Prospective Multicenter Evaluation of Tramadol Exposure

Spiller, Henry A.; Gorman, Susan E.; Villalobos, Danny; Benson, Blaine E.; Ruskosky, Dawn R.; Stancavage, Margaret M.; Anderson, Deborah

doi:10.3109/15563659709043367

Cited by 168 publications

(142 citation statements)

References 6 publications

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“…Young males were involved more frequently than females, which is in agreement with other studies in Iran and other countries [5,9,22]. The results show that ingestion of tramadol was the only route of intoxication.…”

Section: Discussionsupporting

confidence: 91%

Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

et al. 2011

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Section: Discussionsupporting

confidence: 91%

Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

et al. 2011

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“…10 The toxic reaction was brief and self-limited, severe cardiovascular toxicity, such as hypotension or arrhythmias, was not seen and general supportive therapy appeared to be sufficient in managing these cases of overdose. 10 With a 5 mg·kg -1 loading dose, not exceeding 500 mg, we did not observe any serious adverse events. Conversely, intraoperative loading doses less than 1.25 mg·kg -1 appear of little benefit because of lack of analgesia in the PACU.…”

Section: Me Et Th Ho Od Ds S Following Approval By the Hospital's Rmentioning

confidence: 99%

“…We did not use doses greater than 5 mg·kg -1 in the design of this study, based on the report by Spiller et al 10 In a prospective multi-centre evaluation of tramadol, they reported 87 cases of tramadol intoxication in which 500 mg tramadol was the lowest dose associated with seizure, tachycardia, hypertension or agitation while 800 mg was the lowest dose associated with coma and respiratory depression. 10 The toxic reaction was brief and self-limited, severe cardiovascular toxicity, such as hypotension or arrhythmias, was not seen and general supportive therapy appeared to be sufficient in managing these cases of overdose.…”

Section: Me Et Th Ho Od Ds S Following Approval By the Hospital's Rmentioning

confidence: 99%

Tramadol 2.5 mg·kg−1 appears to be the optimal intraoperative loading dose before patient-controlled analgesia

Pang

Tung

2003

Can J Anesth/J Can Anesth

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“…However, tramadol toxicity may be underestimated. Some non-lethal cases of respiratory depression, seizures, and serotonin syndrome have been reported with tramadol (1)(2). Several deaths have also been reported when tramadol was ingested alone in overdose (3)(4)(5), or when it was ingested with others drugs (6)(7)(8), particularly with central nervous system (CNS) depressants like benzodiazepine (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Refractory shock and asystole related to tramadol overdose

Daubin

Quentin

Goullé

et al. 2007

Clinical Toxicology

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Introduction. Tramadol use is largely considered safe. However, several lethal cases of tramadol intoxication were reported, suggesting an underestimated toxicity. We report for a tramadol overdose case in combination with other central nervous system depressants, leading to refractory shock requiring extracorporeal life support. Case report. A 33-year-old man was admitted in our intensive care unit for drug intoxication with coma, seizures, and hypotension without signs of heart failure. A few hours later, he developed a ventricular tachycardia, followed by a brief cardiac arrest in asystole with refractory shock requiring an extracorporeal life support, vasopressors, and hemofiltration. With this aggressive support, his overall status gradually improved. Repeated echocardiography showed an improvement in the cardiac function. The patient was weaned off extracorporeal life support on day eight and discharged on day 12. On admission, a urine analysis, using gas chromatography-mass spectrometry, showed high peaks of tramadol and desmethyltramadol with the presence of hydroxyzine, gabapentine, and clonazepam. The tramadol blood concentration measured by the high-performance liquid chromatography method-diode array detector was 23.9 mg/L, much higher than many previously reported fatal overdoses. No other drugs with potential cardiac toxicity, such as beta-blockers, calcium antagonists, antiarrythmic, antidepressants, meprobamate, or other xenobiotics were detected. Conclusion. This case illustrates that tramadol overdose may cause refractory shock and asystole when taken in combination with CNS depressants, and reminds all physicians to be vigilant with regard to the potential toxic effects of tramadol.

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Prospective Multicenter Evaluation of Tramadol Exposure

Abstract: This study suggests significant neurologic toxicity from tramadol overdose. Serious cardiovascular toxicity was not seen.

Cited by 168 publications

References 6 publications

Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

Tramadol 2.5 mg·kg−1 appears to be the optimal intraoperative loading dose before patient-controlled analgesia

Refractory shock and asystole related to tramadol overdose

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