Tramadol-induced hypoglycaemia

Cronin, Thomas D.; Smith, Luke Francis

doi:10.1136/postgradmedj-2017-135217

Cited by 10 publications

(6 citation statements)

References 4 publications

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“…Finally, this report is consistent with the data in the literature [7][8][9][10][11][12][13][14][15][16][17]. Mechanism of hypoglycemia induced by Tramadol is not well elucidated in previous reports [7][8][9][10][11][12][13][14][15][16][17]. We believe that the onset and perpetuation of hypoglycemia during Tramadol use may be caused by elevated ratio of IGF2/plasma Glucose (368,338) due to lack of suppression of IGF2 in presence of hypoglycemia Table 1 attributed to increased production or decreased metabolism or clearance of IGF2 induced by Tramadol.…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, total remission of hypoglycemia and seizures following withdrawal of Tramadol and other anticonvulsants established the diagnosis of Tramadol induced hypoglycemia in this patient. Finally, this report is consistent with the data in the literature [7][8][9][10][11][12][13][14][15][16][17]. Mechanism of hypoglycemia induced by Tramadol is not well elucidated in previous reports [7][8][9][10][11][12][13][14][15][16][17].…”

Section: Discussionsupporting

confidence: 89%

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Tramadol Induced Hypoglycemia Masquerading as a Seizure Disorder

Banzal¹,

Kabadi²

2019

Endocrinol Metab Syndr

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Background: Common causes of hypoglycemia include hypoglycemic agents including exogenous insulin and insulin secretagogues, increased endogenous insulin, decline in circulating cortisol, human growth hormone and enzymes required for glucose production as well as hepatic and renal dysfunction. Case presentation: Patient presented to emergency room with recurrent seizures treated with Levetricatem and Topiramate for 10 years with increased frequency of 2-3/week during last 6 months. During ER visits to different hospitals for these episodes, plasma glucose, 1.5-1.8 mM/L and undetectable levels of insulin, C peptide, proinsulin, Insulin antibodies eliminated hyperinsulinemia due to insulinoma, insulin secretagogues as well as exogenous insulin as a cause of hypoglycemia. Normal HGH, ACTH and cortisol responses at onset of hypoglycemia excluded hypopituitarism with HGH and/or ACTH deficiency and primary adrenal insufficiency. Large tumor secreting IGF2 was eliminated by CT scans of chest and abdomen. Hepatic and renal disease as a cause of hypoglycemia were excluded as well by documentation of normal laboratory tests. Tramadol use in high daily dose confirmed by elevated urine levels and total remission of hypoglycemia and seizures following withdrawal of tramadol resulted in documenting this unique presentation of tramadol induced hypoglycemia. We believe lack of suppression of IGF2 in presence of hypoglycemia may indicate role of Tramadol in stimulating production or decreasing metabolism or clearance of IGF2 responsible for onset and perpetuation of hypoglycemia. Conclusion: A unique presentation of Tramadol induced hypoglycemia masquerading as a seizure disorder probably caused by IGF2 dysregulation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Tramadol Induced Hypoglycemia Masquerading as a Seizure Disorder

Banzal¹,

Kabadi²

2019

Endocrinol Metab Syndr

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“…There is significant heterogeneity in the types of literature reporting tramadol-associated hypoglycemia especially with trial design, statistical tests, covariates, and study inclusion and exclusion criteria. 4,6-17 Two case-control studies of diabetic and nondiabetic patients by Golightly et al 13 and Fournier et al 9 support our findings that there is a stronger signal for tramadol-associated hypoglycemia in patients not taking diabetes medications. Golightly et al reported an increased risk of hypoglycemia in tramadol patients who were not diabetic compared with oxycodone patients with hypoglycemia who were not diabetic (RR = 3.12 [95% CI = 1.53-6.51]).…”

Section: Discussionsupporting

confidence: 72%

“…There have been 12 reports published about tramadol-induced hypoglycemia in English between 2009 and 2018 representing the United Kingdom, the United States of America, Australia, India, Saudi Arabia, Qatar, Iran, France, Nigeria, Italy, and Taiwan. [6][7][8][9][10][11][12][13][14][15][16][17] Spontaneous, voluntary reporting systems such as the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database serve as a valuable resource for identifying rare side effects that are less likely to emerge during costly, time-limited clinical trials enrolling homogeneous patient populations of limited size. A limitation of FAERS and similar databases is the lack of reliable exposure information as well as a control group, but this can be partially overcome through the use of disproportionality analysis.…”

Section: Introductionmentioning

confidence: 99%

A Review of the Food and Drug Administration Adverse Event Reporting System for Tramadol-Related Hypoglycemia

