Assessment of Tramadol Blood Concentration in Cases of Acute Tramadol Overdose (original) (raw)
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Frequency of tramadol toxicity in Shahid Mohammadi Hospital in Bandar Abbas
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Epidemiology Analysis of Poisonings with Tramadol
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It is reported that suicide was the most frequent cause of poisoning by tramadol. Seizure is a serious nervous disturbance in tramadol overdose. This study intends to characterize the poisoning with tramadol cases admitted to the Department of Emergency, Imam-Khomeini Hospital in Kermanshah, Iran. The number 1023 patients admitted from March 2008 till March 2010 were evaluated retrospectively. Information of demographic characteristics, cause of poisoning; dose of poisoning; duration of hospitalization; seizure status; co-ingestion; and mortality rate were collected from medical records of the hospital. The most poisoned subjects were bachelor (79.8%) and 20 years old (11.1%). Suicide (55.1%) was the most common mode of tramadol poisoning cause. 41.8% of cases had seizure symptom and seizure incidence in male was greater than female (P<0.001). correlation between dosages of used tramadol and outbreak of seizure was significant. Abuse and poisoning by tramadol led to seizure and death, and frequencies of poisoning by tramadol were among people with less than 30 years old and with the intension of suicide. The essential issue is the necessity to try to increase level of knowledge among youth regarding consumption, approaches of suicide prevention and limitation of approachability and distribution of tramadol especially in younger ages.
2021
Tramadol-induced seizures (TIS) are reported to occur in 15%-35% of tramadol poisoned cases. The present study aimed to evaluate the risk factors of TIS and to find out if there is a correlation between TIS and the ingested dose and the blood level of tramadol. This study included cases of both genders with acute tramadol poisoning admitted to Tanta University Poison Control Center from January 2019 to December 2019. Each case was subjected to history taking, clinical and laboratory evaluation including tramadol urine screen, and tramadol blood level estimation at admission. Sixty-two cases were enrolled in the study. Their mean age was 28.3 9.6 years, 85.5% of them were males; addiction was the most common mood of poisoning. The seizure was recorded in 40.4% of the cases. There was a significant statistical difference between non-seizing and seizing groups regarding ingested tramadol dose and tramadol blood level. Furthermore, there was a strong significant positive correlation between ingested tramadol dose, tramadol blood level and occurrence of seizures. Receiver operating curve analysis revealed that ingested tramadol dose and tramadol blood level had an excellent discriminatory power in predicting seizure occurrence, but tramadol blood level had a better area under the curve. It was concluded that acute tramadol poisoning is associated with an increased risk of developing seizures. The ingested tramadol dose and the tramadol blood level could be used as excellent predictors of seizures in cases of tramadol overdoses.
Severe Adverse Effects Associated with Tramadol Over Dose in 2013-2017, Iran
Epidemiology and Health
OBJECTIVES: Severe complications of tramadol overdose have been reported; however, few large-scale studies have investigated this issue. Therefore, this study aimed to explore the presentation and complications of tramadol overdose in patients admitted to an intoxication referral center in northwestern Iran.METHODS: Patients with tramadol overdose admitted to Sina Teaching Hospital in Tabriz, Iran during 2013-2017 were included. For each patient, the following data were collected: demographics, previous drug or medication overdose, whether the patient was in the process of quitting drug use, ingested dose of tramadol and co-ingestants, Glasgow Coma Scale (GCS) score, clinical symptoms at the time of admission, and admission characteristics. Serotonin toxicity was diagnosed in patients who fit the Hunter criteria. Multiple logistic regression was performed to identify variables associated with the incidence of severe complications of tramadol overdose.RESULTS: In total, 512 cases of ...
Hypo and hyperglycemia among tramadol overdose patients in Loghman Hakim Hospital, Tehran, Iran
Pakistan journal of pharmaceutical sciences, 2015
Tramadol is a synthetic and centrally active analgesic. Hypoglycemia as another possible major side effect among abusers has not been known well. Our objective is evaluation of the Blood Glucose Level (BGL) among tramadol-overdosed patients. This prospective cross-sectional study was performed from Feb to June 2013; BGL was measured at the time of admission, 8 and 12 hours later. All patients with hypoglycemia received infusion of 0.5-1 gr/kg of hypertonic dextrose and their BGL was checked every hour until normal BGL. Patients' demographic, clinical and paraclinical data were collected. Totally, 128 patients with a mean (SD) age of 24.5 (6.9) years were recruited; 127 (99.2%) were male. Seizure occurred in 59.4% cases. Mean ± SD admission BGL was 94.88 ± 21.5mg/dL. Fourteen patients experienced hypoglycemia within 12 hours period. Hyperglycemia was experienced in 8 patients (6.25%) on admission day. There was no significant relation between the dose of tramadol and BGL. In conc...
Tramadol Poisoning: A Systematic Review of Studies in Iran
Negah Institute for Social Research & Scientific Communication, 2021
Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran. Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation. Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for >24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level. Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults.
Factors related to seizure in tramadol poisoning and its blood concentration
2011
Abstract This study examines the relation between seizure and plasma tramadol concentration in patients with tramadol poisoning, as a novel centrally acting analgesic used for the treatment of mild to severe pain. All patients admitted with a history of tramadol overdose accompanied by unconsciousness or seizures referred to Baharloo Hospital Poison Center, Tehran, Iran from March 2008 to March 2009 were included. Demographic information, clinical findings, and blood tramadol concentrations were studied.
Journal of Analytical Toxicology, 1997
Tramadol is a centrally acting, binary analgesic that is neither an opiate-derived nor a nonsteroidal anti-inflammatory drug and that was approved for use in the United States in 1995. It is used to control moderate pain in chronic pain settings such as osteoarthritis and postoperative cases. Used in therapy as a racemic mixture, the (+)-enantiomer weakly binds to'the p.-opiold receptor, and both enantiomers inhibit serotonin and norepinephrine reuptake. Tramadol's major active metabolite, O-desmethyltramadol (ODT), shows higher affinity for the ~topioid receptor and has twice the analgesic potency of the parent drug. The synergism of these effects contributes to tramadoi's analgesic properties with the (+)-enantiomer exhibiting 10-fold higher analgesic activity than the (-)-enantiomer. Although tramadol was initially thought to exhibit low abuse potential, Ortho-McNeil, the drug's manufacturer, recently reported a large number of adverse events attributed to tramadol including abuse by opioid-dependent patients, allergic reactions, and seizures. The high number of adverse reactions has prompted the company to update the prescribing information for the drug. An analytical method using gas chromatography-mass spectrometry (GC-MS) without derivatization for the determination of tramadol and its metabolites is reported. An n-butyl chloride extraction is followed by GC-MS analysis using a 5% phenylmethylsilicone column (30 m x 0.32-gm i.d.). Analysis of 12 blood samples from tramadol-related deaths and four nonfatal intoxications involving tramadol revealed concentrations ranging from 0.03 to 22.59 mg/L for tramadol, from 0.02 to 1.84 mg/L for ODT, and from 0.01 to 2.08 mg/L for N-desmethyltramadol. Three deaths were clearly attributable to acute morphine toxicity, one was a doxepin overdose, and six were multiple drug overdoses. The role of tramadol in each death is explored.