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RESEARCH REPORTS |
1 Senior Toxicology Management Specialist, California Poison Control System, Sacramento Division; Associate Clinical Professor of Pharmacy, Division of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco; Clinical Professor of Medicine, Section of Medical Toxicology and Clinical Pharmacology, Division of Pulmonary and Critical Care, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA
2 Managing Director, California Poison Control System, Sacramento Division; Associate Clinical Professor of Pharmacy, Division of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco; Clinical Professor of Medicine, Section of Medical Toxicology and Clinical Pharmacology, Division of Pulmonary and Critical Care, Department of Internal Medicine, University of California Davis School of Medicine
3 Medical Director, California Poison Control System, Sacramento Division; Professor of Medicine, Anesthesiology, Pharmacology/Toxicology, and Emergency Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Internal Medicine and Emergency Medicine, School of Medicine, University of California Davis School of Medicine, and the Veterans Affairs Northern California Health Care System
* To whom correspondence should be addressed. E-mail: kmarquardt{at}calpoison.org.
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Abstract |
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BACKGROUND: Tramadol is a unique analgesic that has been associated with seizures on overdose.
OBJECTIVE: To determine the toxic effects associated with tramadol exposure.
METHODS: A retrospective chart review of tramadol exposures reported to a multisite, state-wide poison control system over a 2.5-year period was performed.
RESULTS: A total of 602 cases were retrieved; 190 had sufficient data for study evaluation. Cases with coingestants or unknown outcomes were eliminated. Of the 190 remaining cases, 55% were females. Acute ingestions represented 90.0%, chronic ingestions 7.9%, and acute on chronic 2.1% of the overdoses. Ages of the patients ranged from 9 months to 80 years. Suicide attempts represented the largest group of exposures. Main symptoms included central nervous system (CNS) depression (27.4%), nausea and vomiting (21.1%), tachycardia (17.4%), and seizures (13.7%). Dosage ranged from a taste amount to 5000 mg. The smallest amount of tramadol associated with seizure was 200 mg, and 84.6% of seizures occurred within 6 hours of time of ingestion. Logistic regression analysis showed an association between seizures and tramadol use in males, chronic use, suicide attempts, intentional abuse or misuse, and tachycardia (HR >100 beats/min). No effect was seen in 36.3% of patients, minor effects in 43.7%, moderate effects in 19.5%, and major effects in 0.5%. Symptoms resolved within 24 hours in 96.7% of the 121 patients who had symptoms. Naloxone improved CNS depression in 7 of 8 patients in whom a response was documented.
CONCLUSIONS: Tramadol overdoses frequently cause CNS depression, nausea/vomiting, tachycardia, and seizures. Symptoms generally resolve within 24 hours. Accidental ingestions in children were well tolerated, primarily causing sedation.
Key Words: seizures, tramadol overdose
Reprints: Dr. Marquardt, California Poison Control System, Sacramento Division, University of California Davis Medical Center, HSF Bldg., Rm. 1024, 2315 Stockton Blvd., Sacramento, CA 95817-2201, fax 916/227-1414, kmarquardt@calpoison.org
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  R. B. Raffa and D. J. Stone Jr. Unexceptional Seizure Potential of Tramadol or Its Enantiomers or Metabolites in Mice J. Pharmacol. Exp. Ther., May 1, 2008; 325(2): 500 - 506. [Abstract] [Full Text] [PDF]
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 S Shadnia, K Soltaninejad, K Heydari, G Sasanian, and M Abdollahi Tramadol intoxication: a review of 114 cases Human and Experimental Toxicology, March 1, 2008; 27(3): 201 - 205. [Abstract] [PDF]
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