Seizures associated with low-dose tramadol for chronic pain treatment

Beyaz, Serbülent Gökhan; Sonbahar, Tuğba; Bayar, Fikret; Erdem, Alı Fuat

doi:10.4103/0259-1162.177181

Cited by 19 publications

(16 citation statements)

References 14 publications

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“…Seizures emerged as a concern within a year of tramadol’s 1995 market approval in the USA, based on postmarketing reports to the Food and Drug Administration 5. The drug’s US label warns of the potential risk of seizures,6 which have been reported at standard doses and after overdose 6–8…”

Section: Introductionmentioning

confidence: 99%

Tramadol and the risk of seizure: nested case-control study of US patients with employer-sponsored health benefits

et al. 2019

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ObjectivesTramadol is a widely prescribed analgesic that influences both opioid and monoamine neurotransmission. While seizures have been reported with its use, the risk in clinical practice has not been well characterised. We examined risk of seizure with tramadol relative to codeine, a comparable opioid analgesic.DesignRetrospective nested case-control study. For each case, we identified up to 10 controls matched on age, sex, US state of residence and date of cohort entry (±365 days). We calculated ORs to determine the association between seizure and exposure to tramadol, codeine (≥15 mg), both or neither, in the preceding 30 days.SettingCohort of patients, who had continuous health coverage and resided in the same state for≥3 years, identified from linked administrative health data in US MarketScan databases from 2009 to 2012.ParticipantsWe identified 96 753 patients with seizure and 888 540 matched controls.Primary and secondary outcome measuresIn the primary analysis, we defined cases using a broad definition of seizure (based on either an outpatient physician claim for seizure disorder or a seizure-related emergency department visit or hospitalisation). In a secondary analysis, we used a more specific definition of seizure restricted to a hospital visit with a principal diagnosis of seizure.ResultsIn the primary analysis, we found no association between risk of seizure and exposure to tramadol compared with codeine (OR 1.03, 95% CI 0.93 to 1.15). However, in the secondary analysis (using a more specific definition of seizure), this association was statistically significant (OR 1.41, 95% CI 1.11 to 1.79).ConclusionsTramadol was not associated with an increased risk of seizure defined by inpatient and outpatient diagnoses. However, this finding was sensitive to the outcome definition used and requires further study.

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Section: Introductionmentioning

confidence: 99%

Tramadol and the risk of seizure: nested case-control study of US patients with employer-sponsored health benefits

et al. 2019

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“…Interestingly, some evidences have emphasized that seizure following the use of tramadol is not dose-dependent (9). In the present report, the researchers described a case that used a single dose of tramadol 200 mg orally that led to acute generalized seizure requiring intensive care management.…”

Section: Discussionmentioning

confidence: 99%

Generalized Tonic Colonic Seizure Followed by Loss of Consciousness Early After Using Low Dose of Tramadol: A Case Report

Memarian¹,

Farhidnia²,

Fallahi³

2018

Anesth Pain Med

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IntroductionDespite high efficacy and safety of tramadol as a pain relieving analgesic, some minor side effects have been reported following its consumption. However, very rarely, serious and life-threatening side effects may appear following administration of tramadol.Case PresentationThis research describes a case of tramadol poisoning that appeared with acute seizure needing emergent and intensive cares. In the described case, using a low dose of tramadol (200 mg, orally), the patient experienced generalized tonic colonic seizure followed by loss of consciousness and shoulder dislocation due to trauma, requiring admission to the intensive care unit.ConclusionsAs shown in the study, even using a low dose of tramadol might lead to acute generalized seizure with loss of consciousness and the need for intensive care.

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“…Table 1 enumerates the various factors that are associated with prescribed opioid misuse and could be considered as red flags when considering treatment with opioid analgesics or after having started opioids. 14…”

Section: Clinical Reviewmentioning

confidence: 99%

“…Prescription drug monitoring programmes (PDMPs) are databases containing information on controlled drug prescriptions that can reduce problems such as duplicate prescriptions and unavailability of a patient's treatment history. 14,40 Instead of using PDMPs as a means to reject a patient for treatment with opioid analgesics, current guidelines advise using PDMP data as an opportunity to discuss safety concerns regarding opioid prescriptions. 11 Periodic retrospective opioid utilisation reviews by healthcare providers is an organisation-level strategy that helps promote pragmatic opioid use.…”

Section: Risk Mitigation Strategies At Organisation/ Policy Levelmentioning

confidence: 99%