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Transient depersonalisation/derealisation syndrome from tramadol
Suthimon Thumtecho1, Sorawit Wainipitapong2, Polpat Tantakitti3
1Division of Toxicology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand suthimont@gmail.com.
Tramadol may cause transient depersonalisation/derealisation (DD) syndrome, especially when combined with CYP2D6 inhibitors like etoricoxib. This drug interaction can increase tramadol concentration, leading to these dissociative symptoms.
Area of Science:
- Pharmacology
- Neuroscience
- Toxicology
Background:
- Depersonalisation/derealisation (DD) syndrome is linked to trauma and certain medications.
- Tramadol is a common analgesic metabolized by cytochrome P450 (CYP) 2D6.
Observation:
- A patient experienced transient DD symptoms hours after taking tramadol with etoricoxib, acetaminophen, and eperisone.
- Symptoms resolved upon discontinuing tramadol.
Findings:
- The patient had normal metaboliser status with reduced function for CYP2D6.
- Etoricoxib, a CYP2D6 inhibitor, likely increased tramadol concentrations.
- This interaction is proposed as the cause of the patient's tramadol-induced DD.
Implications:
- Highlights potential drug interactions with tramadol.
- Suggests caution when prescribing tramadol with CYP2D6 inhibitors.
- Informs clinical practice regarding medication-induced dissociative symptoms.
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