrical activity of the heart. This review focusses on the effects of opioids on QT interval prolongation and their arrhythmogenic liability. Methods: By using various keywords, papers published up to 2018 in different databases were searched and identified. The search terms were opioids names, corrected QT interval, human-ether-a-go-go gene, torsades de pointes (TdP), cardiac arrhythmias, opioid dependence and other relevant terms. It emphasized the effects of each opioid agent alone on electrocardiogram (ECG) and some interactions. Results: Available data indicate that some opioids such as methadone are high-risk even at low doses, and have potential for prolongation of the QT interval and development of TdP, a dangerous ventricular tachycardia. A number of opioids such as tramadol and oxycodone are intermediate risk drugs and may develop long QT interval and TdP in high doses. Some other opioids such as morphine and buprenorphine are low-risk drugs and do not produce QT interval prolongation and TdP at least in routine doses. Opium-consumers are at higher risk of supra-ventricular arrhythmias, sinus bradycardia, cardiac block and atrial fibrillation. Conclusion: The cardiac arrhythmogenicity of various opioids is different. Methadone has a higher capability to induce long QT interval and dangerous arrhythmias in conventional doses than others. To reduce of arrhythmogenic risk, high doses of opioids must be used cautiously with periodic monitoring of ECG in high-risk consumers such as patients under opioid maintenance treatment.

show abstract

Section: Tramadolmentioning

confidence: 99%

Opioids and Cardiac Arrhythmia: A Literature Review

2018

View full text Add to dashboard Cite

show abstract

“…Regarding the drug factors; it depends on its chemical properties such as molecular weight, plasma protein binding, ionization, and lipid solubility. For a drug to be transferred into human milk, it must has the following characteristics; smaller molecular weights, low protein binding, weak base and lipid soluble [4][5][6]. Tramadol and its active metabolite; M1 (O-desmethyl tramadol) are small, lipid soluble molecules with low protein binding and low volume of distribution sharing a high membrane permeability.…”

Section: Discussionmentioning

confidence: 99%

Tramadol Intoxication in an 8-Months-Old Infant through Breastfeeding: A Case Report

Hussien¹

2017

J Clinic Toxicol

View full text Add to dashboard Cite

Tramadol is a widely used, synthetic centrally acting opioid analgesic commonly used for the treatment of moderate to severe pain. Very few reports about its excretion into breast milk were published and most of them suggested that short-term maternal use of tramadol is compatible with breastfeeding. No available data about its chronic daily use in addict lactating mothers. To date, there are no published reports of tramadol poisoning through breastfeeding. We report a case of tramadol intoxication in 8-month-old infant through breastfeeding as her mother was an addict on tramadol. The infant presented to the Emergency Department (ER) of the Poison Control Center (PCC) of Ain Shams University Hospital twice with 36 h apart. The first time, the infant was discharged from the hospital with no sequelae after receiving the appropriate management. The second time, the infant deceased due to cardiac arrest three days after tramadol poisoning. This case report highlights the dangers of excretion of tramadol in milk and the severity of complications that can even be near fatal to infant.

show abstract

“…Most of the patients were in their 3 rd decade of life. This is while the age range of the patients was reported to be between 5-week-old and 87-year-old in different studies [1,3,8,37,44,45,[47][48][49][50][51]. Patients generally ingested tramadol [6,8,45,52].…”

Section: Epidemiology Of Tramadol Toxicitymentioning

confidence: 91%

“…Most of the tramadol-intoxicated patients are male (63% to 89.3%) [3,21,37,[42][43][44][45][46][47][48] and single [1,8,21]. However, in few studies, female patients were more (55% to 59%) [49,50].…”

Section: Epidemiology Of Tramadol Toxicitymentioning

confidence: 99%

“…Seizure is an important problem in tramadol toxicity with its frequency being reported between 8% and 14% in different social studies and 15% to 55.3% in hospital studies. Most of the patients experience only one episode of seizure [44,47,49,50]. Seizure is more common in young males (mean age of 22 -39.5 y) [8,23,43,44,52]; however, some studies reported no significant difference in the frequency of seizure between different genders [3,47,72,73].…”

Section: Cns Manifestations Of Tramadol Toxicitymentioning

confidence: 99%

See 1 more Smart Citation