Juba

Manen²,

Fellows

2019

Ann Pharmacother

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Background: Background: Hypoglycemia is a rare adverse effect of tramadol that is described in the medical literature and package insert. Objective: Objective: The purpose of this study was to review reports of tramadol and hypoglycemia in the Food and Drug Administration Adverse Event Reporting System (FAERS) database to determine a potential association. Methods: Methods: Disproportionality analysis with Bayesian correction was used to compare tramadol and hypoglycemia with other medications in FAERS. The results were considered significant if the fifth percentile of the Empirical Bayesian geometric mean distribution (EB05) >2. Logistic regression odds ratios was used to determine if age, diabetes medications, and renal insufficiency masked the disproportionality of hypoglycemia, with the fifth percentile of the logistic regression odds ratio (LR05) >2 indicating a potential signal. The Interaction Signal Score (INTSS) was computed to determine the influence of predisposing risk factors on the signal. Results: Results: A total of 605 cases of tramadol-associated hypoglycemia were reported, but our results were not significant (EB05: 1.590). Tramadol-associated hypoglycemia was significant in patients who did not take diabetes medications (EB05: 2.256; LR05: 2.2104). Renal insufficiency was not found to increase the risk of tramadol-associated hypoglycemia (INTSS: 0.865). There was a significant signal for tramadol-associated hypoglycemia in patients aged 0 to 1 year (LR05: 3.0240) and 2 to 4 years (LR05: 2.6853). Conclusion and Conclusion and Relevance: Relevance: Results of our analysis suggest a potential signal between hypoglycemia and tramadol use in patients not taking diabetes medications. Our results do not support a predisposition for tramadolassociated hypoglycemia in patients with renal insufficiency, increasing age, and/or diabetes as noted in the tramadol package insert. Abstract:Background: Hypoglycemia is a rare adverse effect (AE) of the central analgesic tramadol that is described in the medical literature and package insert.Objective: The purpose of this study was to review reports of tramadol and hypoglycemia in the Food and Drug Administration Adverse Event Reporting System (FAERS) database to determine a potential association. Methods: Disproportionality analysis with Bayesian correction was used to compare tramadol and hypoglycemia with other medications in FAERS using Empirica Signal Software. The results were considered significant if the fifth percentile of the Empirical Bayesian geometric mean (EBGM) distribution (EB05) > 2. Logistic regression odd-ratios (LROR) was used to determine if age, diabetes medications, and renal insufficiency masked the disproportionality of hypoglycemia with LR05 > 2 indicating a potential signal. The Interaction Signal Score (INTSS) was computed to determine the influence of predisposing risk factors' on the signal.Results: Six hundred and five cases of tramadol associated hypoglycemia were reported in the FAERS database, but our results were not significan...

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“…Recently, several episodes of hypoglycemia in people treated with tramadol ( 17 – 26 ) and methadone ( 5 , 27 – 32 ) have been described.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Different Opioids on Acid-Base Balance and Blood Gas Analysis in Hospitalized Dogs

et al. 2022

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Pain management is central to veterinary practice, contributing to successful case outcomes and enhancement of the veterinarian-client-patient relationship. Analgesic drugs represent one of the pillars of the multimodal approach to acute and chronic pain management. In dogs, the most used opioids are methadone, buprenorphine and tramadol. Several episodes of hypoglycemia in people treated with tramadol and methadone have recently been described. The aim of this work is to evaluate the changes in the glycemic and acid-base balance induced by tramadol, methadone and buprenorphine in hospitalized dogs. A retrospective review of the medical records of dogs hospitalized for both medical and surgical reasons was performed. During 2018-2020, a total of 876 canine patients were treated with opioids, including 228 with tramadol, 273 with methadone and 375 with buprenorphine. Of all these dogs, only a small percentage met the inclusion criteria presented in the initial design. All the hospitalized animals were monitored daily through clinical examination and blood sampling. Blood samples were obtained before opioid administration (T0), and 24 h (T1) and 48 h (T2) after °pioid administration. The following parameters were evaluated: blood gas value (pH, pCO2), acid-base state (cHCO3), oxymetric values (ctHb, haematocrit), electrolyte values (K+, Na+, iCa, Cl-) and metabolic values (glucose, lactate, anion GAP K+c). The glycemic value in enrolled dogs showed a decrease over time, regardless of the type of opioid used, but remained within the physiological range. The highest average glycemic drop was recorded for methadone, between T0 and T1, followed by tramadol between T1 and T2, while buprenorphine recorded the highest overall glycemic drop between T0-T2 when compared to the other two opioids. Female dogs showed the greatest drop in glycemic value. Lactate concentration always presented values beyond the physiological range at an early stage, which then normalized quickly. Measurement of electrolyte concentrations showed a consistent increase in the values of iCa, Na and Cl. In hospitalized dogs treated with opioids monitoring of gas analytic parameters is important and more attention should be paid to patients hospitalized with certain metabolic and endocrine diseases.

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Tramadol-induced hypoglycaemia

Cited by 10 publications

References 4 publications

Tramadol Induced Hypoglycemia Masquerading as a Seizure Disorder

Tramadol Induced Hypoglycemia Masquerading as a Seizure Disorder

A Review of the Food and Drug Administration Adverse Event Reporting System for Tramadol-Related Hypoglycemia

The Effect of Different Opioids on Acid-Base Balance and Blood Gas Analysis in Hospitalized Dogs

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