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Prospective multicenter evaluation of tramadol exposure
H A Spiller1, S E Gorman, D Villalobos
1Kentucky Regional Poison Center, Louisville 40232-5070, USA. haspiller@aol.com
Journal of Toxicology. Clinical Toxicology
|January 1, 1997
Summary
Tramadol overdose can cause significant neurological effects like seizures and agitation, primarily due to its monoamine uptake inhibition. Serious cardiovascular toxicity was not observed in this study.
Area of Science:
- Pharmacology
- Toxicology
- Emergency Medicine
Background:
- Tramadol is a widely used analgesic with dual opiate and noradrenergic activity.
- Limited data exists on tramadol's toxicity profile in overdose situations.
- Its increasing use necessitates a better understanding of potential adverse effects.
Purpose of the Study:
- To investigate the clinical manifestations and toxicity of tramadol overdose.
- To characterize the symptoms, severity, and outcomes of tramadol overdose cases.
- To identify potential contributing factors to tramadol-related toxicity.
Main Methods:
- A multicenter prospective case series design was employed.
- Data were collected from seven Poison Centers over a 11-month period (October 1995 to August 1996).
- All reported tramadol exposures were evaluated for clinical effects and management.
Main Results:
- Out of 126 tramadol exposures, 87 involved tramadol alone.
- Common symptoms included lethargy (30%), nausea (14%), tachycardia (13%), agitation (10%), and seizures (8%).
- Neurologic toxicity was observed, with seizures occurring at doses as low as 500 mg; however, serious cardiovascular toxicity was not noted.
Conclusions:
- Tramadol overdose toxicity is largely attributed to monoamine uptake inhibition, potentially causing a mild serotonin syndrome.
- Significant neurologic adverse effects, including seizures, are a concern in tramadol overdose.
- Serious cardiac complications were not observed, differentiating it from some other analgesics.