Tramadol toxicity-induced rhabdomyolysis

Khan, Fahmi Yousef; Yousef, Hind; Errayes, Mehdi

doi:10.4103/0974-2700.70766

Cited by 11 publications

(7 citation statements)

References 4 publications

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“…We did not search for salicylates, metformin, and iron (all potential triggers of lactic acidosis), since the patient did not have access to these drugs (he was jailed, as previously reported). The value of creatine kinase (CK), a well-established biomarker of rhabdomyolysis (i.e., a frequent complication of opioid and tramadol overdose), 17,18 was normal. The electrocardiogram (ECG) remained always normal.…”

Section: Case Reportmentioning

confidence: 99%

Severe acute lactic acidosis and hypoglycemia due to isolate tramadol poisoning

Granauro

Comite²,

Lippi

et al. 2016

Emerg Care J

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Section: Case Reportmentioning

confidence: 99%

Severe acute lactic acidosis and hypoglycemia due to isolate tramadol poisoning

Granauro

Comite²,

Lippi

et al. 2016

Emerg Care J

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“…The limit of detection (LOD) was set according to a signal‐to‐noise ratio ≥ 3 for all the monitored transitions (quantifier and qualifier) and evaluated by a series of dilutions. The LLOQ was set in agreement with the therapeutic blood level of tramadol (0.1–0.8 mg/L) and was tested for the accurate determination of its concentration with accuracy and precision within ± 20%. 10 …”

Section: Methodsmentioning

confidence: 99%

Automated high‐throughput analysis of tramadol and O‐desmethyltramadol in dried blood spots

Luginbühl¹,

Angelova

Gaugler³

et al. 2020

Drug Testing and Analysis

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The World Anti‐Doping Agency (WADA) and the International Testing Agency (ITA) recently announced the development and implementation of dried blood spot (DBS) testing for routine analysis in time for the 2022 Winter Olympic and Paralympic Games in Beijing. Following the introduction of a ban on the use of tramadol in competition in March 2019, the Union Cycliste International (UCI) started a pilot study for the manual analysis of tramadol in DBS for antidoping purposes. In this context, we present a fully automated LC–MS/MS‐based method with automated sample preparation using a CAMAG DBS‐MS 500 for the analysis of tramadol and its metabolite O‐desmethyltramadol in DBS. The presented approach reduces manual handling in the laboratory to an absolute minimum, only requiring the preparation of calibration and quality control DBS cards. The method was developed, optimized, and validated before performing cross‐validation with a liquid blood‐based analysis method using authentic samples from forensic cases. During the validation process, the method showed an extraction efficiency of 62%, linearity r2 > 0.99, accuracy and precision (within ± 15% and ± 20% at the LLOQ) for the determination of tramadol and O‐desmethyltramadol. Method comparison in liquid blood with 26 samples showed good agreement (90 ± 19% for tramadol and 94 ± 14% for O‐desmethyltramadol). In conclusion, automated analysis of tramadol and O‐desmethyltramadol in DBS provides a fast and accurate solution for antidoping screening. It is suited for high‐throughput analysis, having a run time of about 4 min per sample. Furthermore, with the automated approach, manual sample extraction becomes obsolete.

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“…Rhabdomyolysis and increased creatine phosphokinase (CPK) are rare but serious complications in tramadol intoxication [3,57,94,95]. These observations have been proposed as a consequence of seizure but could not be confirmed in other studies [3].…”

Section: Musculoskeletal Systemmentioning

confidence: 99%

A review on tramadol toxicity: mechanism of action, clinical presentation, and treatment

et al. 2021

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Aims As an analgesic that acts upon the central nervous system (CNS), tramadol has gained popularity in treating moderate to severe pain. Recently, it has been increasingly reported as a drug of misuse with intentional overdoses or intoxications. This review focuses on tramadol intoxication in humans and its effects on different systems. Subject and method This narrative review provides a comprehensive view of the pharmacokinetics, mechanism of action, and incidence of tramadol toxicity with an in-depth look at its side effects. In addition, the main approaches to the management of tramadol poisoning are described. Results Tramadol poisoning can affect multiple organ systems: gastrointestinal, central nervous system (seizure, CNS depression, low-grade coma, anxiety, and over time anoxic brain damage), cardiovascular system (palpitation, mild hypertension to life-threatening complications such as cardiopulmonary arrest), respiratory system, renal system (renal failure with higher doses of tramadol intoxication), musculoskeletal system (rhabdomyolysis), endocrine system (hypoglycemia), as well as, cause serotonin syndrome. Seizure, a serious nervous disturbance, is more common in tramadol intoxication than with other opioids. Fatal tramadol intoxications are uncommon, except in ingestion cases concurrent with other medications, particularly CNS depressants, most commonly benzodiazepines, and ethanol. Conclusion With the increasing popularity of tramadol, physicians must be aware of its adverse effects, substantial abuse potential, and drug interactions, to weigh its risk–benefit ratio for pain management. Alternative therapies might be considered in patients with a previous overdose history to reduce risks for adverse outcomes.

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Tramadol toxicity-induced rhabdomyolysis

Cited by 11 publications

References 4 publications

Severe acute lactic acidosis and hypoglycemia due to isolate tramadol poisoning

Severe acute lactic acidosis and hypoglycemia due to isolate tramadol poisoning

Automated high‐throughput analysis of tramadol and O‐desmethyltramadol in dried blood spots

A review on tramadol toxicity: mechanism of action, clinical presentation, and treatment

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