Tramadol toxicity in a cat: case report and literature review of serotonin syndrome

Indrawirawan, Yenny; McAlees, Trudi

doi:10.1177/1098612x14539088

Cited by 30 publications

(18 citation statements)

References 57 publications

(139 reference statements)

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“…Recently, symptoms related to serotonin syndrome secondary to tramadol overdose (80 mg/kg administered PO twice) have been reported for the first time in a cat. 147 The serotonin syndrome is induced by pharmacological treatment with serotonergic agents that increase serotonin activity, including selective serotonin reuptake inhibitors, tricyclic antidepressants (amitriptyline), monoamine oxidase inhibitors, lithium, carbamazepine, amphetamine and derivatives, dextromethorphan, tramadol and meperidine; and also by St John’s wort ( Hypericum perforatum ). In people symptoms include cognitive behavioural changes, neuromuscular excitability and autonomic instability.…”

Section: Tramadolmentioning

confidence: 99%

Practical use of opioids in cats: a state-of-the-art, evidence-based review

Bortolami

Love

2015

Journal of Feline Medicine and Surgery

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Section: Tramadolmentioning

confidence: 99%

Practical use of opioids in cats: a state-of-the-art, evidence-based review

Bortolami

Love

2015

Journal of Feline Medicine and Surgery

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“…In humans, serotonin syndrome typically has three forms of symptoms, including neuromuscular hyperactivity (tremor, clonus, hyperreflexia, rigidity), autonomic hyperactivity (pyrexia, tachycardia, tachypnea) and altered mental status (agitation, excitement). 8,9 In cats, serotonin syndrome has been reported in conjunction with tramadol and selective serotonin reuptake inhibitor (SSRI) toxicity. 8,10 In cats with SSRI-induced serotonin syndrome clinical signs consisted of sedation, gastrointestinal signs (vomiting, diarrhea, nausea, drooling), central nervous stimulation (vocalization, hyperactivity, hyper-reflexia, agitation, tremors), cardiovascular signs (tachycardia, bradycardia, hypertension) and hyperthermia.…”

Section: Discussionmentioning

confidence: 99%

Mirtazapine toxicity in cats: retrospective study of 84 cases (2006–2011)

Ferguson

McLean

Bates³

et al. 2016

Journal of Feline Medicine and Surgery

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Objectives Mirtazapine is commonly used in veterinary medicine at doses of 1.88 or 3.75 mg as an appetite stimulant. The objectives of this study were to determine the most common adverse effects reported and the dose associated with these signs. Methods Records of cats with mirtazapine exposure (2006-2011) were obtained from the American Society for the Prevention of Cruelty to Animals' Animal Poison Control Center. The following parameters were recorded: signalment, weight, outcome, agent ingested, amount ingested, route of exposure, clinical signs observed, intended of use, onset time of signs and duration of signs. Results The 10 most commonly observed adverse effects reported in 84 cats exposed to mirtazapine included vocalization (56.0% of cats; mean dose 2.56 mg/kg), agitation (31.0%; 2.57 mg/kg), vomiting (26.2%; 2.92 mg/kg), abnormal gait/ataxia (16.7%; 2.87 mg/kg), restlessness (14.3%; 3.55 mg/kg), tremors/trembling (14.3%; 2.43 mg/kg), hypersalivation (13.0%; 2.89 mg/kg), tachypnea (11.9%; 3.28 mg/kg), tachycardia (10.7%; 3.04 mg/kg) and lethargy (10.7%; 2.69 mg/kg). Fifty-nine (70.2%) cases were considered accidental ingestions and 25 (29.8%) cases were given mirtazapine as prescribed. The doses associated with signs of toxicity were 15.00 mg (40 cats), 3.75 mg (25 cats), 7.50 mg (four cats), 30.00 mg (one cat), 18.75 mg (one cat), 11.25 mg (one cat), 5.80 mg (one cat) and 1.88 mg (one cat). For cats with available information, the onset of clinical signs ranged from 15 mins to 3 h, and time to resolution of clinical signs ranged from 12-48 h. Conclusions and relevance The greater number of adverse effects at 3.75 mg rather than 1.88 mg suggests that the latter may be a more appropriate starting dose for stimulating appetite while limiting toxicity. The benefit of dispensing exact doses of mirtazapine is implied given the likelihood of accidental administration of a full tablet (15 mg) and the resulting toxicity.

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“…Several case reports in human beings have associated trazodone or tramadol use with serotonergic syndrome (Margolese and chouinard 2000, Kitson and Carr 2005, Takeshita and Litzinger 2009). Tramadol toxicity leading to serotonergic syndrome has been reported in a cat (Indrawirawan and McAlees 2014). One study of trazodone in conscious dogs found six of six greyhounds developed a transient tachycardia following intravenous administration of 8 mg/kg trazodone and three of the six developed signs of aggression.…”

Section: Discussionmentioning

confidence: 99%