Tramadol and Seizures: A Surveillance Study in a Managed Care Population

Gardner, Jacqueline S.; Blough, David K.; Drinkard, Carol R.; Shatin, Deborah; Anderson, Gail D.; Graham, David J.; Alderfer, Raymond

doi:10.1592/phco.20.19.1423.34854

Cited by 149 publications

(91 citation statements)

References 22 publications

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“…Also, we found that seizure is not gender related and previously proposed relation to younger ages is questionable. These observations are inconsistent with some previous reports [25,26]. Blood tramadol concentration was much higher in males maybe because males are more prone to drug dependency, abuse, and tolerance.…”

Section: Discussioncontrasting

confidence: 99%

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Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

et al. 2011

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Section: Discussioncontrasting

confidence: 99%

“…Seizure occurred in almost one third of tramadol overdoses (135 out of 401), which is inconsistent with previous reports [5,9,25]; although lower prevalence of seizure has been reported [8,26]. In this study, the smallest reported dose associated with seizure was 200 mg (was seen in four patients).…”

Section: Discussioncontrasting

confidence: 99%

Factors Related to Seizure in Tramadol Poisoning and Its Blood Concentration

et al. 2011

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“…The high frequency of seizure (46.2%) in the present study is remarkably different from other studies [23,24]. Jick et al in 1998 found no increased risk of seizure upon use of tramadol alone [25], while Gardner et al found seizures in 1% of adult tramadol users after the first tramadol prescription [23]. In both studies, patients received tramadol at therapeutic doses.…”

Section: Discussioncontrasting

confidence: 90%

Dose-independent occurrence of seizure with tramadol

et al. 2009

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Introduction: Tramadol, as a centrally-acting, opioid-like analgesic with serotonin reuptake inhibition property, is one of the most prescribed analgesics in the world. We assessed the incidence of seizure, as it is one of the most important adverse effects.Methods: In a cross-sectional study, 215 cases of tramadol users or abusers who were admitted to Loghman-Hakim Hospital Poisoning Center (LHHPC) in Tehran during a 5-month period, from April 2007 to September 2007, were assessed to evaluate the occurrence of seizure. Patients with positive history of co-ingestion of other drugs, addiction, convulsive disorders, renal diseases, or head trauma with abnormal electroencephalography (EEG) or computerized tomography (CT) scan of the brain were excluded, thus 132 patients were included in the study. For patients who had seizure, CT scan of the brain and EEG were performed, and frequency and type of seizure were identified. Mean tramadol dose was compared between patients with and without seizure.Results: Among the patients, 97 (73.5%) were male. Seizure occurred in 61 patients (46.2%) within 24 hours after tramadol ingestion. The majority of patients who had seizure were male (male, 83.6% vs. female, 16.4%). Mean tramadol dose was lower among females than males (males, 2413 mg vs. females, 1706 mg), but the difference was not statistically significant. Of 35 patients with documented seizure type, all showed generalized tonic-clonic seizure and 12 patients had abnormal EEG (35.3%). No statistically significant difference was observed in mean tramadol intake between patients with or without seizure. Analysis of patients with seizure, according to tramadol intake, indicated that most patients used tramadol in the dose range of 500-1000 mg followed in occurrence by 1500-2000 mg, then 100-500 mg, 2500-3000 mg, and 3500-4000 mg.Conclusions: Mean tramadol intake does not differ between patients with and without seizure, and the most common dose range in those with seizure is 500-1000 mg. We thus conclude that the incidence of seizure with tramadol is not dose dependent.

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“…The lack of effect on the respiratory centre has also made tramadol by default, the 'weak opioid' of choice in paediatrics following the withdrawal of codeine [6]. However, it is also the serotoninergic and noradrenergic effects that give tramadol its most troublesome reported side-effects: sedation [7]; lowering of the convulsion threshold [8]; and delirium [9]. Tramadol is a racemic mixture of two enantiomers: (+)-tramadol and (À)-tramadol.…”

Section: Pharmacology Of Tramadolmentioning

confidence: 99%

“…The early studies [6][7][8] included fewer than 60 patients each, so were subject to sampling error, and were carried out during the era of highdose opioid anaesthesia. The later studies were prospective, used a balanced anaesthesia technique, and included 600-900 patients, finding an incidence of 0.3-1.14% [11][12][13].…”

mentioning

confidence: 99%